Why is it important to reduce inflammation?
If you are a frequent reader of our IOE blog you already know how important it is to keep inflammation in your body down as much as possible after a cancer diagnosis. In particular it is the longstanding, chronic inflammation that leads to many problems:
- increased cancer growth rates
- increased cancer spread (metastases)
- increased resistance to cancer treatments
- increased cancer recurrence rates
- increased rates of dying from cancer
- decreased quality of life
- increased pain and fatigue
- decreased appetite and increased muscle loss (cachexia)
- increased risk of complications from cardiovascular disease, diabetes, immune suppression
Dr. Lawenda’s top recommendations for reducing inflammation?
If you want to reduce chronic inflammation (and make your body less conducive to cancer growth), here are my top recommendations:
- consume an anti-inflammatory diet
- do 30-minutes of moderate intensity exercise each day
- do 30-minutes of daily stress reduction
- reduce your exposure to toxins
- get 7-9 hours of nightly sleep
Potential benefits of NSAIDs in cancer patients:
If you have no contraindications to taking an NSAID or non-steroidal anti-inflammatory medication (i.e. aspirin, ibuprofen, naproxen, indomethacin), I may recommend these for a variety of reasons:
- decreased pain, synergistic action with narcotic pain medications
- decreased muscle loss (cachexia)
- improved quality of life
- improved cancer survival rates for various cancers
Taking a daily baby aspirin (an NSAID) has also shown increased survival in various cancers, but this may be limited to tumors that are particularly responsive to anti-inflammatory medications. (i.e. overexpress cyclooxygenase 2, PIK3CA gene mutation, etc.). For example, in one study, patients with colon cancer who continued to take aspirin after their cancer diagnosis had a 61% lower risk of dying from their colon cancer if their tumors overproduced a protein (cyclooxygenase 2) commonly involved in the inflammatory process. Based on numerous studies, taking one baby aspirin per day may be all that is needed.
Taking an old school (generic and cheap) anti-inflammatory medication called indomethacin (an NSAID) was reported to double survival times in undernourished patients with a variety of advanced metastatic cancers!! Survival increased from 250 days (if they received a placebo) to 510 days (if they received indomethacin, 50 mg twice daily) Indomethacin also reduced pain, use of pain medications and improved overall performance status compared with placebo. Considering most of these patients had failed standard anti-cancer treatments, I am very impressed on how much benefit the patients received with minimal side effects and cost. Why was this study never conducted again to confirm these incredible results? These days, we consider a drug a blockbuster success when it offers survival benefits of 2+ months…and the drug companies charge $100K for that course of treatment.
Might plant-based anti-inflammatory supplements have a similar effect as NSAIDs (i.e. curcumin, ginger, boswellin, etc.)? It is quite possible, but unfortunately we don’t have high quality studies to inform us. By the way, aspirin is plant-based. I’m a big curcumin fan, and I recommend this to many patients for its anti-inflammatory, anti-oxidant and anti-cancer effects. Read my post on curcumin.
See contraindications to taking NSAIDs here.
NSAIDs increase the risk of bleeding complications and cardiovascular events. They also may reduce the effectiveness of other medications that are metabolized by same liver enzymes. Furthermore, they can also pose a risk of causing injury to the kidneys in some patients. Statistically, the risks of these complications are small. Regardless, it is essential that you discuss your use of these medications (including any natural supplements) with your treating physicians before taking them.
**Do not take more than one NSAID at a time (i.e. aspirin + indomethacin, ibuprofen + naproxen, or any other combinations) or you may increase the risk of complications and side effects.**
The Bottom Line:
To be fair and balanced, it is important to know that not all studies show a survival benefit when cancer patients are started on an NSAID medication (i.e. celecoxib for prostate cancer). Clearly more studies are needed to better clarify which patients will benefit from these relatively non-toxic, inexpensive therapies and who will not. In the future we will know a lot more as numerous clinical studies are ongoing (search for “NSAIDs” and “Cancer” or the drug name and “Cancer”).
What should we do until we have these research answers? First and foremost, follow my anti-inflammatory lifestyle recommendations (mentioned above). Then, in the absence of contraindications to taking NSAIDs (or any natural, plant-based anti-inflammatory supplements or foods) it is quite reasonable to consider adding these compounds to your daily routine (many of my patients take a daily baby aspirin)…especially for cancer patients with advanced disease. Consider an integrative oncology consultation before taking any new supplement or to review whether specific anti-cancer therapies make sense for you.