General practitioner attitudes towards prescribing aspirin to carriers of Lynch Syndrome: findings from a national survey


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Samuel Smith1,Robbie Foy2,Jennifer McGowan3,Lindsay Kobayashi3,John Burn4,Karen Brown5,Lucy Side3,Jack Cuzick1
1Queen Mary University of London,2University of Leeds,3University College London,4Newcastle University,5University of Leicester

Abstract

Background

The CaPP2 trial provided evidence for the effectiveness of aspirin (600mg) for cancer prevention among Lynch Syndrome carriers. A dose non-inferiority study comparing 100mg, 300mg and 600mg of aspirin is currently underway (CaPP3 trial). To encourage rapid implementation of the CaPP3 findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers.

Method

We conducted an online survey of UK GPs in 2016 (N=1007). Using a within-subjects design, GPs read a statement on the harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100mg, 300mg, 600mg). Doses were presented randomly to prevent order effects. Additional data collected included awareness of Lynch Syndrome (and its associated names) and the preventive effects of aspirin among carriers, and comfort discussing harms and benefits of aspirin.

Results

Almost one third (29.2%) of GPs had not heard of Lynch Syndrome, and 62.0% of GPs were unaware of the preventive effects of aspirin among carriers of the syndrome. GPs were most willing to prescribe at the lowest dose (100mg, 91.3%), and there was a significant graded decline for prescribing at 300mg (81.8%) and 600mg (62.3%) (p<0.001 for trend). In multivariable analyses adjusted for country, practice partnership, gender, and special interests, willingness to prescribe aspirin (600mg) was higher among GPs older than 50 years (OR=1.46 [95% CI, 1.03-2.07], p=0.033), and those with more than 10 years’ experience (OR=1.50 [95% CI, 1.10-2.04], p=0.010). Two-thirds (68.1%) of GPs indicated they would be comfortable discussing the harms and benefits of aspirin with a Lynch Syndrome patient.

Conclusion

There is low awareness among GPs of Lynch Syndrome and the preventive effects of aspirin among carriers. To ensure the optimal dose identified in the CaPP3 trial is readily available to patients, strategies to educate GPs and establish prescribing pathways should be developed.