Aspirin could cut risk of death in cancer patients by 20% major review of studies suggests

CARDIFF University team carried out a review and analysis of research on aspirin and cancer mortality. They looked at patients with a wide range of cancers who take aspirin as part of their treatment could help to reduce their risk of death by 20%, a major review of existing research has suggested. The academics, at Cardiff University, carried out a systematic review of 118 published observational studies in patients with 18 different cancers. They pooled the results and found that in a total of about 250,000 patients with cancer who reported taking aspirin, this was associated with a reduction of about 20% in cancer deaths. The review said the available body of evidence on its efficacy and safety:- "justifies its use" as a supplementary treatment in a wide range of cancers; and patients should be informed of this. Their review has since been published in the open access journal eCancermedicalscience.

Lead Author Professor Peter Elwood, Honorary, a Professor at Cardiff University, who has studied the effects of aspirin for more than 50 years, said:- "In recent years, my research team and I have been struck by the actions of aspirin on the biological mechanisms relevant to cancer; and these seem to be the same in many different cancers. We therefore wanted to review the scientific evidence available on the use of aspirin as an additional treatment for a wide range of cancers. Overall, we found that at any time after a diagnosis of cancer, about 20% more of the patients who took aspirin were alive, compared with patients not taking aspirin."

The team also considered the risks of aspirin taking and wrote to an author on each of the papers asking about any stomach or other bleeding episodes. A small number of patients had experienced a bleed, but there was no evidence of any excess deaths attributable to bleeding in the patients on aspirin, the review said.

Professor Elwood said:- "Our research suggests that not only does aspirin help to cut risk of death, but it has also been shown to reduce the spread of cancer within the body; so called metastatic spread. There is now a considerable body of evidence to suggest a significant reduction in mortality in patients with cancer who take aspirin; and that benefit appears to not be restricted to 1 or a few cancers. Aspirin therefore appears to deserve serious consideration as an adjuvant treatment of cancer and patients with cancer and their carers should be informed of the available evidence. However, we must also stress that aspirin is not a possible alternative to any other treatment."

In 1974, a research team led by Professor Elwood and Professor Archie Cochrane at the Medical Research Council's Unit in Wales were the 1st to show that taking an aspirin tablet a day reduced deaths from heart disease and stroke by about 24%.  The report gained global traction in 1990 and was judged by the BMJ to have been 1 of the top 50 most important research studies published since 1945.

Professor Elwood said his original study stimulated a new phase of research work on aspirin. At the time of the report about 100 clinical research studies on aspirin were published each year, but now, more than 1,000 are reported each year. He said a number of new clinical trials had been set up to test aspirin treatment in several cancers and the results of these should offer further clear evidence. Professor Elwood:- "Further research into aspirin and cancer would clearly be of great value, and new studies should be encouraged, especially if focused on some of the less common cancers."

Inequality gap widens for children with type 1 diabetes from ethnic minority backgrounds

THE National Paediatric Diabetes Audit (NPDA) says that immediate action from Government is required to address the disparity in access to life changing diabetes technologies, leading charity Diabetes UK has said in response to a new report.  Findings from the NPDA show widening inequalities in the care of children and young people with type 1 diabetes, within England and Wales, for the 6th year. These include poorer diabetes outcomes and worsening access to diabetes technology in children and young people from ethnic minority backgrounds and socially deprived areas.

The NPDA reveals that:-

► Children and young people with type 1 diabetes from ethnic minority backgrounds are more likely to have higher average blood sugar levels (HbA1c) compared to White children.

► Black children and young people have the highest average HbA1c levels, followed by children with a Mixed ethnic background and Asian children respectively.

► Children in the most deprived areas are more likely to have higher average blood sugar levels (HbA1c) compared to those in the least deprived areas.

► A high HbA1c level means too much sugar in the blood over time. This increases the risk of developing serious complications, such as kidney failure, eye and foot problems, heart attacks and stroke.

Diabetes technologies such as insulin pumps and Continuous Glucose Monitors (CGMs) help people with diabetes to manage their condition, including HbA1c, and have been shown to improve health and wellbeing. And while the NPDA reports an overall upward trend in the use of diabetes technologies, technology use is lowest in children and young people from socially deprived areas and from ethnic minority communities.

Specifically, the NPDA shows that:-

►  The gap between children using an insulin pump in the most and least deprived areas has widened from 7.9% in 2014/15, to 12.6% in 2019/20.

►  There is significantly lower use of insulin pumps and CGMs in Black children compared to White children, who have the highest use of diabetes technology.

►  A total of 27,653 children and young people in the UK have type 1 diabetes according to the NPDA; the highest prevalence in Europe.

There is limited research exploring why these inequalities exist in the UK. But there is clear action that can be taken now, which is why Diabetes UK believes tackling the issue of unequal access to diabetes technologies, and the wider issue of health inequalities in diabetes care needs to be fought on 2 fronts:-

►  By Government providing urgent funding to break the postcode lottery that today causes significant variation in access to diabetes technology depending on where a person lives, their level of deprivation and their ethnicity...

►  By Government and funders committing to support research to help understand why these inequalities exist, and what can be done to address them...

To support this, Diabetes UK is working with leading diabetes researchers through its Diabetes Research Steering Groups, and in partnership with JDRF, to develop research to reveal barriers to equal access to diabetes technology. In the longer term this work will help identify targeted interventions to address this 6 year trend of widening inequalities.

While the research needed to understand the root causes of these issues will take time and commitment from Government and funders to happen, ending the postcode lottery is something that can be addressed today. That is why Diabetes UK is urging the Government to take immediate action to ensure that every child and young person can access diabetes technology regardless of where they live.

Chris Askew OBE, Chief Executive at Diabetes UK, said:- "It is unacceptable that children and young people from ethnic minority communities and socially deprived areas have poorer diabetes related outcomes and lower usage of diabetes technology. We need to understand precisely why these children and young people face such stark and widening inequalities to help address and solve the problem for future generations. But what we can do now is ensure that diabetes technology is made available to all children and young people who meet the eligibility criteria. This funding would save children with diabetes and their families from distress that nobody should have to face, and could help reduce hospital admissions from preventable complications. It is vital that the Government gives all people with diabetes the tools they need, today."

A/Professor May Ng, Chair of the Diabetes Research Steering Group focused on Children and Young People who is leading the efforts to drive forward research in this area, said:- "While this year's NPDA reports that use of Continuous Glucose Monitoring (CGM) and insulin pump technology is associated with better HbA1c outcomes, even when other factors are adjusted; it is very concerning that inequalities in health outcomes have grown, and the use of technologies in children with diabetes living in the most deprived areas and of ethnic minority backgrounds were faring worse. This disparity has widened over the last 6 years. For example, the gap between insulin pump and CGM usage amongst children from an ethnic minority backgrounds and those living in the most and least deprived areas has widened with time from 2014 to 2020. We should be looking at why this is happening and how we should be reducing variations in care. It is time for everyone to act now."

Karen Addington, UK Chief Executive of the type 1 diabetes charity JDRF, said:- "The latest NPDA findings paint a dire picture of inequality among children and young people with type 1 diabetes. Wearable medical technologies for managing type 1 diabetes can improve lives and clinical outcomes, yet children and young people from ethnic minority communities and socially deprived areas are particularly missing out. Everybody who wants and needs access to type 1 diabetes technology should receive it, which is why we're calling for more to be done to reach people with type 1 from these groups. We're working in partnership with Diabetes UK to understand the barriers, many of which were identified in our 2020 Pathway to Choice report, and call on the Government and local NHS bodies to work with us to overcome them."