In an Australian population–based study reported in the Journal of Clinical Oncology, Spilsbury et al found that perioperative dispensing of nonselective beta-blockers was associated with improved survival among patients with a history of a cardiovascular condition undergoing surgery for epithelial ovarian cancer.
As stated by the investigators, “Surgery for epithelial ovarian cancer may activate stress-inflammatory responses that stimulate tumor growth and increase metastatic growth. Animal and in vitro studies have shown that inhibition of the catecholamine-induced inflammatory response via beta-adrenergic receptor blockade has antitumor potential in epithelial ovarian cancer. However, observational studies have reported mixed results.”
Study Details
The study involved linked administrative data on 3,844 Australian patients diagnosed between 2002 and 2014 who underwent surgery at age ≥ 50 years. Beta-blocker use at surgery was defined as a usage period overlapping the month of surgery. Among the 3,844 women, 3,194 did not receive beta-blockers; 560 (14.5%) were supplied a selective beta-blocker (eg, atenolol in 59%, metoprolol in 39%, bisoprolol in 2%); and 67 (1.7%) were supplied a nonselective beta-blocker (eg, propranolol in 91%, oxprenolol and pindolol in small numbers of patients).
Key Findings
Median follow-up from the time of surgery was 3.2 years. Significant differences were observed across the three groups for all-cause mortality (overall P = .002) and epithelial ovarian cancer–specific mortality (overall P = .003) but not for mortality from causes other than epithelial ovarian cancer (overall P = .113).
At 2 years postsurgery, the overall survival rate was 80% (95% confidence interval [CI] = 68%–88%) among women dispensed nonselective beta-blockers at surgery vs 69% (95% CI = 67%–70%) among women not supplied nonselective beta-blockers. At 2 years, the hazard ratio for all-cause mortality for nonselective beta-blocker use vs no beta-blocker use was 0.47 (95% CI = 0.24–0.94) and the hazard ratio for epithelial ovarian cancer–specific mortality was 0.38 (95% CI = 0.16–0.93). The overall survival benefit and epithelial ovarian cancer–specific mortality benefit appeared to be maintained for 8 years after surgery.
No association with survival was observed among women dispensed selective beta-blockers vs those who received no beta-blockers. For example, hazard ratios at 2 years were 1.03 (95% CI = 0.89–1.19) for all-cause mortality and 1.02 (95% CI = 0.84–1.25) for epithelial ovarian cancer–specific mortality.
The investigators concluded, “Perioperative supply of nonselective beta-blockers appeared to confer a survival advantage for women [older than age] 50 years with a history of cardiovascular conditions. Long-term clinical trials are required to confirm these findings.”
Susan J. Jordan, PhD, of the School of Public Health, The University of Queensland, Brisbane, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Australian National Health and Medical Research Council. For full disclosures of the study authors, visit ascopubs.org.
