The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study
-
Published:2023-10-25
Issue:21
Volume:12
Page:6749
-
ISSN:2077-0383
-
Container-title:Journal of Clinical Medicine
-
language:en
-
Short-container-title:JCM
Author:
Strobach Dorothea1, Haimerl Lisa1, Mannell Hanna2, Stief Christian G.3, Karl Alexander4, Grimm Tobias5, Buchner Alexander3ORCID
Affiliation:
1. Hospital Pharmacy and Doctoral Programm Clinical Pharmacy, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany 2. Physiology, Institute for Theoretical Medicine, Faculty of Medicine, University of Augsburg, Universitätsstraße 2, 86159 Augsburg, Germany 3. Department of Urology, LMU University Hospital, Marchioninistraße 15, 81377 Munich, Germany 4. Department of Urology, Hospital Barmherzige Brüder, Romanstraße 93, 80639 Munich, Germany 5. Urology Practice Kaufbeuren, Gutenbergstraße 8, 87600 Kaufbeuren, Germany
Abstract
We aimed to characterize non-oncologic chronic drug therapy of bladder cancer (BC) patients and evaluate a possible impact on recurrence-free (RFS) and cancer-specific survival (CSS). Patients with a first diagnosis (FD) of BC or radical cystectomy (RC) were included in a prospective, monocentric, observational study. Drugs and medical data was assessed at start and three-monthly for 24 months. Drugs were classified by anatomical-therapeutic-chemical code (ATC). Endpoints for outcome analysis were RFS and CSS in univariate (Kaplan–Meier curves and log-rank test, Cox regression for Hazard Ratio (HR)) and multivariate (Cox regression models) analyses. Of 113 patients, 52 had FD and 78 RC. Median age was 74 and 72 years, 83% and 82% were male. Drugs of 114 ATC classes were taken by 48 (92%) FD patients (median number 4.5/IQR 2–7.5) and 73 (94%) of RC patients (median 5/IQR 2–9). In univariate analysis (log-rank test (p)/Cox regression (HR, 95% CI, p)), polypharmacy (p = 0.036/HR = 2.83, 95% CI = 1.02–7.90, p = 0.047), calcium channel blockers (p = 0.046/HR = 2.47, 95% CI = 0.97–6.27, p = 0.057) and proton pump inhibitors (p = 0.015/HR = 3.16, 95% CI = 1.18–8.41, p = 0.022) had a significant negative impact on RFS in RC patients, statins (p = 0.025/HR = 0.14, 95% CI = 0.02–1.06, p = 0.057) a positive effect on RFS in FD patients, angiotensin-converting enzyme inhibitors (p = 0.008/HR = 10.74, 95% CI = 1.20–96.17, p = 0.034) and magnesium (p = 0.042/HR = 5.28, 95% CI = 0.88–31.59, p = 0.067) a negative impact on CSS in FD patients. In multivariate analysis, the only significant drug effects were the negative impact of angiotensin-converting enzyme inhibitors (HR = 15.20, 95% CI = 1.30–177.67, p = 0.030) and magnesium (HR = 22.87, 95% CI = 1.57–333.81), p = 0.022) on CSS in FD patients, and the positive impact of statins (HR = 0.12, 95% CI = 0.01–0.97, p = 0.047) on RFS in FD patients. Impact of non-oncologic drugs on RFS and CSS was small in this prospective study. Thus, appropriate treatment of comorbidities is encouraged.
Reference51 articles.
1. International Agency for Resaerch on Cancer (2023, February 12). Cancer Today. Available online: https://gco.iarc.fr. 2. Bladder cancer: Esmo clinical practice guideline for diagnosis, treatment and follow-up;Powles;Ann. Oncol.,2021 3. Babjuk, M., Burger, M., Comperat, E., Gontero, P., Liedberg, F., Masson-Lecomte, A., Mostafid, A.H., Palou, J., van Rhijn, B.W.G., and Roupret, M. (2023, February 12). EAU Guidelines on Non-Muscle-Invasive Bladder Cancer (TaT1 and CIS). European Association of Urology. Available online: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-Muscle-Invasive-Bladder-Cancer-2022.pdf. 4. (2023, February 12). AWMF Online: Leitlinienprogramm Onkologie. S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinoms Langversion 2.0–März 2020 AWMF-Registernummer: 032/038OL. S3-Leitlinie Harnblasenkarzinom. Available online: https://www.leitlinienprogramm-onkologie.de. 5. A review on the etiology and epidemiology of bladder cancer: All you need to know;Halaseh;Curreus,2022
|
|