Study Finds Surprising Link Between Aspirin in Seniors and Cancer Mortality

 Have your competent? doctor explain how this affects you.

I've been taking a 325 apirin for almost 19 years now to reduce clotting ability not to thin the blood. Not going to change.

Study Finds Surprising Link Be tween Aspirin in Seniors and Cancer Mortality

Longer follow-up of the ASPREE cohort is warranted, says researcher

by Charles Bankhead, Senior Editor, MedPage Today

 Key Takeaways 

• Among more than 19,000 older adults, cancer incidence during 10 years of follow-up was almost identical in patients who used aspirin and those who did not. 
• Use of aspirin was associated with increased cancer-related mortality.
• Aspirin was linked to a reduced risk of melanoma and an increased risk of brain cancer, though this was based on small numbers of events. 

Low-dose aspirin was not associated with a reduced incidence of cancer in older adults, but was associated with an increased risk of dying of cancer, according to a cohort study of participants from the randomized ASPREE trial. Among more than 19,000 adults with a mean age of 75, cancer incidence during 10 years of follow-up was almost identical in patients who used aspirin and those who did not (HR 0.98, 95% CI 0.92-1.05). The risk of dying of cancer was 15% higher in patients who took low-dose aspirin. An analysis of 14,907 surviving participants who continued follow-up in the extension phase of the randomized ASPREE trial showed no difference in cancer incidence or cancer mortality, reported Suzanne G. Orchard, PhD, of Monash University in Melbourne, Australia, and colleagues in JAMA Oncology.

Despite the size of the study and the extended duration of follow-up, the results do not rule out the possibility of a benefit from low-dose aspirin, said Orchard.

"It is hard to say anything definitive, especially since there are not that many studies conducted in older persons," she told MedPage Today. "The earlier studies have found that cancer incidence benefits can take up to 10 to 15 years to manifest, and so longer follow-up of the current ASPREE cohort is warranted, to see if the associations between aspirin and cancer incidence and mortality change over time."

"We would like to see whether aspirin can impact specific subgroups differently, and earlier work in our group has indicated this may be the case," she noted. "Studies exploring the mechanism of action in older people would also be valuable -- for example, those with certain gene variants. There have been some reports of individuals with PI3K gene variations responding differently to aspirin. So, genetic profiling of the cancers from those in the aspirin arm versus the placebo arm may shed some light on the mechanism."

The data did show a reduced incidence of melanoma in the aspirin arm, and an increased incidence of brain cancer, two findings that require further investigation, Orchard said.

Early randomized clinical trials of aspirin and cancer, mostly involving middle-age adults, showed a reduced risk of cancer and lower cancer-related mortality, particularly for colorectal cancer (CRC). The Women's Health Study provided additional evidence of a favorable effect of aspirin on CRC.

More recent studies showed that starting aspirin at an older age had no effect on cancer outcomes or increased rates of malignancy. However, follow-up in these studies was too brief for a preventive effect on cancer to emerge, the authors noted in their introduction.

The ASPREE trial comprised a randomized phase with a median follow-up of 4.7 years and a 5-year extension phase (ASPREE-XT) to examine long-term impact of prior randomization to aspirin or placebo. Conducted in Australia and the U.S., the trial enrolled patients ages 70 and older (65 or older for Black and Latino patients in the U.S.), who were randomized to low-dose aspirin (100 mg/day) or placebo. Eligible patients were free of cardiovascular disease, dementia, and independence-limiting physical disability.

The randomized phase enrolled patients from 2010-2014 with follow-up to 2017. ASPREE-XT followed study participants from 2018-2024.

For the overall population, 3,448 cancers and 1,173 cancer-related deaths occurred during 10 years of follow-up (median 8.6 years). New cancers were almost evenly distributed between the two arms, 1,701 in the aspirin group and 1,747 in the placebo group. Incidence of localized, metastatic, and hematologic malignancies was also similar between the two groups. The aspirin arm had 623 deaths versus 550 in the placebo arm, resulting in a hazard ratio of 1.15 (95% CI 1.03-1.29).

During ASPREE-XT, 689 cancers occurred in the patients originally randomized to aspirin versus 762 in the placebo group, a nonsignificant 9% difference (95% CI 0.82-1.01). Each group had 188 cancer-related deaths (HR 1.02, 95% CI 0.83-1.25).

