Use of antidepressants and NSAIDs in relation to mortality in long-term breast cancer survivors.
OBJECTIVE
The aim of this study was to assess the post-diagnosis use of antidepressants and non-steroidal anti-inflammatory drugs (NSAIDs) in relation to all-cause, breast cancer, and cardiovascular disease (CVD) mortality among long-term breast cancer survivors.


METHODS
A cohort of 3058 breast cancer survivors, who previously participated in a series of case-control studies diagnosed between 1988 and 1999 in Wisconsin. Cancer survivors completed a self-administered mailed follow-up questionnaire in 1998-2001 that addressed use of medications post-diagnosis, including antidepressants and NSAIDs. Vital status information was obtained through the National Death Index through 31 December 2006. We used multivariable Cox proportional hazards modeling to estimate hazard ratios and 95% confidence intervals (CI).


RESULTS
We identified 463 deaths due to all-causes, 163 due to breast cancer, and 93 due to CVD during follow-up. Among women who had used any antidepressant after a breast cancer diagnosis, there was an increased risk of all-cause (adjusted HR=1.50, 95%CI: 1.12-2.02) and CVD mortality (HR=2.42, 95%CI: 1.21-4.83), but not breast cancer mortality (HR=0.93, 95%CI: 0.55-1.56). The use of NSAIDs after diagnosis was not associated with all-cause (HR=0.87, 95%CI: 0.69-1.18), breast cancer mortality (HR=0.69, 95%CI: 0.44-1.10), or CVD (HR=0.97, 95%CI: 0.57-1.65).


CONCLUSIONS
The use of antidepressants or NSAIDS was not related to breast cancer mortality in long-term breast cancer survivors. In these women, however, antidepressants may increase the risk of all-cause mortality.
Program in Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98101, USA. wernli.k@ghc.org
Karen J
KJ
Wernli
John M
JM
Hampton
Amy
A
Trentham-Dietz
Polly A
PA
Newcomb
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000928:Antidepressive Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014922:Wisconsin / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents
Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1403-9
19366908
Cancer. 2002 May 15;94(10):2719-27
12173342
Eur J Pain. 2009 May;13(5):478-85
18635381
Breast Cancer Res Treat. 2007 Jan;101(2):191-7
16823508
Cancer Epidemiol Biomarkers Prev. 2008 Feb;17(2):379-86
18250341
Arch Intern Med. 2009 Dec 14;169(22):2128-39
20008698
Cancer. 2009 Nov 15;115(22):5349-61
19753617
Carcinogenesis. 2009 Aug;30(8):1298-304
19443905
Arch Intern Med. 2008 Nov 10;168(20):2232-7
19001200
J Am Coll Cardiol. 2009 Mar 17;53(11):950-8
19281925
Toxicol Rev. 2005;24(3):205-14
16390222
Arch Intern Med. 2004 Feb 9;164(3):289-98
14769624
Breast Cancer Res Treat. 2008 Nov;112(1):123-32
18058227
J Psychopharmacol. 1997;11(4):345-8
9443523
Expert Opin Drug Saf. 2008 Mar;7(2):181-94
18324881
J Am Geriatr Soc. 2004 Jan;52(1):106-11
14687323
JAMA. 2002 Jan 16;287(3):337-44
11790213
J Clin Oncol. 2010 Mar 20;28(9):1467-72
20159825
Br J Psychiatry. 1996 Nov;169(5):647-54
8932897
Psychosomatics. 2003 Jan-Feb;44(1):24-30
12515834
Recent Results Cancer Res. 2009;181:223-9
19213572
Cancer. 1990 May 1;65(9):2028-32
2372769
Lancet Oncol. 2001 Apr;2(4):199-204
11905764
Breast. 2007 Dec;16 Suppl 2:S27-33
17764938
Cancer Causes Control. 2007 Aug;18(6):613-20
17404892
Lancet Oncol. 2009 May;10(5):501-7
19410194
Breast J. 2007 Sep-Oct;13(5):490-5
17760671
Cancer Causes Control. 2009 Sep;20(7):1083-90
19330531
Am J Obstet Gynecol. 1991 Jan;164(1 Pt 1):147-52
1986602
Cancer Res. 2004 Sep 15;64(18):6814-9
15375001
Qual Life Res. 2007 Aug;16(6):947-60
17457697
Arch Intern Med. 2007 Mar 26;167(6):562-72
17389287
Oncol Nurs Forum. 2008 Jan;35(1):57-63
18192153
Heart. 2009 Dec;95(23):1901-6
19666461