One in five GPs unwilling to prescribe aspirin to Lynch syndrome patients

One in five GPs unwilling to prescribe aspirin to Lynch syndrome patients
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New data finds that one in five GPs could be unwilling to prescribe aspirin to patients with Lynch syndrome, a cancer-causing condition.

A study carried out by the University of Leeds and funded by Cancer Research UK looked at types of information that would influence GPs to prescribe aspirin for patients with Lynch syndrome, an inherited condition that increases the risk of developing several cancers including bowel cancer.

Lynch syndrome is a rare condition that can run in families. People affected by Lynch syndrome have a higher risk of developing some cancers, including bowel, womb, and stomach cancers. People born with Lynch syndrome have a gene mutation, and over the individual’s lifetime, more mutations build up.

Aspirin for bowel cancer prevention

In the study, 672 GPs in England and Wales read scenarios where a patient with Lynch syndrome had been advised to take aspirin for bowel cancer prevention by a clinical geneticist – a specialist who manages patients and families with or at risk of a genetic condition.

The GPs then filled in a survey indicating if they were willing to prescribe aspirin based on the scenario, with one in five respondents saying they are unwilling. Those GPs were concerned about the side effects of long-term aspirin use and the fact that the use of the drug is not listed on labels by aspirin manufacturers.

Previous research from the CAPP2 study revealed that people with Lynch syndrome could reduce their risk of developing bowel cancer by taking aspirin daily for at least two years.  The National Institute for Health and Care Excellence (NICE) included the findings in clinical guidance for preventing bowel cancer in a Lynch syndrome population.

Lynch syndrome and aspirin use

The changes in guidance do not change the fact that patients still face barriers when seeking an aspirin prescription from their GP. Less than half of the GPs in the study were aware of this use of aspirin before partaking in the study, and over 17% of the GPs were aware of the NICE guidance.

Kelly Lloyd, Postgraduate Researcher at the Leeds Institute of Health Sciences, and lead author said: “We want all GPs to have effective conversations with their patients who have Lynch syndrome about the benefits and harms of taking aspirin.

“Nearly one in four GPs don’t feel fully equipped to have conversations with their patients about aspirin, which is why we want to see more training made available to ensure all GPs are aware of the guidance and can help their patients benefit from it.”

The GPs were provided with different information about aspirin prescription for bowel cancer prevention in Lynch syndrome, covering NICE guidance, previous research and comparisons of aspirin’s benefits and harms. The results showed that GPs’ decisions to prescribe were not changed by the distinct types of information they received.

Nine in ten of the unwilling GPs were concerned about the harms of aspirin, as it can cause ulcers in the stomach or gut if taken for a long time and in large doses. Furthermore, four in five were concerned about prescribing ‘off-label’, as manufacturers have not yet registered this use of aspirin.  This is because licensing medication for further use is a long and expensive process.

Intervention is needed to support GPs

The research team is calling for targeted interventions, such as formal training, educational events, and features in GP magazines, to ensure and encourage GPs to follow the NICE guidance.

Lloyd said: “Our findings suggest one approach to supporting GPs’ discussions with patients on the benefits and harms of aspirin for preventive therapy is increasing awareness on using aspirin for this purpose through formal training, educational events, and GP magazines.

“Ultimately, we want to make sure everyone with Lynch syndrome has equal access to aspirin as a preventative treatment. We hope that these findings can help to effectively implement the NICE guidance recommending aspirin into routine clinical practice.”


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