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Nonsteroidal anti-inflammatory drugs†

Effects on mortality after colorectal cancer diagnosis

  1. Jason A. Zell DO, MPH1,2,‡,*,
  2. Argyrios Ziogas PhD1,
  3. Leslie Bernstein PhD3,
  4. Christina A. Clarke PhD4,
  5. Dennis Deapen DrPH5,
  6. Joan A. Largent PhD1,
  7. Susan L. Neuhausen PhD1,
  8. Daniel O. Stram PhD5,
  9. Giske Ursin MD, PhD5,
  10. Hoda Anton-Culver PhD1

Article first published online: 13 OCT 2009

DOI: 10.1002/cncr.24705

Issue

Cancer

Cancer

Volume 115, Issue 24, pages 5662–5671, 15 December 2009

Additional Information

How to Cite

Zell, J. A., Ziogas, A., Bernstein, L., Clarke, C. A., Deapen, D., Largent, J. A., Neuhausen, S. L., Stram, D. O., Ursin, G. and Anton-Culver, H. (2009), Nonsteroidal anti-inflammatory drugs. Cancer, 115: 5662–5671. doi: 10.1002/cncr.24705

Author Information

  1. 1

    Genetic Epidemiology Research Institute and Department of Epidemiology, University of California at Irvine, Irvine, California

  2. 2

    Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California at Irvine Medical Center, Orange, California

  3. 3

    Division of Cancer Etiology, Department of Population Sciences, City of Hope National Medical Center, Duarte, California

  4. 4

    Division of Surveillance Research, Northern California Cancer Center, Fremont, California

  5. 5

    Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California

  1. ‡

    Fax: (949) 824-1343

*Department of Epidemiology, School of Medicine, University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697-7550

  1. †

    Presented in part at the American Society of Preventive Oncology Annual Meeting, Bethesda, Maryland, March 16–18, 2008.

Publication History

  1. Issue published online: 2 DEC 2009
  2. Article first published online: 13 OCT 2009
  3. Manuscript Accepted: 20 APR 2009
  4. Manuscript Revised: 14 APR 2009
  5. Manuscript Received: 4 FEB 2009

Funded by

  • National Cancer Institute. Grant Numbers: R01 CA77398, R25 CA85771
  • National Institute of Environmental Health Sciences. Grant Number: P30 ES 07,048
  • California Breast Cancer Research Fund. Grant Number: 97-10,500

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Keywords:

  • colon cancer;
  • colorectal cancer;
  • nonsteroidal anti-inflammatory drugs;
  • rectal cancer;
  • survival

The association between nonsteroidal anti-inflammatory drug (NSAID) use and mortality after a colorectal cancer (CRC) diagnosis was investigated among women in the California Teachers Study cohort. A total of 621 CRC cases were identified for analysis. Among CRC cases, prediagnosis regular NSAID use and prediagnosis prolonged NSAID duration independently predicted decreased CRC-specific mortality after adjustment for relevant clinical factors.

Abstract

BACKGROUND:

Nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a decreased colorectal cancer (CRC) risk. However, to the best of the authors' knowledge, the effects of NSAID on clinical outcomes after CRC diagnosis are not well defined. The authors investigated the association between prediagnosis NSAID use and mortality after CRC diagnosis among women in the California Teachers Study cohort.

METHODS:

Women aged <85 years participating in the California Teachers Study, without a prior CRC diagnosis at baseline (1995-1996), and who were diagnosed with CRC during follow-up through December 2005, were eligible for analysis of the association between prediagnosis NSAID use and mortality. NSAID use (including aspirin and ibuprofen) was collected through a self-administered questionnaire. Cancer occurrence was identified through California Cancer Registry linkage. Multivariate Cox proportional hazards regression models were used to estimate hazards ratios (HR) for death and 95% confidence intervals (95% CIs).

RESULTS:

Among 621 CRC patients who were identified, 64% reported no prediagnosis regular NSAID use, 17% reported use of 1 to 6 days/week, and 20% reported daily use. A duration of NSAID use <5 years was reported by 17% of patients and a use of ≥5 years was reported by 18%. Regular prediagnosis NSAID use (1-3 days/week, 4-6 days/week, and daily) versus none was associated with improved overall survival (OS) (HR, 0.71; 95% CI, 0.53-0.95) and CRC-specific survival (HR, 0.58; 95% CI 0.40-0.84) after adjustment for clinically relevant factors. Prediagnosis NSAID use ≥5 years (vs none) was found to be associated with improved OS (HR, 0.55; 95% CI, 0.37-0.84) and CRC-specific survival (HR, 0.40; 95% CI, 0.23-0.71) in adjusted analyses.

CONCLUSIONS:

When used regularly or over a prolonged duration before CRC diagnosis, NSAIDs are associated with decreased mortality among female CRC patients. Cancer 2009. © 2009 American Cancer Society.

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