Association between perioperative beta blocker use and cancer survival following surgical resection

Musselman, Reilly; Bennett, Sean; Li, Wenbin; Mamdani, Muhammad; Gomes, Tara; Walraven, Carl van; Boushey, Robin P.; Al‐Obeed, Omar; Al‐Omran, Mohammed; Auer, Rebecca C.

doi:10.1016/j.ejso.2018.05.012

Cited by 34 publications

(30 citation statements)

References 31 publications

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“…A total of 842 potentially eligible studies were retrieved from the selected databases during the initial search. After removing duplicates and further screening the titles and abstracts, 26 studies on breast cancer risk ( Meier et al, 2000 ; Li et al, 2003 ; Gonzalez-Perez et al, 2004 ; Fryzek et al, 2006 ; Largent et al, 2006 ; Davis and Mirick, 2007 ; Van Der Knaap et al, 2008 ; Coogan et al, 2009 ; Largent et al, 2010 ; Huang et al, 2011 ; Hallas et al, 2012 ; Lee et al, 2012 ; Mackenzie et al, 2012 ; Biggar et al, 2013 ; Li et al, 2013 ; Saltzman et al, 2013 ; Devore et al, 2015 ; Numbere et al, 2015 ; Azoulay et al, 2016 ; Chang et al, 2016 ; Gomez-Acebo et al, 2016 ; Wilson et al, 2016 ; Brasky et al, 2017 ; Raebel et al, 2017 ; Busby et al, 2018b ; Zheng et al, 2021 ), and 30 studies on breast cancer prognosis ( Powe et al, 2010 ; Barron et al, 2011 ; Ganz et al, 2011 ; Melhem-Bertrandt et al, 2011 ; Shah et al, 2011 ; Şendur et al, 2012 ; Holmes et al, 2013a ; Holmes et al, 2013b ; Botteri et al, 2013 ; Cardwell et al, 2013 ; Chae et al, 2013 ; Sorensen et al, 2013 ; Boudreau et al, 2014 ; Cardwell et al, 2014 ; Sakellakis et al, 2014 ; Babacan et al, 2015 ; Chen et al, 2015 ; Springate et al, 2015 ; Cardwell et al, 2016 ; Choy et al, 2016 ; Chen et al, 2017 ; Spera et al, 2017 ; Busby et al, 2018a ; Musselman et al, 2018 ; Cui et al, 2019 ; Takada et al, 2019 ; Modi et al, 2...…”

Section: Resultsmentioning

confidence: 99%

Association Between Antihypertensive Medication Use and Breast Cancer: A Systematic Review and Meta-Analysis

Xie

Men

et al. 2021

Front. Pharmacol.

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Background: The prevalence rate of hypertension and breast cancer increases with advancing age. Renin-angiotensin system inhibitors (RASIs), β-blockers (BBs), calcium channel blockers (CCBs), and diuretics are widely used to treat patients with hypertension. Although, the association between the use of antihypertensive medication and breast cancer has been highly debated, recent evidence supporting this association remains controversial.Objective: To evaluate the association between the use of antihypertensive medication and the risk of breast cancer and its prognosis.Methods: This study was conducted using data from the PubMed, Embase, and Cochrane Library databases retrieved for the period from January 2000 to April 2021. Articles and their references were checked and summary effects were calculated using random- and fixed-effects models. Heterogeneity test and sensitivity analysis were also performed.Results: This meta-analysis included 57 articles, which were all related to breast cancer risk or prognosis. Assessment of breast cancer risk using the pooled data showed that the use of BBs or CCBs or diuretics was associated with increased cancer risk [BB: relative risk (RR) = 1.20, 95% confidence interval (CI) = 1.09–1.32; CCBs: RR = 1.06, 95% CI 1.03–1.08; diuretics: RR = 1.06, 95% CI 1.01–1.11]. Long-term use of diuretic increased the risk of breast cancer (RR = 1.10, 95% CI 1.01–1.20), whereas long-term RASIs treatment reduced the risk (RR = 0.78, 95% CI 0.68–0.91). In addition, we found that diuretic users may be related to elevated breast cancer-specific mortality [hazard ratio (HR) = 1.18, 95% CI 1.04–1.33], whereas using other antihypertensive medications was not associated with this prognosis in patients with breast cancer.Conclusion: Using CCBs, BBs, and diuretics increased the risk of breast cancer. In addition, diuretics may elevate the risk of breast cancer-specific mortality. The long-term use of RASIs was associated with a significantly lower breast cancer risk, compared with non-users. Thus, this analysis provides evidence to support the benefits of the routine use of RASIs in patients with hypertension, which has important public health implications.

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Section: Resultsmentioning

confidence: 99%

Association Between Antihypertensive Medication Use and Breast Cancer: A Systematic Review and Meta-Analysis

Xie

Men

et al. 2021

Front. Pharmacol.

