Analgesics and Ovarian Cancer Survival


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Melissa A. Merritt, PhD

Melissa A. Merritt, PhD

In a prospective cohort study reported in The Lancet Oncology, Melissa A. Merritt, PhD, of the University of Hawaii Cancer Center’s Epidemiology Program, and colleagues found evidence that recent use of aspirin or nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) after diagnosis appears to improve ovarian cancer–specific survival.

The study involved data from the prospective Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII) whose participants have completed biennial questionnaires since 1976 and 1989. Between June 1976 and May 2012 for the NHS and between June 1989 and May 2013 for NHSII, a total of 1,789 participants were diagnosed with epithelial ovarian cancer and 1,143 (64%) were eligible for inclusion in the current study; of these, 1,031 (90%) were included in the prediagnosis exposure analysis and 964 (84%) in the postdiagnosis analysis. Eligible participants had confirmed invasive stage I to III epithelial ovarian cancer and had data available on analgesic use. The primary objective was to determine whether self-reported regular use (≥ 2 days per week) of aspirin, nonaspirin NSAIDs, or paracetamol before and after ovarian cancer diagnosis was associated with ovarian cancer–specific survival. Analyses were adjusted for age and year of diagnosis, disease stage, and histology.

Benefit of Use Postdiagnosis

Compared with never-users, participants who reported recent (current use in the past 2 years) postdiagnosis use of aspirin (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.52–0.89) and nonaspirin NSAIDs (HR = 0.67, 95% CI = 0.51–0.87) had improved ovarian cancer–specific survival. No positive association with ovarian cancer–specific survival was found for prediagnosis use of any type of analgesic or postdiagnosis use of paracetamol. In analyses of change in analgesic use from prediagnosis to postdiagnosis, participants who became postdiagnosis recent users of aspirin (HR = 0.44, 95% CI = 0.26–0.74) or recent users of nonaspirin NSAIDs (HR = 0.46, 95% CI = 0.29–0.73) had improved ovarian cancer–specific survival compared with never-users.

The investigators concluded, “Recent use of aspirin or nonaspirin NSAIDs, defined as current use in the past 2 years, after diagnosis appears to improve ovarian cancer–specific survival. If these results are confirmed in further studies, further research should explore potential synergistic effects of anti-inflammatory medications used in combination with standard ovarian cancer therapies to improve the prognosis for patients diagnosed with ovarian cancer.” ■

Merritt MA, et al: Lancet Oncol 19:1107-1116, 2018.


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