Beta-blockers show ‘no evidence’ of reducing anxiety in cancer survivors
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Key takeaways:
- Patients who received beta-blocker therapy reported higher anxiety, more frequent depressed mood and worse quality of life.
- Results contradict previous findings suggesting a protective effect for beta-blockers.
Beta-blocker therapy did not reduce negative intrusive thoughts or anxiety among cancer survivors, according to results of an emulated trials analysis published in BMC Cancer.
Researchers reported increased prevalence of negative psychological effects among cancer survivors who initiated beta-blocker therapy after their diagnosis.
“This emulated trial could not find evidence of a protective effect of beta-blockers on intrusive thoughts in colorectal and prostate cancer survivors,” Carolina Ehrencrona, data manager with Scandinavian Surgical Outcomes Research Group at University of Gothenburg, and colleagues wrote. “Rather, patients who initiated treatment with beta-blockers had lower quality of life and more anxiety than those who did not initiate beta-blockers.”
Background, methods
High rates of intrusive thoughts have previously been reported among cancer survivors, whereas other investigations have suggested lower levels of cancer-related intrusive thoughts among individuals being actively treated with beta-blockers compared with nonusers, according to background information provided by the study’s investigators.
Researchers emulated two randomized controlled trials to investigate if initiation of beta-blocker therapy reduces prevalence or severity of intrusive thoughts among cancer survivors.
Frequency and severity of intrusive thoughts served as the study’s co-primary endpoints, along with secondary endpoints that included prevalence of anxiety, depressed mood and change in quality of life in cancer survivors.
Ehrencrona and colleagues used patient-reported outcomes data from three cohort studies of Swedish patients previously diagnosed with colon, prostate or rectal cancer, and combined it with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register.
The first emulated study had follow-up 1 year after diagnosis, while the second trial had follow-up 2 years after diagnosis, with baseline in both trials being 12 months before follow-up started.
Patients who received beta-blocker therapy between baseline and follow-up made up the active group, whereas patients who did not receive beta-blockers made up the control group.
Trial 1 (83% men) consisted of 59 active patients and 3,936 control patients, whereas trial 2 (94% men) consisted of 87 active patients and 3,132 control patients.
Results
Researchers reported no significant differences between patients in the active and control groups in either of the two trials with respect to the co-primary endpoints.
In trial 1, patients in the active group had a lower prevalence of intrusive thoughts (OR = 0.82; 95% CI, 0.48-1.4) and less severe intrusions (OR = 0.71; 95% CI, 0.43-1.2) than the control group.
In trial 2, patients in the active group had a higher prevalence of intrusive thoughts (OR = 1.2; 95% CI, 0.76-1.8) and less severe intrusions (OR = 0.95; 95% CI, 0.63-1.4) than patients in the control group.
For the three secondary endpoints of depressed mood, quality of life and periods of anxiety or worry, researchers noted a tendency with higher impairment among patients in the active group.
Trial 1 saw an OR of 1.6 (95% CI, 0.68–3.4) for depressed mood, 1.9 (95% CI, 1.2–3.) for quality of life and 1.5 (95% CI, 0.82–2.7) for periods of anxiety or worry, whereas trial 2 saw corresponding ORs of 1.8 (95% CI, 0.78–4) for depressed mood, 1.6 (95% CI, 1–2.4) for quality of life and 2.6 (95% CI,1.5–4.3) for periods of anxiety or worry.
Next steps
Researchers observed no significant protective effect of beta-blocker therapy against intrusive thoughts among cancer survivors, contradicting previous findings.
“Based on the analysis results, there was no evidence suggesting that beta-blockers improve the well-being of cancer survivors,” researchers wrote. “This study does not rule out a possible protective effect of beta-blockers on intrusive thoughts, but interventional trials are required to assert the effect of beta-blockers without the confounder of cardiovascular (or other) disease the prescribed beta-blocker was intended as a treatment for.”
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