The Impact of Beta Blockers on Survival in Cancer Patients: A Systematic Review and Meta-Analysis
Alisha Sharma, Stephanie Chan, Adam S. Komorowski, Xingshan Cao, Yizhuo Gao, Kushal Kshatri, Kairavi Desai, Markus Kuksis, Michael N. Rosen, Anjali Sachdeva, Isabella Kojundzic, Saif Samari, Iacovos P. Michael, Husam Abdel‐Qadir, Katarzyna J. Jerzak
Abstract
Background/Objectives: Beta adrenergic signaling has been implicated in cancer progression, leading to interest in repurposing beta blockers (BBs) as adjunctive anti-cancer agents. However, clinical findings are inconsistent. This systematic review and meta-analysis evaluates the association between BB use and survival outcomes in cancer patients. Methods: A systematic search of OVID Medline, EMBASE, and CENTRAL was conducted through 13 September 2023, for studies comparing survival outcomes in solid tumor patients using BBs versus non-users. Eligible studies reported hazard ratios (HRs) for overall survival (OS), progression-free survival (PFS), or cancer-specific survival (CSS). Perioperative studies and those without BB-specific HRs were excluded. Data extraction and quality assessment were performed in duplicate using ROBINS-I. A random-effects model was used, with heterogeneity assessed by the I2 statistic. Results: Seventy-nine studies (492,381 patients) met the inclusion criteria; 2.5% were prospective. The most frequently studied cancers were breast (n = 33), ovarian (n = 30), and colorectal (n = 28). BB use was associated with improved PFS (HR 0.78, 95% CI: 0.66–0.92, I2 = 79.8%), with significance maintained after excluding high-bias studies (HR 0.74, 95% CI: 0.61–0.91, I2 = 36.6%). No significant associations were observed for OS (HR 0.99, 95% CI: 0.94–1.04, I2 = 84.9%) or CSS (HR 0.95, 95% CI: 0.91–1.00, I2 = 77.4%). Conclusions: BB use may be associated with longer PFS in cancer patients, but findings are limited by study design and heterogeneity; high-quality prospective studies are needed.