Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation, with notable benefits in increasing survival and reducing risk of several types of cancer; however expert consensus is that the risks of harm from using these drugs long-term are greater than the benefits for prevention against cancer for many people.

How can non-aspirin NSAIDs help me? What the research says

We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).

Learn more about how we research and rate therapies.

Preclinical evidencetesting a drug, a procedure, or another medical treatment in isolated cells or in animals; preclinical evidence is considered only an initial indication of possible effects in people is summarized in Are you a health professional? ›

COX inhibitors

You’ll see throughout this page mentions of COX-2 inhibitors and selective or non-selective COX inhibitors. 

COX-2 (cyclooxygenase-2) is an enzyme responsible for inflammation and pain. COX-1 is a similar enzyme that also contributes to inflammation and pain, but in addition produces substances that activate platelets and protect the stomach and intestinal lining. COX-1 also helps maintain kidney blood flow and filtration.1Ogbru A. COX-2 Inhibitor Medications. RX List. April 8, 2021. Viewed September 29, 2021. Any drugs that inhibit COX-1 also increase the risk of bleeding or problems with your stomach and kidneys.

COX-2 inhibitors were developed to target inflammation and pain, but with lower risk of bleeding, stomach, and kidney problems. NSAIDs that directly and selectively target COX-2 are classified as COX-2 selective inhibitors. Celecoxib is an example. Non-selective COX inhibitors, such as ibuprofen, inhibit both COX-1 and COX-2.2Dyall-Smith D. Non-steroidal anti-inflammatory drugs and their skin side effects. DermNet NZ. Viewed January 28, 2021.

Treating cancer

Are non-aspirin NSAIDs linked to improved survival? Are they linked to less cancer growth or metastasis? Do they enhance the anticancer action of other treatments or therapies? We present the evidence.

See preclinical evidencetesting a drug, a procedure, or another medical treatment in isolated cells or in animals; preclinical evidence is considered only an initial indication of possible effects in people of synergistic effects with conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies in Are you a health professional? ›

Cancer as a whole

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

Breast cancer

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. among people with postmenopausal breast cancer treated with celecoxib, either alone or when combined with exemestane in 2 studies

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 better survival among people with breast cancer treated with ketorolac around the time of surgery

Colorectal cancer

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

Weak evidence of better survival or of tumor response among people with colorectal cancer treated with celecoxib in addition to chemotherapy

Gastrointestinal cancer

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

Head and neck cancer

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

Kidney cancer

Preliminary evidence of better survival among people with kidney cancer treated with ketorolac around the time of surgery

Lung cancer

Preliminary (conflicting) evidence of better short-term survival—although good evidence of better response to chemotherapy—among people with advanced non-small cell lung cancer treated with celecoxib, but with serious toxicities

No evidence of improved survival among people with advanced non‐small cell lung cancer adding celecoxib to radiotherapy

Preliminary evidence of better survival among people with lung cancer treated with diclofenac around the time of surgery

Ovarian cancer

Modest evidence 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

Weak evidence of a better response to carboplatin among heavily-treated people with recurrent ovarian cancer using celecoxib

Pancreatic cancer

Weak evidence of tumor response with a combination treatment of gemcitabine plus diclofenac, cimetidine, low-dose cyclophosphamide, and sulfasalazine

Sarcoma

Weak evidence of tumor response among people with Desmoid tumors (metronomic treatment) and inflammatory myofibroblastic tumors treated with diclofenac

Optimizing your body terrain

Do non-aspiring NSAIDs promote an environment within your body that is less supportive of cancer development, growth, or spread? We present the evidence.

Blood sugar and insulin resistance

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of lower fasting blood sugar among people with type 2 diabetes treated with usual oral hypoglycemic therapy and ibuprofen

Inflammation

NSAIDS—non-steroidal anti-inflammatory drugs—are widely recognized as having strong anti-inflammatory effects. Small studies provide 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 this effect among people with advanced cancer.

Managing side effects and promoting wellness

Are non-aspirin NSAIDs linked to fewer or less severe side effects or symptoms? Are they linked to less toxicity from cancer treatment? Do they support your quality of life or promote general well-being? We present the evidence.

