Beta-blocker use and survival after pancreatic cancer surgery: A nationwide population-based cohort study

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PURPOSE: We examined the association between use of beta-blockers and survival in pancreatic cancer patients after curative-intent surgery.

METHODS: Using Danish healthcare registries, we conducted a population-based cohort study of all patients undergoing curative-intent surgery for pancreatic cancer in Denmark 1997-2021. We defined beta-blocker use according to exposure before surgery as current (≤90 days), recent (91-365 days), or former (366-730 days) use, requiring at least one filled prescription. Patients were followed from the date of surgery for up to 5 years. We used Cox regression to compute hazard ratios (HRs) of deaths with 95% confidence intervals (CIs), adjusting for age, sex, year of diagnosis, cardiovascular disease, diabetes, liver disease, alcohol, and smoking. We also conducted an active comparator analysis, where we used angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers as comparators instead of nonusers.

RESULTS: We included 2592 patients, of which 16.7% were beta-blocker users. Median survival for the entire population was 24.4 months. Beta-blocker use was associated with increased mortality (adjusted HR: 1.18; 95% CI: 1.04-1.34). This was evident in current (adjusted HR: 1.19; 95% CI: 1.02-1.38) and recent (adjusted HR: 1.29; 95% CI: 1.04-1.59) but not former (adjusted HR: 0.91; 95% CI: 0.64-1.43) users. In the active comparator analysis, the association between beta-blocker exposure and mortality attenuated slightly (adjusted HR: 1.12; 95% CI: 0.93-1.35).

CONCLUSIONS: We observed an association between beta-blocker use and increased mortality in patients operated for pancreatic cancer. Findings are likely explained by confounding by indication.

Original languageEnglish
Article numbere5726
JournalPharmacoepidemiology and Drug Safety
Number of pages10
Publication statusPublished - Jan 2024


  • beta-blockers
  • epidemiology
  • pancreatic cancer
  • pharmacoepidemiology
  • prognosis
  • survival
  • Adrenergic beta-Antagonists/adverse effects
  • Angiotensin-Converting Enzyme Inhibitors
  • Humans
  • Proportional Hazards Models
  • Pancreatic Neoplasms/epidemiology
  • Cohort Studies


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