The incidence and mortality for colorectal cancer, a topic of multiple studies of cancer prevention with aspirin, were almost identical in the overall and ASPREE-XT analyses.

Over the entire duration of follow-up, fewer cases of melanoma occurred in the aspirin arm (159 vs 209, HR 0.77, 95% CI 0.62-0.94). The difference persisted in the analysis limited to ASPREE-XT participants (71 vs 101, HR 0.71, 95% CI 0.53-0.96).

During the randomized phase of the investigation, significantly more patients in the aspirin group developed brain cancer, though absolute numbers were small (HR 1.96, 95% CI 1.05-3.65). Additionally, the aspirin group had a higher mortality for combined rare cancers (HR 2.09, 95% CI 1.21-3.61).

"The results are difficult to be certain of due to low sample sizes," said Orchard.

US adults living alone may face higher risk of cancer death, study suggests

I've been living alone now for 12+ years. I can't see getting married, it would severely limit my traveling and social connections. But there are quite a few old college roommates which could work.

This problem is not going to happen to me, my social connections are vast.

Martha Gellhorn on her relationship with Ernest Hemingway

'I do very well without marriage
I'd rather sin respectably any day of the week
Ernest thinks, of course, that marriage saves you a lot of trouble and he is all for it,
I think sin is very clean, there are no strings attached to it'

The latest here:

US adults living alone may face higher risk of cancer death, study suggests

 

Adults living by themselves may have a higher risk of dying from cancer compared with those who live with others, a new study suggests, and the share of adults in the United States who live alone is on the rise.

The research, published Thursday in the journal Cancer, found that among 114,772 working-age adults who lived alone, 2.5% of them died of cancer during the study period. In comparison, among 358,876 adults who lived with others, a much smaller share — 1.6% — died of cancer in the study. Adults ages 18 to 64 were enrolled in the study and researchers found the strongest association was in those ages 45 to 64.

Loneliness or social isolation linked to serious health outcomes, study finds

“We found that working adults living alone had a 1.32 times higher risk of cancer death than adults living with others,” said Dr. Farhad Islami, an author of the study and senior scientific director of cancer disparity research at the American Cancer Society in Atlanta. That suggests that adults living alone have about a 32% higher risk of cancer death.

“Living alone is only one of the components of social isolation, and it may not capture other components like social networks or participation in social activities. But I should say also that living alone is still an important measure,” he said. “This is really important to think about finding ways to reduce the adverse effects of living alone and social isolation, to reduce mortality in this growing population.”

Being ‘socially frail’ comes with health risks for older adults

The proportion of people in the United States who live alone has climbed over decades. US Census Bureau data shows that the proportion of one-person households in the United States more than doubled from 1960, when 13% or about 7 million households were single, to 2022, when 29% or about 38 million households were.

The researchers, from the American Cancer Society and the US Department of Health and Human Services, analyzed data, from 1998 to 2019, on more than 470,000 adults from the National Health Interview Survey and the National Death Index, taking a close look at how many of the adults lived alone versus with others and how many died of cancer. The study did not control for the stage of cancer when diagnosed, specific cancer types or treatment regimens.

The adults, ages 18 to 64 when they enrolled in the study, were followed for up to 22 years, from the time they participated in the survey through December 31, 2019. About 24% of them lived alone.

The researchers also pointed out that there were higher proportions of one-person households among Black households than White, Asian and Hispanic households, among young adults and the elderly versus middle age adults, among females than males and among adults with higher education versus those with low education levels.

The male loneliness epidemic and how it affects fathers

But the association between living alone and cancer mortality persisted among non-Hispanic White adults and adults with higher education levels even after accounting for differences in a wide range of sociodemographic, behavioral, and health characteristics, according to the study.

“Our findings may suggest that stronger social support existed for communities from racial ethnic minority groups and people of lower socioeconomic status and that might have alleviated that association between living alone and cancer mortality in this group, but we need more research on reasons for these differences,” Islami said.

Compared with adults living with others, adults living alone were more likely to have fair or poor self-reported health status, activity limitation, serious psychological distress, severe obesity, smoke cigarettes, or consume alcohol, according to the study.

“These findings underscore the significance of addressing living alone in the general population and among cancer survivors, calling for interventions to reduce adverse effects of living alone and social isolation and further research to identify the underlying mechanisms for this association,” the researchers wrote in their study.

