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NSAID use and unnatural deaths after cancer diagnosis : a nationwide cohort study in Sweden

NSAID use and unnatural deaths after cancer diagnosis : a nationwide cohort study in Sweden

Title: NSAID use and unnatural deaths after cancer diagnosis : a nationwide cohort study in Sweden
Author: Shen, Qing
Sjölander, Arvid
Sloan, Erica K.
Walker, Adam K.
Fall, Katja
Valdimarsdóttir, Unnur Anna
Sparén, Pär
Smedby, Karin E.
Fang, Fang
Date: 2022-01-17
Language: English
Department: Faculty of Medicine
Series: BMC Cancer; 22(1)
ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-09120-9
Subject: Slys; Svíþjóð; Svíþjóð; Krabbamein; Sjálfsvíg; Hóprannsóknir; Lyf; Aspirín; Accident; Aspirin; cancer; Cohort study; NSAIDs; Suicide; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use; Humans; Middle Aged; Accidents/mortality; Proportional Hazards Models; Aspirin/therapeutic use; Suicide/statistics & numerical data; Male; Mortality, Premature/trends; Cause of Death; Sweden; Drug Prescriptions/statistics & numerical data; Neoplasms/mortality; Female; Registries; Aged; Genetics; Oncology; Cancer Research
URI: https://hdl.handle.net/20.500.11815/3053

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Shen , Q , Sjölander , A , Sloan , E K , Walker , A K , Fall , K , Valdimarsdóttir , U A , Sparén , P , Smedby , K E & Fang , F 2022 , ' NSAID use and unnatural deaths after cancer diagnosis : a nationwide cohort study in Sweden ' , BMC Cancer , vol. 22 , no. 1 , 75 . https://doi.org/10.1186/s12885-021-09120-9


Background: Cancer patients experience increased risk of death from accident and suicide. Cognitive impairment induced by cancer-related inflammation and stress-related psychiatric symptoms may be underlying mechanisms. We therefore studied the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of these outcomes. Methods: Following a cohort of 388,443 cancer patients diagnosed between October 2005 and December 2014 in Sweden, we ascertained dispense of aspirin or non-aspirin NSAIDs from 3 months before cancer diagnosis onward and defined the on-medication period as from date of drug dispense until the prescribed dosage was consumed. Follow-up time outside medicated periods and time from unexposed patients were defined as off-medication periods. We used Cox models to estimate hazard ratios (HRs) of death due to suicide or accident, by comparing the on-medication periods with off-medication periods. Results: In total, 29.7% of the cancer patients had low-dose aspirin dispensed and 29.1% had non-aspirin NSAIDs dispensed. Patients with aspirin use were more likely to be male than patients without aspirin use. Compared with off-medication periods, there was a 22% lower risk of accidental death (N = 651; HR 0.78, 95% confidence interval [CI]: 0.70 to 0.87) during on-medication periods with aspirin. The use of aspirin was not associated with risk of suicide (N = 59; HR 0.96, 95% CI: 0.66 to 1.39). No association was noted between use of non-aspirin NSAIDs and the risk of suicide (N = 13; HR 0.95, 95% CI: 0.42 to 2.18) or accidental death (N = 59; HR 0.92, 95% CI: 0.68 to 1.26). Conclusions: Intake of low-dose aspirin after cancer diagnosis was associated with a lower risk of unnatural deaths among cancer patients.


Publisher Copyright: © 2022, The Author(s). Open access funding provided by Karolinska Institute. This work was supported by the Swedish Cancer Society (grant numbers: CAN 2014/417 and 20 0846 PjF to F.F.) and the Swedish Research Council for Health, Working Life and Welfare (grant number: 2017–00531 to F.F.); by Karolinska Institutet Senior Researcher Award and Strategic Research Area in Epidemiology Award (to F.F.); by China Scholarship Council (No. 201407930016 to Q.S.); by the National Health and Medical Research Council (GNT1147498 to E.K.S.) and National Breast Cancer Foundation (IIRS-20-025 to E.K.S.). The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication.

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