Beta-blocker use and survival after pancreatic cancer surgery: A nationwide population-based cohort study

Abstract

Purpose: We examined the association between use of beta-blockers and survival in pancreatic cancer patients after curative-intent surgery. Methods: Using Danish healthcare registries, we conducted a population-based cohort study of all patients undergoing curative-intent surgery for pancreatic cancer in Denmark 1997–2021. We defined beta-blocker use according to exposure before surgery as current (≤90 days), recent (91–365 days), or former (366–730 days) use, requiring at least one filled prescription. Patients were followed from the date of surgery for up to 5 years. We used Cox regression to compute hazard ratios (HRs) of deaths with 95% confidence intervals (CIs), adjusting for age, sex, year of diagnosis, cardiovascular disease, diabetes, liver disease, alcohol, and smoking. We also conducted an active comparator analysis, where we used angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers as comparators instead of nonusers. Results: We included 2592 patients, of which 16.7% were beta-blocker users. Median survival for the entire population was 24.4 months. Beta-blocker use was associated with increased mortality (adjusted HR: 1.18; 95% CI: 1.04–1.34). This was evident in current (adjusted HR: 1.19; 95% CI: 1.02–1.38) and recent (adjusted HR: 1.29; 95% CI: 1.04–1.59) but not former (adjusted HR: 0.91; 95% CI: 0.64–1.43) users. In the active comparator analysis, the association between beta-blocker exposure and mortality attenuated slightly (adjusted HR: 1.12; 95% CI: 0.93–1.35). Conclusions: We observed an association between beta-blocker use and increased mortality in patients operated for pancreatic cancer. Findings are likely explained by confounding by indication.