It has been suggested that stress promotes progression of ovarian cancer through mechanisms including sympathetic nervous system mediators such as norepinephrine and epinephrine. β-Blockers inhibit the actions of these hormones, and several preclinical studies have suggested that these agents prolong survival in several gynecologic malignancies.
The aim of this retrospective review was to determine whether β-blocker use was associated with disease progression and survival in a cohort of women with stage III or stage IV epithelial ovarian cancer. All participants underwent cytoreductive surgery followed by platinum-based chemotherapy. Patients were considered to be β-blocker users if their use was documented on 2 or more medical records at least 6 months apart. Data were assessed with Fisher exact test and Kaplan-Meier survival analysis. Multivariate Cox regression analysis was also used to control for covariates, which were established prognostic factors including age, stage, grade, and cytoreduction status.
Among the 248 patients who met inclusion criteria, 68 used antihypertensives, and 23 used β-blockers. Median progression-free survival was longer among β-blocker users compared with nonusers (27 vs 17 months, P = 0.05). Overall disease-specific survival was also longer for β-blocker users compared with nonusers (56 vs 48 months, P = 0.02; hazard ratio, 0.56). In the adjusted data, β-blocker use was the only independent positive prognostic factor (P = 0.03). There was longer overall survival for patients using β-blockers (56 months) than for hypertensive patients on other medications (34 months) or patients without hypertension (51 months), P = 0.007. The findings of this pilot study suggest that β-blocker use in patients with advanced-stage epithelial ovarian cancer is associated with a 54% reduced chance of death compared with nonusers.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA