Non-aspirin NSAIDs and head and neck cancer mortality in a Danish nationwide cohort study. (April 2022)

• Record Type: Journal Article
• Authors: de la Cour, Cecilie D.; Dehlendorff, Christian; von Buchwald, Christian; Garset-Zamani, Martin; Grønhøj, Christian; Carlander, Amanda-Louise F.; Friis, Søren; Kjaer, Susanne K.
• Is Part Of: Cancer epidemiology. Volume 77(2022)
• Publication Date: 2022-04
• Subjects: CI confidence interval -- COX cyclooxygenase -- DDD defined daily dose -- HNSCC head and neck squamous cell carcinoma -- HPV human papillomavirus -- HR hazard ratio -- NA-NSAIDs non-aspirin non-steroidal anti-inflammatory drugs -- OPSCC oropharyngeal squamous cell carcinoma -- SCC squamous cell carcinoma -- UICC TNM Union for International Cancer Control – Tumor, Node, Metastasis -- WHO World Health Organization; Head and neck cancer -- Oropharyngeal cancer -- Non-steroidal anti-inflammatory drugs -- Survival -- Human papillomavirus; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2022.102121
• Languages: English
• ISSNs: 1877-7821

Abstract

Abstract: Background: Evidence suggests that non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) have antineoplastic properties of potential importance for survival of head and neck cancer. Methods: We conducted a nationwide cohort study including all individuals with primary head and neck squamous cell carcinoma in Denmark during 2000–2016 at age 30–84 years, with no history of cancer (except non-melanoma skin cancer), and alive at 1 year after diagnosis. Nationwide registries provided information on drug use, causes of death and potential confounders, and additional clinical information was obtained for a subpopulation. We conducted Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between post-diagnosis non-aspirin NSAID use (defined as ≥1 filled prescription within first year after diagnosis) and cancer-specific mortality. Results: Among 10, 770 head and neck cancer 1-year survivors, the HR for cancer-specific mortality with non-aspirin NSAID use was 1.68 at 1 year after diagnosis, but declined and stabilized around 1.15 (95% CI 1.02–1.29) at 2 years after diagnosis. Among 2-year survivors, the HRs for cancer-specific mortality with non-aspirin NSAID use remained slightly increased in analyses stratified by age, sex, stage, and pre-diagnosis non-aspirin NSAID use. Similar results were seen in the subpopulation (n = 1029) with additional clinical information, and among 5-year survivors with additional non-aspirin NSAID exposure assessment. Conclusion: In this nationwide cohort of patients with head and neck cancer, use of non-aspirin NSAIDs was associated with a slightly increased mortality risk, warranting further evaluation. Highlights: Non-aspirin (NA)-NSAID use has been suggested to reduce head and neck cancer mortality. This nationwide cohort study found a slightly increased mortality with NA-NSAIDs. The increased mortality with NA-NSAIDs persisted across age, sex and stage. No clear trends were found according to patterns of use or COX-2-selectivity.