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“…Indeed, results of early clinical studies showed that use of BB seemed to be associated with reduced incidence of hepatocellular carcinoma [8] and improved disease-specific survival in patients with prostate cancer [9]. However, studies evaluating the association between BB use and clinical outcomes in women with breast cancer showed inconsistent results [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], suggesting that the benefits of BB on cancer survival may be cancer-specific. Some of the previous studies supported that BB use is associated with reduced recurrence or deaths in women with breast cancer [10,11,13,15,17], while others did not [12,14,16,[18][19][20][21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

β-Blocker use is not associated with improved clinical outcomes in women with breast cancer: a meta-analysis

Tian

Tang

et al. 2020

Bioscience Reports

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Background: Evidence remains inconsistent regarding the potential influence of β-blocker (BB) use on clinical outcomes in women with breast cancer. We aimed to evaluate the association between BB and prognosis of breast cancer in an updated meta-analysis. Methods: Follow-up studies comparing the clinical outcomes of breast cancer in women with and without use of BB were included by search of PubMed, Embase, and Cochrane’s Library. A random-effect model was used to pool the results. Results: Seventeen observational studies were included. Pooled results did not support a significant association between BB use and breast cancer recurrence (risk ratio [RR] = 0.85, 95% confidence interval [CI]: 0.68–1.07, P=0.17), breast cancer related deaths (RR = 0.83, 95% CI: 0.65–1.06, P=0.14), or all-cause deaths (RR = 1.01, 95% CI: 0.91–1.11, P=0.91) in women with breast cancer. Study characteristics such as sample size, definition of BB use, follow-up durations, adjustment of menopausal status, or quality score did not significantly affect the results. Subgroup analyses showed that BB may be associated with a trend of reduced risk of all-cause deaths in women with breast cancer in prospective studies (two datasets, RR = 0.81, P=0.05), but not in retrospective studies (eight datasets, RR = 1.06, P=0.16; P for subgroup analyses = 0.02). Conclusions: Current evidence from observational studies does not support a significant association between BB use and improved prognosis in women with breast cancer.

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“…Because lung cancer comprises a heterogeneous disease, and the effects of catecholamines may differ in different lung cancer cells, failure to discriminate lung cancer by histologic subtype may mask the effects of b-adrenoreceptor inhibitors (6). This could partly explain our overall findings as well as the near-null associations observed in previous population-based cohort studies that did not discriminate lung cancer by histology (17,(25)(26)(27)(28) and previous conflicting results among patients with NSCLC (12)(13)(14). Except a hospital-based study in patients with stages I-III NSCLC treated with definitive radiotherapy (13), the other studies (12,14) have not provided evidence of a survival benefit in patients with NSCLC on b-blockers.…”

Section: Discussionmentioning

confidence: 56%

Beta-Blocker Use and Lung Cancer Mortality in a Nationwide Cohort Study of Patients with Primary Non–Small Cell Lung Cancer

Udumyan

Montgomery

Fang

et al. 2020

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: b-Adrenergic receptor blockers have been associated with improved survival among patients with different types of malignancies, but available data for patients with nonsmall cell lung cancer (NSCLC) are contradictory and limited to small hospital-based studies. We therefore aimed to investigate whether b-blocker use at the time of cancer diagnosis is associated with lung cancer mortality in the largest general population-based cohort of patients with NSCLC to date.Methods: For this retrospectively defined nationwide cohort study, we used prospectively collected data from Swedish population and health registers. Through the Swedish Cancer Register, we identified 18,429 patients diagnosed with a primary NSCLC between 2006 and 2014 with follow-up to 2015. Cox regression was used to estimate the association between b-blocker use at time of cancer diagnosis ascertained from the Prescribed Drug Register and cancer-specific mortality identified from the Cause of Death Register.Results: Over a median follow-up of 10.2 months, 14,994 patients died (including 13,398 from lung cancer). Compared with nonuse, b-blocker use (predominantly prevalent use, 93%) was not associated with lung cancer mortality [HR (95% confidence interval): 1.01 (0.97-1.06)]. However, the possibility that diverging associations for specific b-blockers and some histopathologic subtypes exist cannot be excluded.Conclusions: In this nationwide cohort of patients with NSCLC, b-blocker use was not associated with lung cancer mortality when assessed in aggregate in the total cohort, but evidence for some b-blockers is less conclusive.Impact: Our results do not indicate that b-blocker use at lung cancer diagnosis reduces the cancer-specific mortality rate in patients with NSCLC.

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Association between perioperative beta blocker use and cancer survival following surgical resection

Cited by 34 publications

References 31 publications

Association Between Antihypertensive Medication Use and Breast Cancer: A Systematic Review and Meta-Analysis

Association Between Antihypertensive Medication Use and Breast Cancer: A Systematic Review and Meta-Analysis

β-Blocker use is not associated with improved clinical outcomes in women with breast cancer: a meta-analysis

Beta-Blocker Use and Lung Cancer Mortality in a Nationwide Cohort Study of Patients with Primary Non–Small Cell Lung Cancer

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