The impact of perioperative β blocker use on patient outcomes after primary cytoreductive surgery in high-grade epithelial ovarian carcinoma

Al-Niaimi, Ahmed; Dickson, Elizabeth; Albertin, C.; Karnowski, Jennifer; Niemi, Cassandra; Spencer, Ryan; Shahzad, Mian M.K.; Uppal, Shitanshu; Saha, Sandeep; Rice, Laurel W.; Nally, Amy Mc

doi:10.1016/j.ygyno.2016.09.019

Cited by 22 publications

(26 citation statements)

References 16 publications

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“…29,37 Nine studies evaluated non-selective beta-blocker use at cancer diagnosis 24,30,31,37e39,41,42,44 and 10 studies evaluated perioperative beta-blocker use in patients undergoing surgery. 19,21,22,24,26,32,33,36,41,45 Beta-blocker use in any setting (epidemiological or perioperative)…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies

Yap

López-Olivo

Dubowitz

et al. 2018

British Journal of Anaesthesia

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Ten studies, 19,24,25,31,33,35,36,40,41,45 all retrospective in nature, investigated the association between 'any' vs 'no' beta-blocker use and DFS (Fig. 3).…”

Section: Disease-free Survivalmentioning

confidence: 99%

Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies

Yap

López-Olivo

Dubowitz

et al. 2018

British Journal of Anaesthesia

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“…However encouraging the results from experimental studies may be, the role of beta-blockers in cancer patients remains unclear and the results from mostly retrospective observational studies are equivocal. There are studies suggesting the use of beta-blockers may be able to prolong survival of cancer patients [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. On the other hand, there are also studies that do not support such a hypothesis [50][51][52][53][54][55][56][57][58][59][60].…”

Section: Discussionmentioning

confidence: 99%

Incidental Use of Beta-Blockers Is Associated with Outcome of Metastatic Colorectal Cancer Patients Treated with Bevacizumab-Based Therapy: A Single-Institution Retrospective Analysis of 514 Patients

Fiala

Ostasov

Šorejs

et al. 2019

Cancers

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Background: Beta-adrenergic signalling plays an important role in several cancer-related processes, including angiogenesis. The impact of beta-blocker use on prognosis of cancer patients treated with antiangiogenic agents is unclear. The aim of this study was to evaluate the association between the incidental use of beta-blockers and the outcomes of patients with metastatic colorectal cancer (mCRC) treated with bevacizumab-based therapy. Methods: Clinical data from 514 mCRC patients treated with bevacizumab between 2005 and 2019 were analysed retrospectively. The association of progression-free survival (PFS) and overall survival (OS) with the incidental use of beta-blockers and other common antihypertensive drugs was assessed. Results: The median PFS and OS for patients using beta-blockers was 11.40 (95% confidence interval (CI) 10.10–13.61) months and 26.8 (95% CI 22.2–32.2) months compared with 8.30 (95% CI 7.80–9.57) and 21.0 (95% CI 17.8–23.8) months for patients not using beta-blockers (p = 0.006 and p = 0.009, respectively). In the Cox multivariate analysis, the use of beta-blockers was a significant factor predicting both PFS (hazard ratio (HR) = 0.763 (95% CI 0.606–0.960), p = 0.021) and OS (HR = 0.730 (95% CI 0.560–0.951), p = 0.020). Conclusions: The results of the present retrospective study suggest that there is a significant association between the use of beta-blockers and favourable outcomes of mCRC patients treated with bevacizumab-based therapy.

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“…Importantly, although β-blockade and semiselective COX2 inhibition showed beneficial effects separately, their combined use was superior and, in some models, was the only effective approach; this was evident when the β-blocker propranolol was combined with the semiselective COX2 synthesisinhibitor etodolac. 12,22,33,66,67,84,89 Retrospective clinical studies have provided inconclusive results regarding incidental perioperative or chronic use of β-blockers, with several studies, [90][91][92] but not others, 93,94 reporting beneficial effects on long-term cancer outcomes, especially with respect to nonselective β-blockade. Perioperative COX inhibition also has provided inconclusive results, as recently reviewed by Cata et al 43 Notably, aspirin, a nonselective COX inhibitor, was recently recommended for the prevention of colorectal cancer (CRC) in men at risk between the ages of 50 and 59 years.…”

Section: Inhibition Of Perioperative Sirs and Its Effects On Metastasismentioning

confidence: 99%

Perioperative biobehavioral interventions to prevent cancer recurrence through combined inhibition of β‐adrenergic and cyclooxygenase 2 signaling

Ricon

Hanalis-Miller

Haldar

et al. 2018

Cancer

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Evidence suggests that excess perioperative activation of the sympathetic nervous system and the consequent release of catecholamines (ie, epinephrine and norepinephrine) in the context of cancer surgery and inflammation may significantly facilitate prometastatic processes. This review first presents biomedical processes that make the perioperative timeframe pivotal in determining long-term cancer outcomes nonproportionally to its short duration (days to weeks). Then, it analyzes the various mechanisms via which the excess release of catecholamines can facilitate the progression of cancer metastases in this context by directly affecting the malignant tissues and by regulating, via indirect pathways, immunological and other mechanisms that affect metastatic progression in the tumor microenvironment and systemically. In addition, this review addresses the need to supplement β-adrenoreceptor blockade with cyclooxygenase 2 inhibition, especially during surgery and shortly thereafter, because similar mechanisms are simultaneously activated by surgery-induced inflammatory responses. Importantly, this review presents translational and clinical evidence showing that perioperative β-adrenoreceptor blockade and cyclooxygenase 2 inhibition can reduce the prometastatic process and cancer recurrence, and the clinical feasibility and safety of this approach are demonstrated as well. Lastly, alternative psychophysiological approaches to the use of β-adrenergic blockers are presented because a substantial portion of patients have medical contraindications to this pharmacological treatment. The adaptation of existing psychophysiological interventions to the perioperative period and principles for constructing new approaches are discussed and exemplified. Overall, pharmacobehavioral interventions, separately or in combination, could transform the perioperative timeframe from being a prominent facilitator of metastatic progression to an opportunity for arresting or eliminating residual disease, potentially improving long-term survival rates in cancer patients. Cancer 2019;125:45-56.

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The impact of perioperative β blocker use on patient outcomes after primary cytoreductive surgery in high-grade epithelial ovarian carcinoma

Cited by 22 publications

References 16 publications

Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies

Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies

Incidental Use of Beta-Blockers Is Associated with Outcome of Metastatic Colorectal Cancer Patients Treated with Bevacizumab-Based Therapy: A Single-Institution Retrospective Analysis of 514 Patients

Perioperative biobehavioral interventions to prevent cancer recurrence through combined inhibition of β‐adrenergic and cyclooxygenase 2 signaling

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