Skip to main content

Advertisement

SpringerLink
Log in

Exploring clinicians’ attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer

  • Original Article
  • Published:
Familial Cancer Aims and scope Submit manuscript

Abstract

Recent research has shown that aspirin reduces the risk of cancers associated with Lynch Syndrome. However, uncertainty exists around the optimal dosage, treatment duration and whether the benefits of aspirin as a risk-reducing medication (RRM) outweigh adverse medication related side-effects. Little is known about clinicians’ attitudes, current practice, and perceived barriers to recommending aspirin as a RRM. To explore the attitudes of clinicians who discuss risk management options with patients with Lynch Syndrome towards using aspirin as a RRM. Clinicians were invited through professional organisations to complete an online survey. Topics included their clinical experience with Lynch Syndrome, views and practice of recommending aspirin as a RRM, and knowledge about clinical risk management guidelines for Lynch Syndrome. Comparison of attitudes was made between three professional groups. 181 respondents were included in the analysis: 59 genetics professionals (genetic counsellors and clinical geneticists, medical oncologists with specialist training in familial cancer), 49 gastroenterologists and 73 colorectal surgeons. Most clinicians (76 %) considered aspirin to be an effective RRM and most (72 %) were confident about discussing it. In all professional categories, those who were confident about discussing aspirin with patients perceived it to be an effective RRM (OR = 2.8 [95 % CI = 1.8–4.2], p < 0.001). Eighty percent (47/59) of genetics professionals reported having discussed the use of aspirin with Lynch Syndrome patients compared to 69 % of gastroenterologists and 68 % of colorectal surgeons. Those who considered aspirin as an effective RRM or who felt confident in their knowledge of the aspirin literature were more likely (OR = 10 [95 % CI = 1.5–65], p = 0.010, OR = 6 [95 % CI = 2.2–16], p < 0.001, respectively) to discuss it with their patients than other professionals in the study. Similarly health professionals who felt confident in their knowledge of literature of aspirin/confident in discussing with the patients were more likely (OR = 6 [95 % CI = 2.2–16], p < 0.001) to discuss with their patients. Health professionals who saw more than ten patients with Lynch Syndrome per year were more likely to be confident in their knowledge of the aspirin literature and discussing it with patients (OR = 4.1 [95 % CI = 1.6–10.2], p = 0.003). Explicit recommendations to take aspirin, was reported by 65/83 (78 %) of health professionals. Eighty-seven percent of health professionals reported a need for patient educational materials about aspirin. Continuing training is needed to increase clinicians’ confidence in their knowledge of the literature on the use of aspirin as a RRM. Patient education materials may be helpful in improving consistency in patient care and facilitate communication between clinicians and people living with Lynch Syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Balmaña J, Castells A, Cervantes A, Group ObotEGW (2010) Familial colorectal cancer risk: ESMO clinical practice guidelines. Ann Oncol 21(suppl 5):v78–v81

    Article  PubMed  Google Scholar 

  2. tot Nederveen WHDV, Jarvinen HJ, Lynch PM, Engel C, Mecklin JP, Vasen HF (2013) Colorectal surveillance in Lynch syndrome families. Fam Cancer 12(2):261–265

    Article  Google Scholar 

  3. Vasen HFA, Watson P, Mecklin JP, Lynch HT (1999) New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative Group on HNPCC. Gastroenterology 116(6):1453–1456

    Article  CAS  PubMed  Google Scholar 

  4. Lynch HT, de la Chapelle A (2003) Hereditary colorectal cancer. N Engl J Med 348(10):919–932

    Article  CAS  PubMed  Google Scholar 

  5. Australian Institute of Health and Welfare (2014) ACIM (Australian Cancer Incidence and Mortality) books. AIHW, Canberra. http://www.aihw.gov.au/acim-books

  6. de Jong AE, Hendriks YM, Kleibeuker JH et al (2006) Decrease in mortality in Lynch syndrome families because of surveillance. Gastroenterology 130(3):665–671

