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End-of-life prescribing of aspirin in patients with breast or colorectal cancer
  1. Laura Murphy1,
  2. Chris Brown2,
  3. Amelia Smith3,
  4. Faith Cranfield4,
  5. Linda Sharp5,
  6. Kala Visvanathan6,7,
  7. Kathleen Bennett1 and
  8. Thomas Ian Barron3,7
  1. 1 Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 National Cancer Registry, Cork, Ireland
  3. 3 Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, University of Dublin, Dublin, Ireland
  4. 4 Saint Francis Hospice, Dublin, Ireland
  5. 5 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  6. 6 Sidney Kimmel Comprehensive Cancer Centre, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  7. 7 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Ms. Amelia Smith, Department of Pharmacology and Therapeutics, Trinity College, University of Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland D08 W9RT; smitha25{at}tcd.ie

Abstract

Objectives The aim of this study was to evaluate the influence of an approaching cancer death on end-of-life aspirin use, a frequently prescribed medication for cardiovascular disease prevention.

Methods This study was conducted using linked cancer registry and prescribing data. Breast (n=1151) and colorectal (n=1859) cancer decedents were matched to cancer survivors and the probability of either initiating aspirin, or continuing established aspirin use, was estimated in consecutive periods over the 5 years approaching a cancer-specific death (decedents) or matched index date (survivors).

Results Using the linked data sets, we identified patients who died of their cancer (decedents) between 1 January 2001 and 31 December 2009. In the 5 years prior to death, we compared (1) the probability of initiating aspirin use for the first time, and (2) the probability of continuing aspirin use. In comparison to matched cancer survivors, an approaching cancer death was not associated with a reduction in aspirin initiation by breast or colorectal cancer decedents. However, the probability of continuing established aspirin use declined considerably in the 24 months approaching death and at the time of a death was significantly lower for breast (risk difference (RD) −0.26, 95% CI −0.33 to −0.20) and colorectal (RD −0.38, 95% CI −0.46 to −0.30) cancer decedents versus matched survivors.

Conclusion A significant proportion of patients discontinue their aspirin in the time approaching a breast or colorectal cancer-specific death. The safety and benefits of this are unclear and empirical data are needed to guide decisions about aspirin use in the end of life.

  • breast cancer
  • colorectal cancer
  • aspirin
  • end of life

https://doi.org/10.1136/bmjspcare-2017-001370

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    Footnotes

    • Contributors LM, TIB, AS, FC, LS, KV and KB contributed to study conception and design. CB, TIB, AS and LM contributed to data analysis. LM, TIB, KB and AS contributed to drafting the manuscript. All authors contributed to the interpretation of findings and revision of the manuscript.

    • Funding This work was supported by the Irish Cancer Society Collaborative Cancer Research Centre BREAST-PREDICT (CCRC13GAL to KB, TIB) and the Health Research Board Ireland (ICE20119 to KB, LS). LM and AS’s positions are funded by the Irish Cancer Society Collaborative Cancer Research Centre BREAST-PREDICT (CCRC13GAL to KB, TIB). TIB’s position is funded by the Health Research Board Ireland (ICE20119 to KB, LS). CB’s position is funded by the Health Research Board Ireland (HSR201230 to LS, KB, TIB). The Health Research Board Ireland and the Irish Cancer Society had no role in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit for publication. The interpretation and reporting of these data are the responsibility of the authors and should in no way be seen as the official policy or interpretation of the National Cancer Registry Ireland or the Irish Health Services Executive Primary Care Reimbursements Services.

    • Competing interests LS held an unrestricted project grant from Sanofi-Aventis in 2011–2012 for research on survival from breast cancer. All remaining authors have declared no competing interests.

    • Ethics approval The use of anonymised data collected by the NCRI for research is covered by the Health (Provision of Information) Act 1997 and does not require patient consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.