Aspirin and Other Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Summary

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and celecoxib (Celebrex) are used to reduce inflammation and pain. Compelling research is emerging that some NSAIDs may improve survival, make some cancer treatments more effective and reduce the risk of cancer.

NSAIDs are very effective at treating pain. Limited evidence shows they also address other common side effects and symptoms that many people with cancer experience.

Safety is a concern, especially with long-term use. We strongly recommend medical supervision with use.

We rate NSAIDs overall:

Evidence of Effectiveness

Treating Cancer  4 star rating of 5

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Optimizing Your Body Terrain  5 star rating of 5

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Managing Side Effects and Promoting Wellness  5 star rating of 5

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Reducing Cancer Risk  3 star rating of 5

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Use by Integrative Oncology Experts 2 star rating of 5

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Safety 2 star rating of 5

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Affordability and Ease of Access 4 star rating of 5

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Authors

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

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Nancy Hepp, MS, BCCT Project Manager

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Contributor

Maria Williams, BCCT Research & Communications Consultant

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Last updated March 7, 2021.

Details and Evidence

COX Inhibitors

You’ll see throughout this page mentions of COX-2 inhibitors. Cyclooxygenase-2 (COX-2) is an enzyme responsible for inflammation and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) that directly target COX-2:1

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Because the safety profiles and cautions can be very different between aspirin and other NSAIDs, we list the evidence separately whenever possible, even when the impacts with cancer are similar. Some studies lump the effects of aspirin and other NSAIDs together, and so we can evaluate only what researchers report. For many types of cancer and side effects, you may see up to three sections: 

  • All NSAIDs combined
  • Aspirin
  • Non-aspirin NSAIDs

We encourage our readers to evaluate the safety and cautions regarding each type of NSAID along with the evidence of effectiveness and potential benefit in your type of cancer or symptoms. We also strongly encourage you to seek professional medical supervision in using any NSAIDs, even those available without a prescription.

Non-aspirin Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Reviewed on This Page

Further NSAIDs are listed by the US Food and Drug Administration: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes

Generic name Brand name(s)

Celecoxib

Celebrex

Diclofenac

Cambia, Cataflam, Dyloject, Flector, Pennsaid, Solaraze, Voltaren, Voltaren-XR, Zipsor, Zorvolex, Arthrotec (combination with misoprostol)

Ibuprofen*

Advil, Caldolor, Children’s Advil, Children’s Elixsure IB, Children’s Motrin, Ibu-Tab, Ibuprohm, Motrin IB, Motrin Migraine Pain, Profen, Tab-Profen, Duexis (combination with famotidine), Reprexain (combination with hydrocodone), Vicoprofen (combination with hydrocodone)

Indomethacin

Indocin, Tivorbex

Ketorolac

Sprix

Naproxen*

Aleve, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprosyn, Treximet (combination with sumatriptan), Vimovo (combination with esomeprazole)

Sulindac

Clinoril

*Many over-the-counter (OTC) products contain this drug.

Clinical Practice Guidelines

Aspirin

US Preventive Services Task Force (USPSTF) issued a grade B recommendation for the use of low-dose aspirin (75 to 100 mg/day) for the primary prevention of cardiovascular disease and colorectal cancer in adults 50 to 59 years of age who have a 10 percent or greater 10-year cardiovascular disease risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years. The USPSTF also recommended that the decision to use low-dose aspirin for preventing cardiovascular disease and colorectal cancer in adults age 60 to 69 years who have a 10 percent or greater 10-year cardiovascular disease risk should be an individual one. (grade C)2

Other NSAIDs

USPSTF acknowledges benefits in certain high-risk groups but is against general use of non-aspirin NSAIDs for prevention due to the risk of serious cardiovascular and gastrointestinal side effects.3

Treating the Cancer

Clinical Evidence

NSAID use shows anticancer action and improves survival in some cancer types, as detailed below. The impact varies substantially by the type of NSAID used, the cancer type and stage, and characteristics of the people in the studies, such as body weight, presence of diabetes, or other therapies used in tandem. 

All Cancers Combined

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Adrenal Cancer

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Bladder Cancer

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Breast Cancer

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Colorectal Cancer

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Head and Neck Cancer

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Lung Cancer

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Ovarian Cancer

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Pancreatic Cancer

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Prostate Cancer

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Sarcoma

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Stomach Cancer

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Lab and Animal Evidence

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Optimizing Your Terrain

See Body Terrain and the Tumor Microenvironment.

All NSAIDs Combined

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Aspirin

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Non-aspirin NSAIDs

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Managing Side Effects and Promoting Wellness

Changes in Appetite

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Fatigue

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Pain

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Quality of Life

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Wasting (Cachexia)

For Health Professionals: Managing Cachexia

One author advises that single or multiple drugs alone are not sufficient to treat cachexia. Drugs need to be combined with dietary counseling, supplementation, symptom management, and exercise.104

Also, consider that many of the patients with cachexia usually have multiple other symptoms and are frail and often elderly. Use the lowest effective dose of NSAIDs for the shortest period of time and monitor regularly for early detection of adverse events.105

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Other Side Effects and Symptoms

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Reducing Risk

Clinical Evidence

Bladder Cancer

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Breast Cancer

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Colorectal Cancer

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Esophageal Cancer

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Liver Cancer

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Lung Cancer

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Pancreatic Cancer

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Prostate Cancer

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Stomach Cancer

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Uterine Cancer

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Lab and Animal Evidence

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Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.
  • Programs and protocols
    • Block program166 for inflammation
    • Chang strategies167 (Celebrex and low-dose "baby" aspirin to decrease risk of cardiovascular events and clots which can be caused by Celebrex and Chinese herbs
    • Parmar & Kazcor treatment plans168

Cautions

NSAIDs can have serious, even life-threatening side effects. Some NSAIDs have more frequent or more serious side effects than others. Use them only under medical supervision.

Caution is advised for those with hypertension or risk factors for gastrointestinal bleeding. Discontinuing NSAID use in cancer patients is not advised in one review, but careful monitoring for side effects such as cardiovascular events (COX-2) or gastrointestinal bleeding is recommended.169

One study found a trend toward increased risk of cancer progression with use by elderly patients with stage 3 or 4 cancers.170

Side Effects

All NSAIDs, including Aspirin

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Aspirin

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Non-aspirin NSAIDs

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Drug Interactions

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Commentary

BCCT advisor Keith Block, MD,176   and Raymond Chang, MD,177 prescribe COX-2 inhibitors such as celecoxib (Celebrex) in a variety of cancers, including breast cancer. Dr. Block prefers to get at the root of inflammation using diet and other non-drug approaches, but in some situations he uses Celebrex to block the COX-2 enzyme, “since the inflammatory chemicals the enzyme spawns play a major role in blocking the effectiveness of chemotherapy and radiation.”178

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