Side effects as a whole

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

Anxiety

No evidence of an effect on anxiety during chemotherapy among people with stomach cancer treated with celecoxib in a preliminary study

Blood-related symptoms

No evidence of an effect on neutropenia during chemotherapy among people with stomach cancer treated with celecoxib in a preliminary study

Body composition or cachexia

No evidence of an effect on chemotherapy-induced wasting (cachexia) among people with stomach cancer treated with celecoxib in a preliminary study

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 less loss of bone mineral density during exemestane treatment among people with hormone-sensitive breast 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

Changes in appetite

No evidence of an effect on chemotherapy-induced loss of appetite among people with stomach cancer treated with celecoxib in a preliminary study

Preliminary evidence of improved appetite among people with advanced metastatic gastrointestinal cancer treated with ibuprofen

Fatigue

No evidence of an effect on fatigue during chemotherapy among people with stomach cancer treated with celecoxib in a preliminary study

Gastrointestinal symptoms, including nausea and vomiting

No evidence of an effect on chemotherapy-induced vomiting or diarrhea among people with stomach cancer treated with celecoxib in a preliminary study

Neurological symptoms

No evidence of an effect on chemotherapy-induced peripheral neurotoxicity among people with stomach cancer treated with celecoxib in a preliminary study

Oral symptoms

No evidence of an effect on chemotherapy-induced dry mouth among people treated with celecoxib in a preliminary study

Pain

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 chronic cancer pain among people treated with diclofenac

No evidence of an effect on intensity of chronic cancer pain among people treated with ibuprofen, ketorolac tromethamine, naproxen, or sulindac in a large combined review of studies

Preliminary evidence of less pain among people with cancer-related malnutrition treated with indomethacin

Quality of life and physical function

Celecoxib

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

Indomethacin: preliminary evidence of better physical function among people with cancer-related malnutrition

Ibuprofen: preliminary evidence of better quality of life among people with advanced metastatic gastrointestinal cancer

NSAIDS in combination with other complementary therapies: preliminary evidence of less fatigue and better global quality of life among people with advanced gynecological cancer treated with celecoxib, carnitine, and antioxidants

Reducing cancer risk

Are non-aspirin NSAIDs linked to lower risks of developing cancer or of recurrence? We present the evidence.

Breast cancer

Celecoxib: 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 recurrence (disease-free survivalthe time during and after successful treatment of a disease during which there are no signs and symptoms of the disease that was treated; this is the same as recurrence-free survival) among people with postmenopausal hormone receptor-positive breast cancer treated with celecoxib

Ibuprofen: 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

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 risk of recurrence among people using ketorolac at the time of breast cancer surgery

Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of an effect on breast cancer risk among people using non-aspirin NSAIDs

Modest evidence of lower risk of breast cancer with ibuprofen use

Colorectal cancer

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of recurrence among people using celecoxib

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 colorectal cancer among people using NSAIDs as a whole

Preliminary evidence of lower colorectal cancer risk among people using COX-2 inhibitors

Strong evidence of lower risk of adenomas and advanced adenomas among people using celecoxib

Preliminary evidence of substantially lower risk of colon cancer among people using ibuprofen

Modest evidence of fewer adenomas, polyps, and aberrant crypt foci among people with or without familial adenomatous polyposis treated with sulindac

Gastrointestinal cancer

No evidence of a lower risk of cholangiocarcinoma among people using non-aspirin NSAIDs in a very large combined analysis of studies

Lung cancer

Modest evidence of lower risk of lung cancer among people using ibuprofen or selective COX-2 inhibitors such as celecoxib

Melanoma and other skin cancer

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 squamous cell carcinoma and malignant melanoma among people using NSAIDs

Prostate cancer

Preliminary (conflicting) evidence of lower risk of prostate cancer among people using ibuprofen or non-aspirin NSAIDs as a whole

Keep reading about non-aspirin NSAIDs

Author

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewers

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Barry D. Elson, MD

Integrative physician and CancerChoices advisor
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Barry D. Elson, MD, has been practicing and teaching integrative medicine for over 40 years. He has been the medical director of Northampton Wellness Associates, adjunct faculty for Touro University College of Medicine, medical director at Commonweal, and professor of medicine at the Pacific College of Naturopathic Medicine. He recently retired from clinical practice and has been providing freelance medical consulting. He is an avid biker, cross country skier, and sailor. He currently resides in the rolling hills of western Massachusetts.

Barry D. Elson, MD Integrative physician and CancerChoices advisor

Andrew Jackson, ND

Research Associate
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Andrew Jackson, ND, serves as a CancerChoices research associate. As a naturopathic physician practicing in Kirkland, Washington, he teaches critical evaluation of the medical literture at Bastyr University in Kenmore, Washington. His great appreciation of scientific inquiry and the scientific process has led him to view research with a critical eye.

Andrew Jackson, ND Research Associate

Last update: May 17, 2022

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

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