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Beta-adrenergic receptor blockers and liver cancer mortality in a national cohort of hepatocellular carcinoma patients
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics.
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.ORCID iD: 0000-0001-6328-5494
Örebro University, School of Medical Sciences. Department of Infectious Diseases.ORCID iD: 0000-0001-7248-0910
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-81517OAI: oai:DiVA.org:oru-81517DiVA, id: diva2:1428262
Available from: 2020-05-05 Created: 2020-05-05 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)
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Supervisors
Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2020-05-15Bibliographically approved

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Udumyan, RuzanMontgomery, ScottDuberg, Ann-SofiFall, Katja

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