    Article  PubMed  Google Scholar 

  7. Jenkins MA, Dowty JG, Ait Ouakrim D et al (2015) Short-term risk of colorectal cancer in individuals with Lynch syndrome: a meta-analysis. J Clin Oncol 33(4):326–331

    Article  PubMed  Google Scholar 

  8. Jarvinen HJ, Aarnio M, Mustonen H et al (2000) Controlled 15-year trial on screening for colorectal cancer in families with hereditary non-polyposis colorectal cancer. Gastroenterology 118(5):829–834

    Article  CAS  PubMed  Google Scholar 

  9. Stoffel EM, Mercado RC, Kohlmann W et al (2010) Prevalence and predictors of appropriate colorectal cancer surveillance in Lynch syndrome. Am J Gastroenterol 105(8):1851–1860

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rabeneck L, Paszat LF, Hilsden RJ et al (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135(6):1899–1906

    Article  PubMed  Google Scholar 

  11. Wong MCS, Ching JYL, Hirai HH et al (2013) Perceived obstacles of colorectal cancer screening and their associated factors among 10,078 Chinese participants. PLoS One 8(7):e70209

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Klabunde CN, Vernon SW, Nadel MR, Breen N, Seeff LC, Brown ML (2005) Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Med Care 43(9):939–944

    Article  PubMed  Google Scholar 

  13. Møller P, Seppälä T, Bernstein I et al (2015) Cancer incidence and survival in Lynch syndrome patients receiving colonoscopic and gynaecological surveillance: first report from the prospective Lynch syndrome database. Gut. doi:10.1136/gutjnl-2015-309675

    PubMed  Google Scholar 

  14. Garcia-Albeniz X, Chan AT (2011) Aspirin for the prevention of colorectal cancer. Best Pract Res Clin Gastroenterol 25:461–472

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Flossmann E, Rothwell PM (2007) Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet 369(9573):1603–1613

    Article  CAS  PubMed  Google Scholar 

  16. Hassan C, Rex DK, Cooper GS, Zullo A, Launois R, Benamouzig R (2012) Primary prevention of colorectal cancer with low-dose aspirin in combination with endoscopy: a cost-effectiveness analysis. Gut 61(8):1172–1179

    Article  PubMed  Google Scholar 

  17. Burn J, Gerdes A-M, Macrae F et al (2011) Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet 378(9809):2081–2087

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kune GA, Kune S, Watson LF (1988) Colorectal cancer risk, chronic illnesses, operations, and medications: case control results from the Melbourne Colorectal Cancer Study. Cancer Res 48(15):4399–4404

    CAS  PubMed  Google Scholar 

  19. Grau MV, Sandler RS, McKeown-Eyssen G et al (2009) Nonsteroidal anti-inflammatory drug use after 3 years of aspirin use and colorectal adenoma risk: observational follow-up of a randomized study. J Natl Cancer Inst 101(4):267–276

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Dube C, Rostom A, Lewin G et al (2007) The use of aspirin for primary prevention of colorectal cancer: a systematic review prepared for the US Preventive Services Task Force. Ann Int Med 146(5):365–375

    Article  PubMed  Google Scholar 

  21. Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW (2011) Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 377(9759):31–41

    Article  CAS  PubMed  Google Scholar 

  22. Cook NR, Lee IM, Gaziano JM et al (2005) Low-dose aspirin in the primary prevention of cancer: the Women’s Health Study—a randomized controlled trial. JAMA 294(1):47–55

    Article  CAS  PubMed  Google Scholar 

  23. Rothwell PM, Wilson M, Elwin CE et al (2010) Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 376(9754):1741–1750

    Article  CAS  PubMed  Google Scholar 

  24. Reimers MS, Bastiaannet E, van Herk-Sukel MPP et al (2012) Aspirin use after diagnosis improves survival in older adults with colon cancer: a Retrospective Cohort Study. J Am Geriatr Soc 60(12):2232–2236

