Tariq I, Iftikhar QUA, Nashwan AJ. Proton pump inhibitors and mortality in patients with cancer: Unraveling the complex link. World J Clin Oncol 2025; 16(7): 107509 [DOI: 10.5306/wjco.v16.i7.107509]
Corresponding Author of This Article
Abdulqadir J Nashwan, PhD, Department of Nursing, Hamad Medical Corporation, P.O. Box 3050, Doha 3050, Qatar. anashwan@hamad.qa
Research Domain of This Article
Oncology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Jul 24, 2025; 16(7): 107509 Published online Jul 24, 2025. doi: 10.5306/wjco.v16.i7.107509
Proton pump inhibitors and mortality in patients with cancer: Unraveling the complex link
Ibtehaj Tariq, Qurat Ul Ain Iftikhar, Abdulqadir J Nashwan
Ibtehaj Tariq, Department of Hepatobiliary and Liver and Kidney Transplant, Bahria International Hospital Orchard, Lahore 54780, Punjab, Pakistan
Qurat Ul Ain Iftikhar, Department of Medicine, Islamic International Medical College, Rawalpindi 44000, Pakistan
Abdulqadir J Nashwan, Department of Nursing, Hamad Medical Corporation, Doha 3050, Qatar
Co-first authors: Ibtehaj Tariq and Qurat Ul Ain Iftikhar.
Author contributions: Iftikhar QUA wrote the original draft; Tariq I contributed to conceptualization, writing, reviewing, and editing; Nashwan AJ critically reviewed the manuscript; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdulqadir J Nashwan, PhD, Department of Nursing, Hamad Medical Corporation, P.O. Box 3050, Doha 3050, Qatar. anashwan@hamad.qa
Received: March 25, 2025 Revised: April 18, 2025 Accepted: June 5, 2025 Published online: July 24, 2025 Processing time: 119 Days and 15.9 Hours
Abstract
Proton pump inhibitors (PPIs) are widely utilized in oncology to treat gastroesophageal reflux disease, peptic ulcer disease, and chemotherapy-induced mucosal injury. Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer. The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors. This letter raised important methodological concerns, including confounding by indication, reverse causality, and polypharmacy that can influence the observed association. While PPIs are important in oncology, their advantages and disadvantages should be weighed judiciously by clinicians. Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.
Core Tip: The original study by Krishnan et al proposed a link between proton pump inhibitor use and increased all-cause mortality. Our critique highlighted methodological limitations, including residual confounding, indication bias, and a lack of causality assessment. We drew attention to the need for cautious interpretation and advocated for well-designed prospective studies before drawing definitive clinical conclusions.
