Lipid-lowering medication use and cancer-specific survival among endometrial or lung cancer patients: an Australian nati
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Lipid-lowering medication use and cancer-specific survival among endometrial or lung cancer patients: an Australian nationwide cohort study Jia-Li Feng 1,2
&
Xiwen Qin 3,4
Received: 29 March 2020 / Accepted: 25 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Inconsistent results of lipid-lowering medications (LLMs) on improved cancer survival need more investigations. We tested the hypothesis that adherence to the drug would be associated with a lower cancer-specific mortality in a homogeneous population who has ever used the drug. Methods Utilising data from the Australian Cancer database, linked to the Pharmaceutical Benefits Scheme data and the National Death Index, we identified two separate cohorts of 4519 and 3083 women patients with newly diagnosed endometrial and lung cancer respectively between 2003 and 2013. Adherence to this drug was calculated by proportion of days covered. Cox regression models with time-varying covariates were used to estimate the multivariable-adjusted cause-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of adherence to LLMs, statins, lipophilic and hydrophilic statins, and cancer-specific mortality. Results Each 10% increase in 1-year adherence to LLMs reduced cancer-specific mortality among women with endometrial cancer (adjusted HR=0.93, 95% CI 0.90–0.96) or lung cancer (adjusted HR=0.95, 95% CI 0.93–0.97). The inverse associations remained unchanged in different subgroup analyses. The reductions in lung cancer mortality were not apparent for women who adhered to lipophilic statins albeit better endometrial cancer survival appeared in the lipophilic statin group and borderline statistical improvement in the hydrophilic statin group. Conclusions Among LLM users, adherence to this drug is inversely associated with reduced cancer-specific mortality. Together with previous evidence, randomised controlled trials are called for to confirm whether LLMs could be considered as an adjuvant treatment to improve prognosis. Keywords Lipid-lowering medication . Survival . Endometrial cancer . Lung cancer What is new? • Adherence to LLM is inversely associated with declines in cancerspecific mortality in endometrial and lung cancer. • No clear difference in cancer-specific mortality by lipid affinity. • The inverse adherence-response association is independent of timing of use. • Larger reductions in endometrial cancer mortality in Type II endometrial cancer. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-03009-5) contains supplementary material, which is available to authorized users. * Jia-Li Feng [email protected] 1
2
Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia Prevention Division, Queensland Health, Brisbane, QLD, Australia
3
Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne
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