    Article  PubMed  Google Scholar 

  25. Rubenstein JH, Enns R, Heidelbaugh J et al (2015) American gastroenterological association institute guideline on the diagnosis and management of Lynch syndrome. Gastroenterology 149(3):777–782

    Article  PubMed  Google Scholar 

  26. Bibbins-Domingo K (2016) Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement aspirin use for the primary prevention of CVD and CRC. Ann Int Med 164(12):836–845

    Article  PubMed  Google Scholar 

  27. Cancer Insitute New South Wales (2009) Risk management for Lynch syndrome. 25 Jun 2009. https://www.eviq.org.au/Protocol/tabid/66/categoryid/66/id/1410/Risk+Management+for+Lynch+Syndrome.aspx

  28. Cordina C, Shaikh I, Shrestha S, Camilleri-Brennan J (2011) Probiotics in the management of gastrointestinal disease: analysis of the attitudes and prescribing practices of gastroenterologists and surgeons. J Dig Dis 12(6):489–496

    Article  PubMed  Google Scholar 

  29. Provenzale D, Ofman J, Gralnek I, Rabeneck L, Koff R, McCrory D (2003) Gastroenterologist specialist care and care provided by generalists–an evaluation of effectiveness and efficiency. Am J Gastroenterol 98(1):21–28

    PubMed  Google Scholar 

  30. Delvaux N, Merckaert I, Marchal S et al (2005) Physicians’ communication with a cancer patient and a relative. Cancer 103(11):2397–2411

    Article  PubMed  Google Scholar 

  31. Forsetlund L, Bjorndal A, Rashidian A et al (2009) Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2:CD003030

    Google Scholar 

  32. Sarani B, Scanlon J, Jackson P, Evans SRT (2002) Selection criteria among gastroenterologists and surgeons for laparoscopic antireflux surgery. Surg Endosc 16(1):57–63

    Article  CAS  PubMed  Google Scholar 

  33. Shea JA, Asch DA, Johnson RF et al (1997) What predicts gastroenterologists’ and surgeons’ diagnosis and management of common bile duct stones? Gastrointest Endosc 46(1):40–47

    Article  CAS  PubMed  Google Scholar 

  34. Roark R, Petrofski J, Berson E, Berman S (1995) Practice variations among pediatricians and family physicians in the management of otitis media. Arch Pediatr Adolesc Med 149(8):839–844

    Article  CAS  PubMed  Google Scholar 

  35. Weiner JP, Parente ST, Garnick DW, Fowles J, Lawthers AG, Palmer RH (1995) Variation in office-based quality: a claims-based profile of care provided to Medicare patients with diabetes. J Am Med Assoc 273(19):1503–1508

    Article  CAS  Google Scholar 

  36. Lacy BE, Rosemore J, Robertson D, Corbin DA, Grau M, Crowell MD (2006) Physicians’ attitudes and practices in the evaluation and treatment of irritable bowel syndrome. Scand J Gastroenterol 41(8):892–902

    Article  PubMed  Google Scholar 

  37. Cole BF, Logan RF, Halabi S et al (2009) Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials. J Natl Cancer Inst 101(4):256–266

    Article  CAS  PubMed  Google Scholar 

  38. Jacobs EJ, Thun MJ, Bain EB, Rodriguez C, Henley SJ, Calle EE (2007) A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence. J Natl Cancer Inst 99(8):608–615

    Article  CAS  PubMed  Google Scholar 

  39. Patrono C, Garcia Rodriguez LA, Landolfi R, Baigent C (2005) Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 353(22):2373–2383

    Article  CAS  PubMed  Google Scholar 

  40. Farrell B, Godwin J, Richards S, Warlow C (1991) The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 54(12):1044–1054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Patrono C, Coller B, Dalen JE et al (1998) Platelet-active drugs: the relationships among dose, effectiveness, and side effects. CHEST J 114:470S–488S

    Article  CAS  Google Scholar 

  42. Zion AB, Aiman J (1989) Level of reading difficulty in The American College of obstetricians and gynecologists patient education pamphlets. Obstet Gynecol 74(6):955–960

