Single Institution Assessment of Compliance with Guideline Directed Aspirin Therapy in the Prevention of Colorectal Cancer in Lynch Syndrome

Background : Patients with Lynch syndrome (LS) have been shown to have up to an 80% lifetime risk of developing colorectal cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommend LS patients consider taking aspirin daily to reduce their risk of colorectal cancer, which is primarily based on the Cancer Prevention Project 2 (CAPP-2) study results. In this study, we evaluated the compliance of guideline directed aspirin therapy among LS patients at Geisinger Inherited Risk Gastrointestinal clinic (IRGI). Methods: Medical records of 177 patients were retrospectively reviewed from May 2016 to December 2022. After excluding those with missing data or lost to follow-up, our study cohort consisted of 167 patients. Demographics, affected genes, clinical history, and ASA use were collected. Chi-square test and unpaired T-test were used to evaluate the association between various parameters and aspirin use. Results: With a median annual follow up of 36 months and adjustment for patients with relative and absolute contraindications to ASA, 58.5% (83/142) of patients were compliant with ASA therapy. Nearly half 49.4% (41/83) of ASA users took 81 mg daily, 1.2% (1/83) took 250 mg daily, 42.2% (35/83) took 325 mg daily and only 7.2% (6/83) reported taking >600 mg daily. The difference of age on those taking ASA and those not taking ASA was found to be statistically significant (p-value = 0.025.) Conclusions: The adherence to guideline directed therapy likely stems from provider and patient education in addition to improved patient navigation strategies.