TY - JOUR
T1 - Effect of beta-blockers on cancer recurrence and survival
T2 - a meta-analysis of epidemiological and perioperative studies
AU - Yap, A.
AU - Lopez-Olivo, M. A.
AU - Dubowitz, J.
AU - Pratt, G.
AU - Hiller, J.
AU - Gottumukkala, V.
AU - Sloan, E.
AU - Riedel, B.
AU - Schier, R.
N1 - Funding Information:
National Health and Medical Research Council of Australia ( 1147498 ), the Australian and New Zealand College of Anaesthetists ( 17/003 ), and the David and Lorelle Skewes Foundation . Career award from the Rheumatology Research Foundation, USA to M. L.-O.
Funding Information:
National Health and Medical Research Council of Australia (1147498), the Australian and New Zealand College of Anaesthetists (17/003), and the David and Lorelle Skewes Foundation. Career award from the Rheumatology Research Foundation, USA to M. L.-O.
Publisher Copyright:
© 2018 British Journal of Anaesthesia
PY - 2018/7
Y1 - 2018/7
N2 - Background: The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS). Methods: Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias. Results: Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01–0.17) and OS (HR 0.04, 95% CI 0.00–0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10–1.80) and OS (HR 1.50, 95% CI 1.12–2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool. Conclusion: Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.
AB - Background: The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS). Methods: Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias. Results: Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01–0.17) and OS (HR 0.04, 95% CI 0.00–0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10–1.80) and OS (HR 1.50, 95% CI 1.12–2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool. Conclusion: Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.
KW - beta-blockers
KW - cancer recurrence
KW - disease-free survival
KW - overall survival
KW - perioperative
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U2 - 10.1016/j.bja.2018.03.024
DO - 10.1016/j.bja.2018.03.024
M3 - Review article
C2 - 29935594
AN - SCOPUS:85046692557
SN - 0007-0912
VL - 121
SP - 45
EP - 57
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 1
ER -