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Systematic review update of observational studies further supports aspirin role in cancer treatment: time to share evidence and decision-making with patients?
- Source :
- PLoS ONE, Vol 13, Iss 9, p e0203957 (2018), Zaguán. Repositorio Digital de la Universidad de Zaragoza, instname, PLoS ONE
- Publication Year :
- 2018
- Publisher :
- Public Library of Science, 2018.
-
Abstract
- Background Evidence is growing that low-dose aspirin used as an adjuvant treatment of cancer is associated with an increased survival and a reduction in metastatic spread. We therefore extended up to August 2017 an earlier systematic search and meta-analyses of published studies of low-dose aspirin taken by patients with a diagnosis of cancer. Methods Searches were completed in Medline and Embase to August 2017 using a pre-defined search strategy to identify reports of relevant studies. References in all the selected papers were scanned. Two reviewers independently applied pre-determined eligibility criteria and extracted data on cause-specific cancer deaths, overall mortality and the occurrence of metastatic spread. Meta-analyses were then conducted for different cancers and heterogeneity and publication bias assessed. Sensitivity analyses and attempts to reduce heterogeneity were conducted. Results Analyses of 29 studies reported since an earlier review up to April 2015 are presented in this report, and these are then pooled with the 42 studies in our earlier publication. Overall metaanalyses of the 71 studies are presented, based on a total of over 120 thousand patients taking aspirin. Ten of the studies also give evidence on the incidence of metastatic cancer spread. There are now twenty-nine observational studies describing colorectal cancer (CRC) and post-diagnostic aspirin. Pooling the estimates of reduction by aspirin which are reported as hazard ratios (HR), gives an overall HR for aspirin and CRC mortality 0.72(95% CI 0.64-0.80). Fourteen observational studies have reported on aspirin and breast cancer mortality and pooling those that report the association with aspirin as a hazard ratio gives HR 0.69 (0.53-0.90). Sixteen studies report on aspirin and prostate cancer mortality and a pooled estimate yields an HR of 0.87 (95% CI 0.73-1.05). Data from 12 reports relating to other cancers are also listed. Ten studies give evidence of a reduction in metastatic spread; four give a pooled HR 0.31 (95% CI 0.18, 0.54) and five studies which reported odds ratio of metastatic spread give OR 0.79 (0.66 to 0.95). Conclusion Being almost entirely from observational studies, the evidence of benefit from aspirin is limited. There is heterogeneity between studies and the results are subject to important biases, only some of which can be identified. Nevertheless, the evidence would seem to merit wide discussion regarding whether or not it is adequate to justify the recommendation of low-dose therapeutic aspirin, and if it is, for which cancers?
- Subjects :
- Cancer Treatment
lcsh:Medicine
Pathology and Laboratory Medicine
Vascular Medicine
Mathematical and Statistical Techniques
0302 clinical medicine
Neoplasms
Breast Tumors
Medicine and Health Sciences
030212 general & internal medicine
lcsh:Science
Aspirin
Multidisciplinary
Evidence-Based Medicine
Prostate Cancer
Hazard ratio
Prostate Diseases
Observational Studies as Topic
Treatment Outcome
Oncology
Research Design
030220 oncology & carcinogenesis
Meta-analysis
Physical Sciences
Observational Studies
Statistics (Mathematics)
Research Article
medicine.drug
medicine.medical_specialty
Death Rates
Urology
Decision Making
Hemorrhage
Antineoplastic Agents
Research and Analysis Methods
03 medical and health sciences
Signs and Symptoms
Breast cancer
Population Metrics
Diagnostic Medicine
Internal medicine
Breast Cancer
medicine
Humans
Statistical Methods
Adjuvants, Pharmaceutic
Colorectal Cancer
Population Biology
business.industry
lcsh:R
Cancers and Neoplasms
Biology and Life Sciences
Cancer
Publication bias
Odds ratio
medicine.disease
Genitourinary Tract Tumors
lcsh:Q
business
Mathematics
Meta-Analysis
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Database :
- OpenAIRE
- Journal :
- PLoS ONE, Vol 13, Iss 9, p e0203957 (2018), Zaguán. Repositorio Digital de la Universidad de Zaragoza, instname, PLoS ONE
- Accession number :
- edsair.doi.dedup.....5631de66cd154cb55eec49dd4034374c