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Beta-blocker use and lung cancer mortality in a nationwide cohort study of patients with primary non-small cell lung cancer
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
Department of Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden.
Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
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2019 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 29, no 1, p. 119-126Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Beta-adrenergic receptor blockers have been associated with improved survival among patients with different types of malignancies, but available data for non-small cell lung cancer (NSCLC) patients is contradictory and limited to small hospital-based studies. We therefore aimed to investigate if β-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.

PATIENTS AND 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 beta-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 non-use, beta-blocker use (predominantly prevalent use, 93%) was not associated with lung cancer mortality [hazard ratio (95% confidence interval): 1.01 (0.97-1.06)]. However, the possibility that diverging associations for specific beta-blockers and some histopathological subtypes exist cannot be excluded.

CONCLUSION: In this nationwide cohort of NSCLC patients, beta-blocker use was not associated with lung cancer mortality when assessed in aggregate in the total cohort, but evidence for some beta-blockers is less conclusive.

IMPACT: Our results do not indicate that beta-blocker use at lung cancer diagnosis reduces the cancer-specific mortality rate in NSCLC patients.

Place, publisher, year, edition, pages
Prevention American Association for Cancer Research , 2019. Vol. 29, no 1, p. 119-126
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-77618DOI: 10.1158/1055-9965.EPI-19-0710ISI: 000521285100015PubMedID: 31641010Scopus ID: 2-s2.0-85077915694OAI: oai:DiVA.org:oru-77618DiVA, id: diva2:1365515
Funder
Swedish Cancer Society, CAN 2013/650Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2020-05-05Bibliographically approved
In thesis
1. Stress susceptibility, beta-blocker use and cancer survival
Open this publication in new window or tab >>Stress susceptibility, beta-blocker use and cancer survival
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Accumulating evidence suggests that chronic stress may influence tumour biology through activation of neuroendocrine pathways and thus impair survival. However, measuring stressful exposures and their influence on health is challenging, partly due to substantial inter-individual variation in stress susceptibility. The thesis aimed to explore whether stress resilience and use of β-adrenergic receptor blockers, which are implicated in regulation of neuroendocrine stress response pathways, are linked to survival after a primary cancer diagnosis using data from Swedish national registers. In a cohort of male cancer patients born during 1952-1956 who had their stress resilience assessed during a mandatory conscription examination in late adolescence, low compared with high stress resilience was associated with a higher overall mortality rate. Statistically significant reductions in survival were observed among men with carcinomas of the oropharynx, prostate, upper respiratory tract, and Hodgkin’s lymphoma. In a cohort of patients diagnosed with pancreatic adenocarcinoma during 2006-2009, β-blocker users had a lower pancreatic cancer mortality rate than non-users, particularly among patients without distant metastases at diagnosis. In a cohort of patients diagnosed with non-small cell lung cancer during 2006-2014, there was no clear association between β-blocker use and lung cancer survival, but we cannot exclude the possibility of associations in some sub-groups defined by histology, stage and β-blocker types. In a cohort of patients diagnosed with hepatocellular carcinoma during 2006-2014, β-blocker use was associated with lower liver cancer mortality, particularly among patients with localised disease. A higher-magnitude inverse association was observed for non-selective β-blocker use. In conclusion, greater stress resilience and β-blocker use are associated with improved survival among patients with some cancer types, and this may be explained by a variety of pathways.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2020. p. 101
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 212
Keywords
stress resilience, β-blockers, primary cancer, survival analysis, overall mortality, cancer-specific mortality, register-based cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-80720 (URN)978-91-7529-338-7 (ISBN)
Public defence
2020-05-28, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2020-05-15Bibliographically approved

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Udumyan, RuzanMontgomery, ScottFall, Katja

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