An aspirin a day to keep the oncologist away
LONDON — Evidence supporting the daily use of aspirin to help prevent and possibly treat cancer was published Tuesday in a collection of three papers — two in The Lancet and one in Lancet Oncology.
Previous studies have established that daily aspirin reduces the long-term risk of death due to cancer (Lancet 2007, 2010, 2011). However, the short-term effects were less certain, especially in women, as was how the risk/benefit of aspirin changes over time. In the first paper (The Lancet), lead author Peter Rothwell, professor at the University of Oxford and John Radcliffe Hospital, studied individual patient data from 51 randomized trials of daily aspirin versus no aspirin to prevent such vascular events as heart attacks.
They found that aspirin reduced the risk of a cancer death by 15%, compared with control groups. This improved to a 37% reduction risk of a cancer death for those on aspirin from five years and onwards. The reduction in cancer deaths on aspirin resulted in a 12% reduction in nonvascular deaths overall during the trials. In these trials of primary prevention, the reduction in nonvascular deaths accounted for almost all (91%) of the deaths prevented. Daily low-dose aspirin reduced cancer incidence by around a quarter from three years and onwards, with similar reductions in men (23%) and women (25%).
Although the reduced risk of major vascular events in these trials was initially offset by an increased risk of major bleeding, both these effects diminished over time, leaving only the reduced risk of cancer from 3 years and onwards (an absolute reduction of 3 cases per 1,000 patients per year, 12-per-1,000 control versus 9-per-1,000 in aspirin groups). The authors also found that case-fatality from major extracranial bleeds also was two-thirds lower on aspirin versus control groups.
"Alongside the previously reported reduction by aspirin of the long-term risk of cancer death, the short-term reductions in cancer incidence and mortality and the decrease in risk of major extracranial bleeds with extended use, and their low case-fatality, add to the case for daily aspirin in prevention of cancer," Rothwell said. "In view of the very low rates of vascular events in recent and ongoing trials of aspirin in primary prevention, prevention of cancer could become the main justification for aspirin use in this setting."
A second article in The Lancet reported the effect of aspirin on cancer metastasis (i.e., how cancer grows/spreads). In this study, the authors collected new data on metastases of cancers that were diagnosed during all five large randomized trials of daily aspirin (75mg or more daily) versus control for the prevention of vascular events in the United Kingdom.
They found that, with a mean follow-up of 6.5 years, allocation to aspirin reduced risk of cancer with distant metastasis by 36%, risk of adencarcioma (common solid cancers including colon, lung, and prostate cancers) by 46%, and of other solid cancers (e.g. bladder, kidney) by 18%. These reductions were due mainly to a reduction by almost half in the proportion of adenocarcinomas that had metastatic disease.
The third study, published in The Lancet Oncology, also looked at aspirin’s affect on metastases, this time using a systematic review of observational versus randomized trials. They found that observational studies showed a 38% reduced risk of colorectal cancer, matching well to the 42% reduction shown by randomized trials. Similar matches in risk were found for oesophageal, gastric, biliary and breast cancers.
Survey: Supplement users make healthier lifestyle choices
WASHINGTON — When it comes to healthy habits, dietary supplement users appear to make healthier lifestyle choices overall than nonusers, according to a recent study by the Council for Responsible Nutrition released Thursday.
According to the most recent CRN Consumer Survey on Dietary Supplements, supplement users engage in the following healthy habits in higher percentages than do those who don’t take vitamins, minerals and other supplements:
“I try to eat a balanced diet.” Supplement users, 84%; nonsupplement users, 76%;
“I visit my doctor regularly.” Supplement users, 73%; nonsupplement users, 62%;
“I regularly get a good night’s sleep.” Supplement users, 70%; nonsupplement users, 63%;
“I exercise regularly.” Supplement users, 64%; nonsupplement users, 54%; and
“I maintain a healthy weight.” Supplement users, 63%; nonsupplement users, 57%.
“Our study suggests that the majority of supplement users tend to be healthy people with positive attitudes about their diets and their overall health," stated Judy Blatman, SVP communications at CRN. "Given the daily challenges so many people face, making smart choices — such as incorporating dietary supplements into an existing wellness routine — can help many people reach their wellness goals and live healthier lives.”
The study also found that more than two-thirds (69%) of U.S. adults take dietary supplements. When asked why, 58% of supplement users said they took dietary supplements for overall health and wellness; additionally, 42% of supplement users said it was to fill in nutrient gaps in their diet.
The 2011 CRN Consumer Survey on Dietary Supplements was conducted Aug. 25 to 29, 2011, by Ipsos Public Affairs and funded by CRN. The survey was conducted online and included a national sample of 2,015 adults ages 18 years and older from Ipsos’ U.S. online panel. The survey has been conducted annually since 2000.
GSK shares real-world example on how to improve switch through technology
SILVER SPRING, Md. — GlaxoSmithKline on Thursday morning presented exactly how technology might improve appropriate patient self-selection before a panel convened by the Food and Drug Administration to explore expanding the prescripton-to-over-the-counter switch paradigm by incorporating technology and/or pharmacy participation in the application process.
GSK created a prototypical healthcare kiosk that channeled a patient through nine algorithms and assisted him or her in making an appropriate treatment decision for use of an OTC statin, in this case Mevacor — branded Cardiocare as part of the presentation.
And while GSK’s prototype was housed in an actual kiosk, GSK VP wellness category, global regulatory and quality David Schifkovitz noted this kind of funneling program, where each screen poses a question and directs the consumer to the most-appropriate next screen depending upon the answer, easily can be translated to a smartphone app.
In the example of "Cardiocare," the questionnaire walked patients through a series of questions such as their gender, age, knowledge of cholesterol condition and contributing risk factors to their condition — is there a history of heart disease in their family? Based on the patient’s answers, the end screen would either recommend use of the statin or explain why this statin may not be appropriate for self-selection.
Funneling patients toward the most appropriate self-selection conclusion isn’t the only advantage to a program like this, Schifkovitz said. "There’s the ability with this technology to incorporate education into the algorithm itself."
GSK’s experience with developing a Mevacor-based question protocol was borne out of the company’s partnership with Merck when that company last attempted to switch Mevacor in 2007. The absence of appropriate self-selection helped scuttle that switch application. Merck had improved self-selection scores in a consumer label-comprehension study from two years prior (2007 vs. 2005). To help consumers with self-selection, Merck made label revisions, including a highlighted age-exclusion graphic on the front of the package and a stronger warning against the use of Mevacor Daily in women who are pregnant or could become pregnant.
In the usage study based on consumers’ knowledge of their LDL levels, 98% of consumers appropriately chose not to take the medicine, but only 16% of those who chose to take the medicine did so appropriately.