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NSAID use and unnatural deaths after cancer diagnosis: A nationwide cohort study in Sweden

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Cancer patients experience increased risk of death from accident and suicide. Cognitive impairment induced by cancer-related inflammation and stress-related psychiatric symptoms may be underlying mechanisms. We therefore studied the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of these outcomes. | Shen et al. BMC Cancer 2022 22 75 https doi.org 10.1186 s12885-021-09120-9 RESEARCH Open Access NSAID use and unnatural deaths after cancer diagnosis a nationwide cohort study in Sweden Qing Shen1 Arvid Sjölander1 Erica K. Sloan2 Adam K. Walker2 3 4 Katja Fall5 6 Unnur Valdimarsdottir1 7 8 Pär Sparén1 Karin E. Smedby9 10 and Fang Fang5 Abstract Background Cancer patients experience increased risk of death from accident and suicide. Cognitive impairment induced by cancer-related inflammation and stress-related psychiatric symptoms may be underlying mechanisms. We therefore studied the association between use of nonsteroidal anti-inflammatory drugs NSAIDs and risk of these outcomes. Methods Following a cohort of 388 443 cancer patients diagnosed between October 2005 and December 2014 in Sweden we ascertained dispense of aspirin or non-aspirin NSAIDs from 3 months before cancer diagnosis onward and defined the on-medication period as from date of drug dispense until the prescribed dosage was consumed. Follow-up time outside medicated periods and time from unexposed patients were defined as off-medication periods. We used Cox models to estimate hazard ratios HRs of death due to suicide or accident by comparing the on-medication periods with off-medication periods. Results In total 29.7 of the cancer patients had low-dose aspirin dispensed and 29.1 had non-aspirin NSAIDs dispensed. Patients with aspirin use were more likely to be male than patients without aspirin use. Compared with off-medication periods there was a 22 lower risk of accidental death N 651 HR 0.78 95 confidence interval CI 0.70 to 0.87 during on-medication periods with aspirin. The use of aspirin was not associated with risk of suicide N 59 HR 0.96 95 CI 0.66 to 1.39 . No association was noted between use of non-aspirin NSAIDs and the risk of suicide N 13 HR 0.95 95 CI 0.42 to 2.18 or accidental death N 59 HR 0.92 95 CI 0.68 to 1.26 . Conclusions Intake of low-dose aspirin after cancer diagnosis was .