Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)

Modest evidence of benefit

• Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower cancer-specific mortalitydeath, or the death rate in a population; cancer studies often report all-cause mortality (death from any cause) and cancer-specific mortality (death due to the cancer under investigation) among people with epithelial ovarian cancer or serous ovarian cancer using non-aspirin NSAIDs after diagnosis
• Modest evidence of better survival among people with colorectal cancer with KRAS wild-type tumors, but not among those with KRAS-mutant tumors, treated with any NSAID
• Modest evidence of better survival among people with breast cancer treated with ketorolac around the time of surgery

Preliminary evidence of benefit

• Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better survival among people with cancer-related malnutrition treated with indomethacin
• Preliminary evidence of better survival among people with positive COX-2 expression and metastatic or postoperative recurrent stomach cancer treated with celecoxib in addition to chemotherapy
• Preliminary evidence of smaller tumor volume after diagnosis among people with head and neck cancer with PIK3CA gene mutations or amplification treated with sulindac or celecoxib
• Preliminary evidence of better survival among people with kidney cancer treated with ketorolac around the time of surgery
• Preliminary (conflicting) evidence of better short-term survival—although good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of better response to chemotherapy—among people with advanced non-small cell lung cancer treated with celecoxib, but with serious toxicities
• Preliminary evidence of better survival among people with lung cancer treated with diclofenac around the time of surgery

No evidence of benefit

• No evidence of a effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on treatment among people with postmenopausal breast cancer treated with celecoxib, either alone or when combined with exemestane in 2 studies
• No evidence of improved survival among people with advanced non‐small cell lung cancer adding celecoxib to radiotherapy

See How can non-aspirin NSAIDs help you? What the research says ›

What is your body terrain? ›

• Widely recognized as having strong anti-inflammatory effects
• Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of less inflammation among people with advanced cancer treated with NSAIDs

See How can non-aspirin NSAIDs help you? What the research says ›

Good evidence of benefit

• Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of less persistent cancer pain among people treated with diclofenac

Preliminary evidence of benefit

• Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better body weight among people with several types of cancer, including advanced cancer, treated with celecoxib
• Preliminary evidence of weight gain among people with advanced metastatic gastrointestinal cancer treated with ibuprofen
• Preliminary evidence of better resting energy expenditure and weight gain among people with cancer treated with indomethacin
• Preliminary evidence of less loss of bone mineral density during exemestane treatment among people with hormone-sensitive breast cancer treated with celecoxib
• Preliminary evidence of improved appetite among people with advanced metastatic gastrointestinal cancer treated with ibuprofen
• Preliminary evidence of less pain among people with cancer-related malnutrition treated with indomethacin, but see evidence of worse persistent cancer pain in Safety and precautions ›
• Preliminary evidence of better quality of life among people with stomach cancer treated with celecoxib
• Preliminary evidence of better strength among people with lung cancer treated with celecoxib
• Preliminary evidence of better function during exemestane treatment among women with breast cancer treated with celecoxib

No evidence of effect

• No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on the toxicity of exemestane among postmenopausal women with advanced hormone-sensitive breast cancer treated with celecoxib in a preliminary trial
• No evidence of an effect on anxiety, neutropenia, wasting (cachexia), appetite, fatigue, vomiting, diarrhea, dry mouth, or peripheral neurotoxicity during chemotherapy among people with stomach cancer treated with celecoxib in a preliminary study
• No evidence of an effect on intensity of persistent cancer pain among people treated with ibuprofen, ketorolac, tromethamine, naproxen, or sulindac in a large combined review of studies

See How can non-aspirin NSAIDs help you? What the research says ›

Evidence of benefit

• Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of colorectal cancer among people using NSAIDs as a whole
• Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of adenomas and advanced adenomas among people using celecoxib
• Good evidence of lower risk of squamous cell carcinoma and malignant melanoma among people using NSAIDs
• Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of fewer adenomas, polyps, and aberrant crypt foci among people with or without familial adenomatous polyposis treated with sulindac
• Modest evidence of lower risk of recurrence among people using ketorolac at the time of breast cancer surgery
• Modest evidence of lower risk of breast cancer with ibuprofen use; see also higher risk of some types of breast cancer among people using ibuprofen in Safety and precautions ›
• Modest evidence of lower risk of lung cancer among people using ibuprofen or selective COX-2 inhibitors such as celecoxib
• Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of breast cancer recurrence among people currently using ibuprofen at least 3 days per week
• Preliminary evidence of lower colorectal cancer risk among people using COX-2 inhibitors
• Preliminary evidence of substantially lower risk of colon cancer among people using ibuprofen
• Preliminary (conflicting) evidence of lower risk of prostate cancer among people using ibuprofen or non-aspirin NSAIDs as a whole

No evidence of benefit

• No evidenceoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. of a lower risk of bile duct cancer (cholangiocarcinoma) among people using non-aspirin NSAIDs in a very large combined analysis of studies

See How can non-aspirin NSAIDs help you? What the research says ›

• A few of our preferred programs and protocols use COX-2 inhibitors during cancer treatment.
• The US Preventive Services Task Force is against general use of non-aspirin NSAIDs for prevention due to the risk of serious cardiovascular and gastrointestinal side effects.

See How do experts use non-aspirin NSAIDs? ›

• Supervision by a medical professional is essential. Several serious side effects are documented.
• Extreme caution is needed with use by people with high blood pressure or risk factors for gastrointestinal bleeding, or those using warfarin (Coumadin) or fluconazole (Diflucan).
• Ibuprofen (Advil, Motrin and other brands), naproxen (Aleve and other brands), diclofenac, celecoxib (Celebrex) and other NSAIDs increase the risk of heart attack or stroke, even after just a few weeks of use, and even among people without risk factors.
• Many researchers and the US Preventive Services Task Force have concluded that risks of serious cardiovascular events outweigh the cancer-preventive benefits of long-term use.

See Safety and precautions ›

• Most require a prescription in the US, except for low-dose versions of ibuprofen (Advil, Motrin) and naproxen (Aleve and other brands) which are available in most drug stores
• Prices are generally low to moderate (between $500 US and $2000 US/year), and costs for prescription drugs may be covered by insurance.

See Affordability and access ›