Gillian E Hanley1, Paramdeep Kaur2, Andrew Berchuck3, Anne Chase4, Bronwyn Grout5, Cindy McKinnon Deurloo6, Malcolm Pike7, Jean Richardson8, Kathryn L Terry9, Penelope M Webb10, C Leigh Pearce11. 1. Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada. Electronic address: Gillian.hanley@vch.ca. 2. Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada. 3. Department of Gynecologic Oncology, Duke University Medical Center, Durham, NC, United States. 4. Regina, SK, Canada. 5. Sydney, NSW, Australia. 6. East Hampstead, NH, United States. 7. Memorial Sloan Kettering, New York, NY, United States; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States. 8. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States. 9. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States; Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States. 10. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. 11. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
Abstract
OBJECTIVES: Research examining survival among people with ovarian cancer following use of statins or β-blockers has been conflicting. Many studies to date have suffered from immortal time bias and/or had limited power. To address these limitations, we used time-dependent analyses to study the association between statin or β-blocker use among all people diagnosed with an epithelial ovarian cancer in British Columbia, Canada between 1997 and 2015. METHODS: Population-based administrative data were linked for 4207 people with ovarian cancer. Statin or β-blocker use was examined using time-dependent variables for any use, cumulative duration of use and by user-group according to whether use was initiated before or after their ovarian cancer diagnosis. Cox proportional hazards models were run to estimate the association between statin or β-blocker use and survival. RESULTS: Any postdiagnosis use of statins was associated with better ovarian cancer survival in the full cohort (adjusted hazard ratio (aHR) = 0.76, 95% CI 0.64, 0.89) and among women with serous cancers (aHR = 0.80, 95%CI 0.67-0.96). This was primarily driven by new use post-diagnosis (aHR = 0.67, 95%CI, 0.51-0.89), but there was a trend towards better survival among those who continued use from before diagnosis (aHR 0.83, 95%CI, 0.68-1.00). There was no statistically significant association between β-blocker use and survival. CONCLUSION: Postdiagnosis statin use was associated with improved survival among people with ovarian cancer. Given the consistency of this finding in the literature, we recommend a randomized clinical trial of statin use in people with ovarian cancer.
OBJECTIVES: Research examining survival among people with ovarian cancer following use of statins or β-blockers has been conflicting. Many studies to date have suffered from immortal time bias and/or had limited power. To address these limitations, we used time-dependent analyses to study the association between statin or β-blocker use among all people diagnosed with an epithelial ovarian cancer in British Columbia, Canada between 1997 and 2015. METHODS: Population-based administrative data were linked for 4207 people with ovarian cancer. Statin or β-blocker use was examined using time-dependent variables for any use, cumulative duration of use and by user-group according to whether use was initiated before or after their ovarian cancer diagnosis. Cox proportional hazards models were run to estimate the association between statin or β-blocker use and survival. RESULTS: Any postdiagnosis use of statins was associated with better ovarian cancer survival in the full cohort (adjusted hazard ratio (aHR) = 0.76, 95% CI 0.64, 0.89) and among women with serous cancers (aHR = 0.80, 95%CI 0.67-0.96). This was primarily driven by new use post-diagnosis (aHR = 0.67, 95%CI, 0.51-0.89), but there was a trend towards better survival among those who continued use from before diagnosis (aHR 0.83, 95%CI, 0.68-1.00). There was no statistically significant association between β-blocker use and survival. CONCLUSION: Postdiagnosis statin use was associated with improved survival among people with ovarian cancer. Given the consistency of this finding in the literature, we recommend a randomized clinical trial of statin use in people with ovarian cancer.
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