    CAS  PubMed  Google Scholar 

  43. Baker D, Roberts DE, Newcombe RG, Fox KAA (1991) Evaluation of drug information for cardiology patients. Br J Clin Pharmacol 31(5):525–531

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Edwards MH (1990) Satisfying patients’ needs for surgical information. Br J Surg 77(4):463–465

    Article  CAS  PubMed  Google Scholar 

  45. Meiser B, Rahman B, Watts KJ, Kirk J, Tucker KJ, Saunders C, Gleeson M, Barlow-Stewart K, Mitchell G (2012) Evaluation of the efficacy of two models of delivering information about treatment-focused genetic testing among young women newly diagnosed with breast cancer. In: IPOS 14th world congress of psycho-oncology, Brisbane, Australia

  46. Kawamoto K, Houlihan CA, Balas EA, Lobach DF (2005) Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330(7494):765

    Article  PubMed  PubMed Central  Google Scholar 

  47. Farquhar CM, Kofa EW, Slutsky JR (2002) Clinicians’ attitudes to clinical practice guidelines: a systematic review. Med J Aust 177(9):502–506

    PubMed  Google Scholar 

  48. Lynch HT, Lynch J (2000) Lynch syndrome: genetics, natural history, genetic counseling, and prevention. J Clin Oncol 18(21 Suppl):19s–31s

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work is carried out with support from the University of New South Wales and the Inherited Cancer Connect (ICCon) Partnership. The ICCon Partnership is funded by the Cancer Council New South Wales Strategic Research Partnership (STREP) scheme. The authors would like to extend their gratitude to the participants involved in this research, directors of the familial cancer clinics in Australia and the professional organisations (COSA, CSSANZ, CNSA and GESA) who sent out the invitation emails. Michelle Peate is supported by a National Breast Cancer Foundation Early Career Fellowship (ECF-15-005).

Author information

Authors and Affiliations

  1. Sydney Medical School – Northern, Kolling Institute Level 7, Royal North Shore Hospital, University of Sydney, Sydney, NSW, 2065, Australia

    Yanni Chen

  2. Department of Psychosocial Oncology, National Cancer Centre, Singapore, 169610, Singapore

    Yanni Chen

  3. Psychosocial Research Group, Lowy Cancer Research Centre C25, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia

    Michelle Peate, Rajneesh Kaur & Bettina Meiser

  4. Department of Obstetrics and Gynaecology, Level 7, Royal Women’s Hospital, University of Melbourne, 20 Flemington Road, Parkville, VIC, 3052, Australia

    Michelle Peate

  5. School of Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia

    Tim Wong

  6. Westmead Institute for Cancer Research, Westmead Millennium Institute, Sydney, NSW, Australia

    Judy Kirk

  7. Familial Cancer Service, Westmead Hospital, Sydney, Australia

    Judy Kirk

  8. University of Queensland, Brisbane, QLD, 4067, Australia

    Robyn L. Ward

  9. Medical Oncology, Concord Cancer Centre, Sydney, NSW, 2138, Australia

    Annabel Goodwin

  10. Colorectal Medicine and Genetics and University Dept of Medicine, Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia

    Finlay Macrae

  11. School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, 3000, Australia

    Janet Hiller

  12. Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, 3002, Australia

    Alison H. Trainer & Gillian Mitchell

  13. Sir Peter MacCallum Deparment of Oncology, University of Melbourne, Melbourne, VIC, 3052, Australia

    Gillian Mitchell

Authors
  1. Yanni Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michelle Peate
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajneesh Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bettina Meiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tim Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Judy Kirk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robyn L. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Annabel Goodwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Finlay Macrae
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Janet Hiller
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alison H. Trainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gillian Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajneesh Kaur.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Y., Peate, M., Kaur, R. et al. Exploring clinicians’ attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer. Familial Cancer 16, 99–109 (2017). https://doi.org/10.1007/s10689-016-9933-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10689-016-9933-1

Keywords

Search

Navigation