Alone and lonely are not the same

This isn’t the first time that research has found living alone to be associated with increased health risks. Separate studies have previously found that living alone may be associated with a higher risk of being diagnosed with cancer, or even any cause of death.

Surgeon general lays out framework to tackle loneliness and ‘mend the social fabric of our nation’

In May, US Surgeon General Dr. Vivek Murthy released an advisory describing loneliness and social isolation as an epidemic, but social connection can help, serving as a buffer to certain health risks while making communities more resilient.

But living alone does not necessarily mean that someone is lonely or isolated.

More research is needed to identify the exact underlying mechanisms to explain the association between living alone and cancer death, Kathrin Milbury, associate professor of behavioral science at The University of Texas MD Anderson Cancer Center, who was not involved in the new study, said in an email.

“Living with others gives one easy access to human contact. While being well, living alone may be less detrimental. However, people undergoing cancer treatment or dealing with the lasting side effects of treatment may not have the energy to reach out to others, feel uncomfortable going to public places due to appearance changes, or have impaired physical function that reduces their ability to be social. So, those who live alone may be vulnerable to social isolation,” Milbury said in the email.

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“The biological mechanisms of social isolation are not fully understood; however, humans are social beings, and being isolated creates a state of biological stress that is detrimental to our health when chronically experienced,” Milbury said. “The other mechanism I believe is related to being in a relationship with others, beyond benefiting just from their presence, but receiving their support, care and advocacy.”

CanSAR - World's largest cancer database containing 1.7 billion experimental results

 We have NOTHING like this in stroke! The ASA and WSO are completely incompetent in setting a stroke database up.

canSAR.ai | the Cancer Drug Discovery Platform

Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach

 Obviously the solution is to not have your stroke while you have cancer.

Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach

Show all authors

Malin Woock, Nicolas Martinez-Majander, David J. Seiffge, ...

First Published June 28, 2022 Review Article 

https://doi.org/10.1177/17562864221106362

Article information

Abstract

The association between stroke and cancer is well-established. Because of an aging population and longer survival rates, the frequency of synchronous stroke and cancer will become even more common. Different pathophysiologic mechanisms have been proposed how cancer or cancer treatment directly or via coagulation disturbances can mediate stroke. Increased serum levels of D-dimer, fibrin degradation products, and CRP are more often seen in stroke with concomitant cancer, and the clot retrieved during thrombectomy has a more fibrin- and platelet-rich constitution compared with that of atherosclerotic etiology. Multiple infarctions are more common in patients with active cancer compared with those without a cancer diagnosis. New MRI techniques may help in detecting typical patterns seen in the presence of a concomitant cancer. In ischemic stroke patients, a newly published cancer probability score can help clinicians in their decision-making when to suspect an underlying malignancy in a stroke patient and to start cancer-screening studies. Treating stroke patients with synchronous cancer can be a delicate matter. Limited evidence suggests that administration of intravenous thrombolysis appears safe in non-axial intracranial and non-metastatic cancer patients. Endovascular thrombectomy is probably rather safe in these patients, but probably futile in most patients placed on palliative care due to their advanced disease. In this topical review, we discuss the epidemiology, pathophysiology, and prognosis of ischemic and hemorrhagic strokes as well as cerebral venous thrombosis and concomitant cancer. We further summarize the current evidence on acute management and secondary preventive therapy.

Keywords

cancer, cerebral venous thrombosis, clot, diagnostics, hemorrhagic stroke, intracerebral hemorrhage, ischemic stroke, risk, stroke, therapy

Introduction

Cancer and stroke are leading causes of death and disability worldwide. Approximately 40% of all human beings will harbor a malignancy during their lifetimes.¹ Similarly, approximately 25% will experience a stroke.² Both diseases are devastating with high mortality, morbidity, sufferings, and costs. Fortunately, both cancer and stroke treatments took major leaps during the last two decades. While both diseases represent major global health problems, they may occur in the same individual as several lines of evidence suggest an association between several cancer types and various stroke subtypes. About 10% of patients presenting with stroke have a malignancy.³ With aging populations globally, we can expect higher rates already in the forthcoming decades. Patients with malignancies often have similar risk factors as stroke patients, but a clear increase in stroke risks in patients with malignancy occurs without doubt. The mechanisms behind this association are manifold, and not all appropriately explored. From a clinical perspective, an important question is in which stroke patients it is worthwhile and cost-effective to screen for occult cancer. The other relevant clinical question is how to treat patients simultaneously having stroke and cancer, given the increased risk of thrombosis and bleeding at the same time. In the last decades, several encouraging scientific advances in both diagnostics and treatment strategies have greatly changed the course of disease for many patients suffering from cancer or cerebrovascular disease with a prolonged survival rate. This review critically examines the existing data on relationships between cancer and cerebrovascular disease and suggests some approach strategies for clinicians meeting such patients in their practice.

