Re: Study finds possible role for aspirin as treatment for colon cancer

29 April 2012

This observational population-based study from southern region of Netherlands (n=4481 patients) by Bastiaannet E et al has concluded that elderly patients that received no chemotherapy had the most benefit of aspirin in terms of overall survival. The effect on overall survival was only present in colon cancer patients that used aspirin. In rectal cancer patients and in patients using non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), no effect on survival was seen. On the contrary, non-aspirin NSAID use was associated with a worse survival [1].

With estimated incidence of 39 245 cases per year, colo-rectal cancer is the third most common cancer in UK [2]. Rectal and anal cancer account for 36% of total bowel cancer cases in UK. 47% of bowel cancer occurs in the patients aged more than 70 years [3]. 68% of bowel cancers patients are in stage III / IV and are in need of chemotherapy [4]. Oliveria A S has shown that only 55% of these patients are referred to chemotherapy. Age less than 70 years and stage III disease are the significant predictors of oncological referral [5]. From the above figures, we can estimate that nearly 12,000 patients over the age of 70 years will be diagnosed with colon cancers and around 8000 may present with stage III / IV disease in the absence of national bowel cancer screening programme. If we consider the referral rate at 55% for chemotherapy, at least 3500 elderly (>70 years of age) bowel cancer patients not suitable for chemotherapy probably will benefit from therapeutic effect of frequent dosing of aspirin.

45.5% of colon cancer patients have pain as their leading symptom [6] and the study by Bastiaannet E et al may be a warning bell against the use of non-aspirin NSAIDs as analgesics in patients with colorectal cancers.

References

1. Bastiaannet E, Sampieri K, Dekkers O M, de Craen A J M, van Herk-Sukel M P P, V Lemmens et al. Use of Aspirin postdiagnosis improves survival for colon cancer patients. British Journal of Cancer 2012;106:1564–70.
2. GLOBOCAN 2008 (IARC). Section of Cancer Information. Lyon: International Agency on Cancer Research; 2010. Available from: URL:http://globocan.iarc.fr/factsheet.asp (accessed on 29th April 2012)
3. News and resources. Bowel (colorectal) cancer – UK incidence statistics. London: Cancer Research UK; 2010. Available from: URL: http://info.cancerresearchuk.org/cancerstats/types/bowel/incidence/uk-bo... (accessed on 29th April 2012)
4. Data briefing. Colorectal Cancer Survival by Stage - NCIN Data Briefing. London: National Cancer Intelligence network; 2010. Available from: URL: http://www.ncin.org.uk/publications/data_briefings/colorectal_cancer_sur... (accessed on 29th April 2012)
5. Oliveria S A, Yood M U, Campbell U B, Yood S M, Stang P. Medical Care 2004;42:901-6.
6. Najem A Z, Hennessey M, Malfitan R C, Cheung N K, Hobson R W. Colon and rectal carcinoma: clinical experience. Am Surg 1977;43:583-8.

Competing interests: None declared

Ramaiah Vinay Kumar, Radiation Oncologist

Suman Bhasker

All India Institute of Medical Sciences, Ansarinagar, New Delhi - 110029, India

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