title: Commonly used diabetes and cardiovascular medications and cancer recurrence and cancer-specific mortality: a review of the literature.
abstract: BACKGROUND
  Cancer most commonly arises in the elderly who are often burdened with comorbidities. Medications used for treating these comorbidities may alter cancer prognosis. Understanding the impact of these medications on cancer is important in order to make effective evidence-based decisions about managing comorbidities while improving cancer outcomes.
  
  
  METHODS
  The evidence on diabetes, statins, antihypertensive and anti-inflammatory medications and their association with cancer recurrence and cancer-specific mortality are reviewed. The strengths and limitations of the existing literature, the current state of the field and future directions are discussed.
  
  
  CONCLUSIONS
  Metformin and aspirin were associated with a reduced risk of cancer recurrence and cancer-specific mortality. The evidence for statins and antihypertensive medications on cancer survival was inconsistent. There were few studies to suggest that any of the medication classes of interest were associated with negative effects on cancer survival. Methodological shortcomings within observational studies, such as confounding, distinguishing between use of medications pre-cancer versus post-cancer diagnosis/treatment, misclassification of exposures/outcomes, informative censoring and competing risks, must be considered. New observational studies addressing these limitations are essential. Some clinical trials are underway to further investigate the beneficial effects of these drugs and completed trials have confirmed results demonstrated in observational studies.
authors.affiliation: McGill University, Epidemiology, Biostatistics, and Occupational Health , 1020 Pine Avenue, Montreal, Quebec, H3A 1A2 , Canada.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Wu
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.forename: Naoko I
authors.initials: NI
authors.lastname: Simonds
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Freedman
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000473:pathology*; D011379:Prognosis; D013534:Survival
chemical_list: D000893:Anti-Inflammatory Agents; D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents
keywords: cancer recurrence; cardiovascular disease; diabetes; medications; mortality