Association between cancer and different subtypes of stroke

The connection between cancer and stroke is well known.^4,5 In older studies,^6,7 ischemic stroke and intracranial hemorrhage were thought to account for equal parts of cerebrovascular disease in cancer patients. A more recent study demonstrated that ischemic stroke is more frequent in cancer patients, however, accounting for approximately 90% of all strokes, similarly to that of the general stroke population.⁴

A nation-wide registry study from the United States confirmed that 1 in 10 hospitalized ischemic stroke patients has co-morbid cancer, and another study showed that about 20% of patients with cryptogenic stroke have occult malignancy at the time of their stroke.^3,8 Studies restricted to those with active cancer (defined as cancer diagnosis, metastasis of known cancer, recurrent cancer, or receiving cancer treatment, all within 6–12 months before or after stroke onset) report frequencies up to 5% among patients with ischemic stroke. This is significantly higher than the general population.^9–11 Over the last decades, stroke admissions among patients with cancer have remained stable despite a significant decrease in the general population, and the proportion of patients with concomitant cancer among stroke patients has increased.³ This is probably reflecting the positive result of longer life expectancy among the general population, allowing people more time to develop cancer as well as better diagnostics and treatment opportunities for cancer patients improving survival in this group.

In accordance with the study from the United States,³ a recently published meta-analysis showed that the pooled cumulative incidence of cancer within 1 year after an ischemic stroke was 13.6 per 1000, being notably higher in studies focusing on cryptogenic stroke and in those reporting cancer screening.¹² One autopsy study conducted in 1985 indicated that 15% of cancer patients had evidence of cerebrovascular disease upon death.⁷ Several large observational studies have confirmed a substantially increased short-term risk of ischemic and hemorrhagic strokes in patients with newly diagnosed solid or hematological cancers.^4,13–15 Solid tumors in advanced stage disease of the lung, pancreatic, and colorectal cancers seem to carry the highest stroke risk.^4,11,16 Other studies reported high incidence of stroke in breast and prostate cancer.^3,9 (Box 1) A vast increase in stroke risk is also seen in metastatic disease, indicating a more advanced disease.¹⁵ Stroke can be the initial presentation of cancer¹⁶ or follow a cancer diagnosis, however,¹³ and the risk of stroke remains elevated even over 10 years following cancer diagnosis.¹⁵

Box 1. The most common types of cancer seen in ischemic stroke, hemorrhagic stroke, and cerebral venous thrombosis.

Box 1. The most common types of cancer seen in ischemic stroke, hemorrhagic stroke, and cerebral venous thrombosis.

View larger version

The clinical features associated with active cancer in patients with acute ischemic stroke (AIS) are the presence of venous thromboembolism (VTE), cryptogenic stroke subtype, and lower frequency of traditional cardiovascular risk factors, for example, diabetes mellitus and high low-density lipoprotein (LDL) cholesterol levels.⁹ Studies investigating TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes among patients with ischemic stroke and concomitant cancer reported cryogenic stroke to be the most frequent subtype.^14,17,18 Furthermore, Cestari et al.¹⁹ reported embolic ischemic stroke to be more common than non-embolic in ischemic stroke patients with underlying cancer, comprising 54% compared with 46%.

