Low-dose aspirin and survival from lung cancer: a population-based cohort study.

Úna C Mc Menamin,Liam M Murray,Carmel M Hughes,Chris R Cardwell

doi:10.1186/s12885-015-1910-9

Abstract

BackgroundPreclinical evidence suggests that aspirin may inhibit lung cancer progression. In a large cohort of lung cancer patients, we investigated whether low-dose aspirin use was associated with a reduction in the risk of lung cancer-specific mortality.MethodsWe identified lung cancer patients from English cancer registries diagnosed between 1998 to 2009 from the National Cancer Data Repository. Medication usage was obtained from linkages to the UK Clinical Practice Research Datalink and lung cancer-specific deaths were identified from Office of National Statistics mortality data. Hazard ratios (HR) and 95 % confidence intervals (CI) for the association between low-dose aspirin use (before and after diagnosis) and risk of lung cancer-specific mortality were calculated using Cox regression models.ResultsA total of 14,735 lung cancer patients were identified during the study period. In analysis of 3,635 lung cancer patients, there was no suggestion of an association between low-dose aspirin use after diagnosis and cancer-specific mortality (adjusted HR = 0.96, 95 % CI: 0.85, 1.09). Similarly, no association was evident for low-dose aspirin use before diagnosis and cancer-specific mortality (adjusted HR = 1.00, 95 % CI: 0.95, 1.05). Associations were comparable by duration of use and for all-cause mortality.ConclusionOverall, we found little evidence of a protective association between low-dose aspirin use and cancer-specific mortality in a large population-based lung cancer cohort.

Highlights

Preclinical evidence suggests that aspirin may inhibit lung cancer progression
No difference in the rate of overall survival was observed in patients assigned to an anti-inflammatory daily dose of 1000 mg aspirin compared to non-treatment in a small randomised trial of 303 small cell lung cancer patients [22]
In a large population-based cohort of cancer-registry confirmed lung cancer patients utilising detailed prescribing records, we aimed to investigate whether low-dose aspirin use, either before and after diagnosis, was associated with a reduced cancer-specific mortality

Summary

Introduction

Preclinical evidence suggests that aspirin may inhibit lung cancer progression. In a large cohort of lung cancer patients, we investigated whether low-dose aspirin use was associated with a reduction in the risk of lung cancer-specific mortality. The use of aspirin, a commonly prescribed anti-platelet agent, after cancer diagnosis has been associated with a reduction in the risk of recurrence or cancer-specific mortality in colorectal [4, 5], breast [6, 7] and prostate [8] cancer cohorts Motivated by these studies, a large phase 3 randomised trial of aspirin as adjunct treatment is soon to commence including patients at these sites [9]. No difference in the rate of overall survival was observed in patients assigned to an anti-inflammatory daily dose of 1000 mg aspirin compared to non-treatment in a small randomised trial of 303 small cell lung cancer patients [22] These 3 studies provide limited information as they were not population-based [20, 21], did not investigate low-dose aspirin solely and used limited time-points to ascertain drug exposure. Further epidemiological studies of the impact of low-dose aspirin use on lung cancer progression are warranted to inform the conduct of randomised trials of low dose aspirin as adjunct treatment in lung cancer patients

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