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Impact of Concurrent Medication Use on Pancreatic Cancer Survival—SEER-Medicare Analysis

Beg, Muhammad S., MD, MS*,†; Gupta, Arjun, MD; Sher, David, MD†,§; Ali, Sadia, MD; Khan, Saad, MD*,†; Gao, Ang, MS; Stewart, Tyler, MD; Ahn, Chul, PhD†,¶; Berry, Jarett, MD#; Mortensen, Eric M., MD, MSc‡,¶,**

American Journal of Clinical Oncology: August 2018 - Volume 41 - Issue 8 - p 766–771
doi: 10.1097/COC.0000000000000359
Original Articles: Gastrointestinal

Objectives: Preclinical studies have suggested that non-antineoplastic medication use may impact pancreatic cancer biology. We examined the association of several medication classes on pancreatic cancer survival in a large medical claims database.

Materials and Methods: Histologically confirmed pancreatic adenocarcinoma diagnosed between 2006 and 2009 were analyzed from the Surveillance, Epidemiology, and End Results-Medicare database with available part D data. Drug use was defined as having 2 prescriptions filled within 12 months of pancreatic cancer diagnosis. The following medication classes/combinations were analyzed: β-blocker, statin, insulin, metformin, thiazolidinedione, warfarin, heparin, β-blocker/statin, metformin/statin, and β-blocker/metformin. Multivariable Cox proportional hazard models adjusting for age, sex, race, stage at diagnosis, site of cancer, and Charlson comorbidity index were constructed to test the association between medication classes and overall survival.

Results: A total of 13,702 patients were included in the study; median age 76 years, 42.5% males, 77.1% white. The most common anatomic site and stage at diagnosis were head of the pancreas (49.9%) and stage 4 (49.6%), respectively. Ninety-four percent of patients died in the follow-up period (median overall survival 5.3 mo). Multivariable Cox regression analysis showed that use of β-blockers, heparin, insulin, and warfarin were significantly associated with improved survival (P<0.05 for each one), whereas metformin, thiazolidinedione, statin, and combination therapies were not.

Conclusions: In this study, use of β-blockers, heparin, insulin, and warfarin were associated with improved survival in patients with pancreatic cancer. Additional studies are needed to validate these findings in the clinical setting.

Divisions of *Hematology/Oncology

Endocrinology and Metabolism

#Cardiology

Harold C. Simmons Cancer Center

Departments of Internal Medicine

§Radiation Oncology

Clinical Sciences, University of Texas—Southwestern Medical Center

**VA North Texas Health Care System, Dallas, TX

Prior Presentations: “Impact of concurrent medications use on outcome of pancreatic cancer—SEER-Medicare analysis.” Gastrointestinal Cancers Symposium, San Francisco, January 2016.

M.S.B., A. Gupta, A. Gao, C.A.: conception, design, analysis, and interpretation of data. M.S.B., A. Gupta, D.S., S.A., S.K., A. Gao, T.S., C.A., J.B., E.M.M.: drafting, revision, and final approval.

MSB was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001105. E.M.M. was supported in part by a grant from the Agency for Healthcare Research and Quality (R24 HS022418) and the University of Texas—Southwestern Center for Patient-Centered Outcomes Research.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the VA North Texas Health Care System.

Research involving Human Participants and/or Animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The authors declare no conflicts of interest.

Reprints: Muhammad S. Beg, MD, MS, Department of Internal Medicine, Division of Hematology/Oncology, University of Texas—Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8852. E-mail: muhammad.beg@UTSouthwestern.edu.

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