Nonsteroidal anti‐inflammatory drugs

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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.