The risk of hemorrhagic stroke in patients with cancer has been investigated in a number of studies. A large nation-wide population-based Swedish study showed that cancer patients had 2.2 times increased risk for a hemorrhagic stroke in the first 6 months following a cancer diagnosis.¹⁵ The risk remained slightly increased (1.2 times) during the following 10 years. Cancers involving the central nervous system, leukemia, endocrine gland, small intestine, and kidney were associated with the highest risk of stroke in this study, and similar results were seen in a more recently published study.⁴

Intracerebral hemorrhage (ICH) is the most frequent type of intracranial hemorrhage associated with cancer.^7,20 Studies of patients with non-traumatic ICH report a wide incidence range for concomitant cancer, from 0.2% to 15%.^21–25 The highest incidence was found in a more recently published study from Japan.²¹ Two of the five studies investigating concomitant cancer among patients presenting with non-traumatic ICH excluded patients with previous primary brain tumors and metastatic brain tumors. The incidences of concomitant cancer in these studies were 3.8% and 15%, respectively.^21,24 Compared with cancer-free patients with ICH, patients with underlying cancer were older, more often male, had received anticoagulation before ICH, had higher prestroke scores according to the Charlson Comorbidity Index, and lower prevalence of diabetes mellitus and arterial hypertension.²⁴ Lower hemoglobin (Hb) levels were typically observed in the cancer group, but platelet count was in the normal range similar to the cancer-free study group.²¹

The data from a large US cancer center suggest that 46% of cancer-associated intracranial hemorrhages are caused by coagulopathy and 61% by intratumoral hemorrhage from an intracranial neoplasm.²⁰ A single-center cohort study of intracranial neoplasm patients reported a frequency of ICH of 2.4%.²⁵ Solid systemic tumors most commonly associated with ICH are lung, melanoma, breast, and renal cancers. This is probably mainly because of their high incidence in the population and frequent metastasis to the brain.^6,20 Prostate cancer accounted for 5% of ICH in one study.²⁰ Among primary brain tumors, glioblastoma multiforme is most often associated with ICH.^6,25 Among the hematological cancers, leukemia is the one most commonly associated with ICH.⁶ Cerebral venous thrombosis (CVT) is a rare cause of stroke with an incidence of 1.32–1.75 per 100,000 individuals.^26–29 Not only are malignancies a risk factor of CVT, but also a predictor of poor outcome.^30,31 The data from cohort studies suggest prevalence of malignancy of 7–10% among patients diagnosed with CVT.^30,32–34 One case–control study reported increased prevalence of malignancy among CVT patients (53/594, 8.9%) as compared with controls (160/6278, 2.5%) despite younger age among cases.³¹ Cancer types with the highest risk of CVT were lung cancer [adjusted odds ratio (aOR) = 32.4], hematological cancer (aOR = 25.1), gastrointestinal cancer (aOR = 5.8), and breast cancer (aOR = 2.6). The association with CVT was particularly high within the first year after diagnosis of cancer. Another study from the same researchers showed that while cancer history was found in 9.3% of CVT patients younger than 55 years of age, it was 24.4% for those 55 years or older.³⁵ Such high probability should alert physicians to remember cancer as a potential underlying factor especially in older CVT patients.

More at link.

Raise a Glass? Study Tallies Cancer Cases From Booze

Here's the next reason your doctor will tell you no alcohol.  I, with no medical experience will take my chances since the pros are much more important to me.

I prefer this, you can't listen to me, I'm not medically trained, but at least I read research, does your doctor?

Alcohol for these 12 reasons.

  Even with the massive amount of stress your doctor is dumping on you  by giving you nothing towards 100% recovery, don't do the following.

 But your doctor will never suggest this, so don't go against your doctor's advice.

Moderate alcohol intake lowers stress-related brain activity, may reduce CVD risk

The latest here:

Raise a Glass? Study Tallies Cancer Cases From Booze

Heavy drinking habits accounted for about half of the global toll

by Mike Bassett, Staff Writer, MedPage Today July 13, 2021

More than 700,000 new cases of cancer worldwide in 2020 were attributable to alcohol consumption, according to a population-based modeling study.

Men accounted for about three-quarters of these cancer cases, which most commonly affected the esophagus and liver, reported Harriet Rumgay, BSc, of the International Agency for Research on Cancer's Cancer Surveillance Branch in Lyon, France, and colleagues.

And while heavy drinking patterns contributed most to these alcohol-related cancer cases, "we estimate that light to moderate drinking of the equivalent of around one or two alcoholic drinks per day was accountable for more than 100,000 cases of cancer in 2020," wrote Rumgay and her colleagues in an article in The Lancet Oncology.

Even drinking 10 grams daily contributed 41,300 new cases of cancer in 2020.

