Does Analgesic Use Improve Survival in Ovarian Cancer?

Recent use of aspirin or nonsteroidal anti-inflammatory agents (NSAIDs) was associated with improved ovarian cancer–specific survival, according to a retrospective study.

“Increasing evidence suggests that inflammatory factors are associated with worsened outcomes in patients with ovarian cancer,” wrote study authors led by Melissa A. Merritt, PhD, of the University of Hawaii Cancer Center in Honolulu. “Currently very few data are available to evaluate whether postdiagnosis use of common analgesics influences overall survival in patients with ovarian cancer.”

In the new study, the researchers used data from the Nurses’ Health Study (NHS), which was established in 1976, and the Nurses’ Health Study II to examine whether exposure to analgesics including aspirin, NSAIDs, and paracetamol (acetaminophen) is associated with changes to ovarian cancer outcomes. The results were published in Lancet Oncology.

Between 1989 and 2013, the study included 1,789 cases of ovarian cancer. Of those, the researchers included 1,143 total cases; 1,031 of those completed a prediagnosis questionnaire including information on analgesic use, and 964 completed a postdiagnosis questionnaire.

There were no associations between prediagnosis aspirin use and ovarian cancer–specific survival. However, women who reported recent use of aspirin postdiagnosis had improved ovarian cancer–specific survival, with a hazard ratio (HR) of 0.68 (95% CI, 0.52–0.89); significant associations were seen for intake of 1–5 tablets per week, and intake on 2–5 days per week.

Similar to aspirin, there was no association between prediagnosis non-aspirin NSAID use and outcome. But again, compared with never-users, recent users of NSAIDs had improved cancer-specific survival, with an HR of 0.67 (95% CI, 0.51–0.87). The same amounts of intake were significant for NSAIDs. Women who reported NSAID intake of more than 14 tablets per week had an increased risk of mortality, at an HR of 2.33 (95% CI, 1.18–4.61), though this was based on a small number of cases and the significance was eliminated when adjusting for comorbidities.

Neither pre- nor postdiagnosis use of paracetamol was associated with improved ovarian cancer–specific mortality outcomes.

Changes in aspirin or NSAID usage from pre- to postdiagnosis were also analyzed. Women who changed from a never-user of aspirin to a recent user after diagnosis had improved cancer-specific survival, with an HR of 0.44 (95% CI, 0.26–0.74). The same was true for NSAIDs, with an HR of 0.46 (95% CI, 0.29–0.73).

“Ultimately, if findings are confirmed, they might open up new treatment options that when used in combination with standard therapies, could improve overall survival for patients with ovarian cancer,” the authors concluded. “Randomized controlled trials would be needed as the next step to determine the clinical value of these findings.”