Aspirin as secondary prevention in patients with colorectal cancer: An unselected population-based study

Simer J. Bains, Milada Mahic, Tor Åge Myklebust, Milada Cvancarova Småstuen, Sheraz Yaqub, Liv Marit Dørum, Bjørn Atle Bjørnbeth, Bjørn Møller, Kristoffer Watten Brudvik, Kjetil Taskén

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Abstract

Purpose Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (CRC). However, aspirin as primary prevention is debated because of the risk of hemorrhagic adverse effects. Aspirin as secondary prevention may be more justified from a riskbenefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CRC-specific survival (CSS) and overall survival (OS). Materials and Methods An observational, population-based, retrospective cohort study was conducted by linking patients diagnosed with CRC from 2004 through 2011 (Cancer Registry of Norway) with data on their aspirin use (The Norwegian Prescription Database). These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS. Results A total of 23,162 patients diagnosed with CRC were included, 6,102 of whom were exposed to aspirin after the diagnosis of CRC (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific. In multivariable analysis, aspirin exposure after the diagnosis of CRC was independently associated with improved CSS (hazard ratio [HR], 0.85; 95% CI, 0.79 to 0.92) and OS (HR, 0.95; 95% CI, 0.90 to 1.01).Conclusion Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS.

Original languageEnglish (US)
Pages (from-to)2501-2508
Number of pages8
JournalJournal of Clinical Oncology
Volume34
Issue number21
DOIs
StatePublished - Jul 20 2016

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Secondary Prevention
Aspirin
Colorectal Neoplasms
Prescriptions
Registries
Outcome Assessment (Health Care)
Primary Prevention
Norway
Cohort Studies
Retrospective Studies
Mortality
Incidence
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Bains, S. J., Mahic, M., Myklebust, T. Å., Småstuen, M. C., Yaqub, S., Dørum, L. M., ... Taskén, K. (2016). Aspirin as secondary prevention in patients with colorectal cancer: An unselected population-based study. Journal of Clinical Oncology, 34(21), 2501-2508. DOI: 10.1200/JCO.2015.65.3519

Aspirin as secondary prevention in patients with colorectal cancer : An unselected population-based study. / Bains, Simer J.; Mahic, Milada; Myklebust, Tor Åge; Småstuen, Milada Cvancarova; Yaqub, Sheraz; Dørum, Liv Marit; Bjørnbeth, Bjørn Atle; Møller, Bjørn; Brudvik, Kristoffer Watten; Taskén, Kjetil.

In: Journal of Clinical Oncology, Vol. 34, No. 21, 20.07.2016, p. 2501-2508.

Research output: Contribution to journalArticle

Bains, SJ, Mahic, M, Myklebust, TÅ, Småstuen, MC, Yaqub, S, Dørum, LM, Bjørnbeth, BA, Møller, B, Brudvik, KW & Taskén, K 2016, 'Aspirin as secondary prevention in patients with colorectal cancer: An unselected population-based study' Journal of Clinical Oncology, vol 34, no. 21, pp. 2501-2508. DOI: 10.1200/JCO.2015.65.3519
Bains SJ, Mahic M, Myklebust TÅ, Småstuen MC, Yaqub S, Dørum LM et al. Aspirin as secondary prevention in patients with colorectal cancer: An unselected population-based study. Journal of Clinical Oncology. 2016 Jul 20;34(21):2501-2508. Available from, DOI: 10.1200/JCO.2015.65.3519

Bains, Simer J.; Mahic, Milada; Myklebust, Tor Åge; Småstuen, Milada Cvancarova; Yaqub, Sheraz; Dørum, Liv Marit; Bjørnbeth, Bjørn Atle; Møller, Bjørn; Brudvik, Kristoffer Watten; Taskén, Kjetil / Aspirin as secondary prevention in patients with colorectal cancer : An unselected population-based study.

In: Journal of Clinical Oncology, Vol. 34, No. 21, 20.07.2016, p. 2501-2508.

Research output: Contribution to journalArticle

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abstract = "Purpose Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (CRC). However, aspirin as primary prevention is debated because of the risk of hemorrhagic adverse effects. Aspirin as secondary prevention may be more justified from a riskbenefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CRC-specific survival (CSS) and overall survival (OS). Materials and Methods An observational, population-based, retrospective cohort study was conducted by linking patients diagnosed with CRC from 2004 through 2011 (Cancer Registry of Norway) with data on their aspirin use (The Norwegian Prescription Database). These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS. Results A total of 23,162 patients diagnosed with CRC were included, 6,102 of whom were exposed to aspirin after the diagnosis of CRC (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific. In multivariable analysis, aspirin exposure after the diagnosis of CRC was independently associated with improved CSS (hazard ratio [HR], 0.85; 95% CI, 0.79 to 0.92) and OS (HR, 0.95; 95% CI, 0.90 to 1.01).Conclusion Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS.",
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AU - Yaqub,Sheraz

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N2 - Purpose Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (CRC). However, aspirin as primary prevention is debated because of the risk of hemorrhagic adverse effects. Aspirin as secondary prevention may be more justified from a riskbenefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CRC-specific survival (CSS) and overall survival (OS). Materials and Methods An observational, population-based, retrospective cohort study was conducted by linking patients diagnosed with CRC from 2004 through 2011 (Cancer Registry of Norway) with data on their aspirin use (The Norwegian Prescription Database). These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS. Results A total of 23,162 patients diagnosed with CRC were included, 6,102 of whom were exposed to aspirin after the diagnosis of CRC (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific. In multivariable analysis, aspirin exposure after the diagnosis of CRC was independently associated with improved CSS (hazard ratio [HR], 0.85; 95% CI, 0.79 to 0.92) and OS (HR, 0.95; 95% CI, 0.90 to 1.01).Conclusion Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS.

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