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dc.contributor.authorElwood, Peter C
dc.contributor.authorPickering, Janet E
dc.contributor.authorMorgan, Gareth
dc.contributor.authorGalante, Julieta
dc.contributor.authorWeightman, Alison L
dc.contributor.authorMorris, Delyth
dc.contributor.authorLongley, Marcus
dc.contributor.authorMason, Malcolm
dc.contributor.authorAdams, Richard
dc.contributor.authorDolwani, Sunil
dc.contributor.authorChia W K, John
dc.contributor.authorLanas, Angel
dc.date.accessioned2019-02-16T00:30:09Z
dc.date.available2019-02-16T00:30:09Z
dc.date.issued2018
dc.identifier.issn1932-6203
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/289462
dc.description.abstractBACKGROUND: 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 meta-analyses 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?
dc.format.mediumElectronic-eCollection
dc.languageeng
dc.publisherPublic Library of Science (PLoS)
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectHumans
dc.subjectNeoplasms
dc.subjectAspirin
dc.subjectAntineoplastic Agents
dc.subjectAdjuvants, Pharmaceutic
dc.subjectTreatment Outcome
dc.subjectDecision Making
dc.subjectEvidence-Based Medicine
dc.subjectObservational Studies as Topic
dc.titleSystematic review update of observational studies further supports aspirin role in cancer treatment: Time to share evidence and decision-making with patients?
dc.typeArticle
prism.issueIdentifier9
prism.publicationDate2018
prism.publicationNamePLoS One
prism.startingPagee0203957
prism.volume13
dc.identifier.doi10.17863/CAM.36712
dcterms.dateAccepted2018-08-30
rioxxterms.versionofrecord10.1371/journal.pone.0203957
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-01
dc.contributor.orcidElwood, Peter C [0000-0003-4352-1570]
dc.identifier.eissn1932-6203
rioxxterms.typeJournal Article/Review
cam.issuedOnline2018-09-25


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International