Key result
Aspirin use in cancer patients is linked to ~21% lower all-cause mortality.
Why the study?
Aspirin has been of increasing interest as a potential cancer treatment for over 50 years, but the balance of its risks and benefits remains a point of contention.
Does aspirin reduce mortality and metastatic spread in patients with cancer?
Does aspirin reduce mortality and metastatic spread in patients with cancer?
Effect estimate: HR 0.79 (95% CI 0.74, 0.86)
Observational evidence strongly suggests aspirin reduces mortality and metastatic spread in cancer patients with an acceptable safety profile, though definitive RCT evidence is still lacking.
Should not change practice on observational data alone; leaves open confirmation of survival benefit in randomized cancer trials.
Aspirin as a possible treatment of cancer has been of increasing interest for over 50 years, but the balance of the risks and benefits remains a point of contention. We summarise the valid published evidence 'for' and 'against' the use of aspirin as a cancer treatment and we present what we believe are relevant ethical implications. Reasons for aspirin include the benefits of aspirin taken by patients with cancer upon relevant biological cancer mechanisms. These explain the observed reductions in metastatic cancer and vascular complications in cancer patients. Meta-analyses of 118 observational studies of mortality in cancer patients give evidence consistent with reductions of about 20% in mortality associated with aspirin use. Reasons against aspirin use include increased risk of a gastrointestinal bleed though there appears to be no valid evidence that aspirin is responsible for fatal gastrointestinal bleeding. Few trials have been reported and there are inconsistencies in the results. In conclusion, given the relative safety and the favourable effects of aspirin, its use in cancer seems justified, and ethical implications of this imply that cancer patients should be informed of the present evidence and encouraged to raise the topic with their healthcare team.
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Elwood et al. (2023) conducted a review in Cancer (n=1,000,000). Aspirin vs. No aspirin was evaluated on All-cause mortality (HR 0.79, 95% CI 0.74, 0.86). Aspirin use in cancer patients is associated with a 21% reduction in all-cause mortality (HR 0.79) based on pooled observational data, though randomized trial evidence remains limited.
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