As pointed out by the authors, alcohol is causally linked to multiple cancers, including cancers of the oral cavity, pharynx, larynx, esophagus, colon, rectum, liver, and breast – cancers that accounted for 6.3 million cancer cases, and 3.3 million deaths globally in 2020.

In their study, the authors established levels of alcohol intake per person, per country, using 2010 data from the Global Information System on Alcohol and Health (assuming a 10-year latency period between alcohol consumption and cancer development), and combined them with new cancer cases in 2020 to estimate the number of alcohol-associated cancers in each country.

Estimates for alcohol intake were based on data including alcohol production, tax and sales data, surveys, and tourist alcohol consumption. Rumgay and her colleagues then converted alcohol consumption estimates to the amount of alcohol consumed per day.

Rumgay and colleagues calculated that globally, there were an estimated 741,300 cases of new cancers (4.1%) that could be attributed to alcohol consumption in 2020, with males accounting for 76.7% of these cases.

Cancers attributed to alcohol included:

• Esophageal (189,000 cases)
• Liver (154,000)
• Breast (98,300)
• Colon (91,500)
• Rectal (65,100)
• Pharyngeal (39,400)
• Laryngeal (27,600)

 

Skin cancer

My Mom asked if the sore on my forehead ever healed. 'No'. Then get it checked out, probably skin cancer. She should know, she has had 6 cancers removed from her face and neck, growing up as a farm girl. Yes, it was skin cancer, but the safer basil cell type.  And I wear hats/caps all the time, very seldom do I get sunburn on my bald head.

Before

After excision and cauterizing, not much bleeding.

Pretty well healed up

Two more blood pressure medications recalled for ingredient that might cause cancer

Be careful out there. 

Two more blood pressure medications recalled for ingredient that might cause cancer

By David J. Neal
dneal@miamiherald.com

November 28, 2018 06:00 AM

Updated November 28, 2018 02:05 PM

The list of blood pressure drugs recalled because they have NDEA grew by two Tuesday when Teva Pharmaceuticals yanked all lots of Amlodipine/Valsartan and Amlodipine/Valsartan/Hydrochlorothiazide combination tablets.

Both have too much N-nitroso-diethylamine (NDEA) in its Valsartan, the active ingredient made by Mylan India. NDEA has been classified as a probable cancerous ingredient by the International Agency for Research on Cancer.
More NDEA than allowed prompted Mylan’s recall of 15 heart attack and blood pressure medications last week, as well as Sandoz’s recall of Losartan blood pressure meds on Nov. 8 and July’s slew of Valsartan blood pressure drug recalls.

As with previous recalls, the company-written, FDA-posted recall notice advises continuing to take the recalled drugs until the patient and a medical professional agree on another course of action.
“The risk of harm to a patient’s health may be higher if the treatment is stopped immediately without any comparable alternative treatment,” the notice states.

Specific lots in the article. 

Read more here: https://www.miamiherald.com/news/health-care/article222286590.html#storylink=cpy

Read more here: https://www.miamiherald.com/news/health-care/article222286590.html#storylink=cpy

Drug-Delivering Nanoparticles Seek and Destroy Elusive Cancer Stem Cells

Our researchers should be able to find at least one of these 39 proteins to attach and attack with tPA if we had any stroke leadership at all doing ANY TYPE OF THINKING. All they have to do is contact these researchers to find out what those 39 proteins are and talk to the cancer researchers to find out how to deliver drugs via nanoparticles. Damn I hate doing the job of your hospital administration, stroke researcher and neurologist for free, I'm stupid that way being stroke-addled.

Proteomic analysis of differential protein expression in atherosclerosis - 39 proteins identified

Drug-Delivering Nanoparticles Seek and Destroy Elusive Cancer Stem Cells 

Some stroke survivors may have underlying cancer

No clue what you or your doctor can do about this. But did the cancers cause the stroke? Which is cause and which is effect?
http://www.alphagalileo.org/ViewItem.aspx?ItemId=178588&CultureCode=en

