Should Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) be avoided in patients with esophageal cancer?

From the Guidelines

NSAIDs should be avoided in people with esophageal cancer due to the potential risk of gastrointestinal complications and bleeding, which can be particularly problematic for patients with compromised esophageal tissue. While there is evidence to suggest that NSAIDs may decrease the incidence of esophageal cancer 1, the risks associated with their use, such as irritation of the gastrointestinal tract and increased risk of bleeding, may outweigh any potential benefits 1. Additionally, esophageal cancer patients who have undergone surgery or radiation therapy may be more vulnerable to NSAID-related damage, and those on anticoagulants or with low platelet counts may be at increased risk of bleeding when combined with NSAIDs.

Key Considerations

• NSAIDs can irritate the gastrointestinal tract and increase the risk of bleeding, which is concerning for patients with compromised esophageal tissue 1
• Esophageal cancer patients who have undergone surgery or radiation therapy may be more vulnerable to NSAID-related damage
• Some esophageal cancer patients may be on anticoagulants or have low platelet counts due to treatment, further increasing bleeding risks when combined with NSAIDs
• If pain management is needed, acetaminophen (Tylenol) is often a safer alternative

Recommendations

• Avoid using NSAIDs in people with esophageal cancer whenever possible
• If NSAIDs are necessary, use the lowest effective dose for the shortest duration possible and consider gastroprotective medications like proton pump inhibitors (such as omeprazole) to reduce risks 1
• Always consult with the oncologist or treating physician before starting or continuing NSAIDs in the context of esophageal cancer

From the Research

NSAIDs and Esophageal Cancer

• The use of NSAIDs in people with esophageal cancer is a topic of interest, with some studies suggesting a potential benefit in reducing the risk of esophageal adenocarcinoma 2.
• A study published in 2010 found that filled NSAID/aspirin prescriptions were associated with a reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus 2.
• However, there is no direct evidence to suggest that NSAIDs should be avoided in people with esophageal cancer, and the current management of esophageal cancer focuses on treatments such as esophagectomy, chemotherapy, and radiotherapy 3.

Current Management of Esophageal Cancer

• The current management of esophageal cancer involves a multimodal approach, including neoadjuvant chemotherapy or combined chemoradiotherapy followed by surgery 3.
• Minimally invasive esophagectomy (MIE) is being increasingly used, with some studies suggesting a decrease in respiratory complications and length of hospital stay 3.
• The role of NSAIDs in the management of esophageal cancer is not well established, and further research is needed to determine their potential benefits and risks 2, 4.

Risk Factors and Screening

• Esophageal cancer has distinct subtypes, including adenocarcinoma and squamous cell carcinoma, with different risk factors and geographic distributions 5.
• Screening for esophageal adenocarcinoma is not currently a standard practice, but certain patients may benefit from screening/surveillance endoscopies, including those with Barrett's esophagus or other high-risk conditions 5, 6.
• The use of proton pump inhibitors (PPIs) and NSAIDs may have a role in reducing the risk of esophageal adenocarcinoma, but further research is needed to confirm this 2, 4, 6.