β-Blocker usage and colorectal cancer mortality: a nested case-control study in the UK Clinical Practice Research Datalink cohort

Epidemiological and laboratory studies suggest that beta-blockers may reduce cancer progression in various cancer sites. The aim of this study was to conduct the first epidemiological investigation of the effect of post-diagnostic beta-blocker usage on colorectal cancer-specific mortality in a large population-based colorectal cancer patient cohort. Patients and methods: A nested case-control analysis was conducted within a cohort of 4794 colorectal cancer patients diagnosed between 1998 and 2007. Patients were identified from the UK Clinical Practice Research Datalink and confirmed using cancer registry data. Patients with a colorectal cancer- specific death (data from the Office of National Statistics death registration system) were matched to five controls. Conditional logistic regression was applied to calculate odds ratios (OR) and 95% confidence intervals (95% CIs) according to beta-blocker usage (data from GP-prescribing records). Post-diagnostic beta-blocker use was identified in 21.4% of 1559 colorectal cancer-specific deaths and 23.7% of their 7531 matched controls, with little evidence of an association (OR = 0.89 95% CI 0.78-1.02). Similar associations were found when analysing drug frequency, beta-blocker type or specific drugs such as propranolol. There was some evidence of a weak reduction in all-cause mortality in beta-blocker users (adjusted OR = 0.88; 95% CI 0.77-1.00; P = 0.04) which was in part due to the marked effect of atenolol on cardiovascular mortality (adjusted OR = 0.62; 95% CI 0.40-0.97; P = 0.04). In this novel, large UK population-based cohort of colorectal cancer patients, there was no evidence of an association between post-diagnostic beta-blocker use and colorectal cancer-specific mortality. NCT00888797.