04 September 2017 European Society for Medical Oncology (ESMO)

• Under embargo until 06 September 2017 10:00 GMT

Some stroke survivors may have underlying cancer, according to an observational study to be presented at the ESMO 2017 Congress in Madrid. (1)
“Post-mortem studies have suggested that cancer can develop after a stroke, but the magnitude of this association has not been described,” said lead author Dr Jacobo Rogado, medical oncology fellow, Hospital de La Princesa, Madrid, Spain. “We conducted a study that would allow us to establish whether this association actually exists and which factors may predict risk.”
The researchers reviewed the medical records of all 914 patients admitted from the emergency room to the stroke unit of Hospital de La Princesa between January 2012 and December 2014. A total of 381 patients met the inclusion criteria and were followed for 18 months from the diagnosis of stroke. Demographic and clinical data were collected and compared between those who did, and did not, develop cancer. Variables that were significantly associated with cancer in univariate analysis were then subjected to multivariate analysis.
During the 18-month follow-up, 29 (7.6%) of stroke survivors were diagnosed with cancer, most frequently in the colon, lung and prostate. This was higher than the expected incidence of 17 patients (4.5%), based on statistics for the general population.
The average time from stroke onset to cancer diagnosis was six months. Nearly 45% of cancer diagnoses occurred within the first six months after a stroke diagnosis. Almost two-thirds (62%) of cancer patients presented with metastatic or locally advanced disease.
Multivariate analysis revealed that older age (>76 years), previous diagnosis of cancer, high levels of fibrinogen (>450 mg/dl) and low levels of haemoglobin (<13 g/dl), were associated with cancer.
Rogado said: “We found that the incidence of cancer in stroke survivors was almost twice that of the general population. When cancer was diagnosed it was usually at an advanced stage, and the diagnosis was made within six months after a stroke. This indicates that the cancer was already present when the stroke occurred but there were no symptoms.”
“It has been suggested that cancer is a hypercoagulable state in which tumour cells activate the coagulation system,” he added. “This could explain our observation of higher fibrinogen in those who were diagnosed with cancer. It may be that the prothrombotic effect of cancer contributed to the strokes.”
Rogado said: “Stroke survivors should be followed clinically for the development of cancer in the 18 months after the diagnosis of stroke. This applies particularly to older patients who had cancer previously, or who have high fibrinogen or low levels of haemoglobin.”
Commenting on the research for ESMO, Dr Fausto Roila, director of medical oncology, Santa Maria della Misericordia Hospital, Perugia, Italy: "The link between stroke and cancer is an interesting issue that has been previously studied. (2-6) The design of this study has an important limitation, which is the lack of a matched control group; a case-control study would have been more suitable. Moreover, comparing the detected number of incident cases (29) with those observed in a general population (17), the difference is only 12 patients and this could be due to differences in age between the two groups. The general population includes people of all ages, while the case population (patients with stroke) is primarily older patients. Therefore, further studies are needed before a firm association can be established between stroke and cancer.”
Disclaimer
This press release contains information provided by the authors of the highlighted abstracts and reflects the content of those abstracts. It does not necessarily reflect the views or opinions of ESMO who cannot be held responsible for the accuracy of the data. Commentators quoted in the press release are required to comply with the ESMO Declaration of Interests policy and the ESMO Code of Conduct .
http://www.esmo.org/Press-Office/Press-Releases/Some-Stroke-Survivors-May-Have-Underlying-Cancer

• Full bibliographic information1 Abstract 1412P_PR ‘Ischemic stroke as cancer predecessor and associated predictors’ will be presented by Dr Jacobo Rogado during Poster Display Session on Sunday, 10 September, 13:15 to 14:15 (CEST), in Hall 8.
  
  2 Selvik HA, et al. Cancer-associated stroke: The Bergen NORSTROKE Study. Cerebrovasc Dis Extra. 2015;5(3):107–113. doi: 10.1159/000440730.
  
  3 Cocho D, et al. Predictors of occult cancer in acute ischemic stroke patients. J Stroke Cerebrovasc Dis. 2015;24(6):1324–1328. doi: 10.1016/j.jstrokecerebrovasdis.2015.02.006.
  
  4 Dearborn JL, et al. Stroke and cancer- A complicated relationship. J Neurol Transl Neurosci. 2014;2(1):1039.
  
  5 Prandoni P, et al. Cancer and venous thromboembolism. Lancet Oncol. 2005;6(6):401–410.
  
  6 Schwarzbach CJ, et al. Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke. 2012;43(11):3029–3034. doi: 10.1161/STROKEAHA.112.658625.