Medication use and survival in diabetic patients with kidney cancer: A population-based cohort study.
Survival rates in kidney cancer have improved little over time, and diabetes may be an independent risk factor for poor survival in kidney cancer. We sought to determine whether medications with putative anti-neoplastic properties (statins, metformin and non-steroidal anti-inflammatory drugs (NSAIDs)) are associated with survival in diabetics with kidney cancer. We conducted a population-based cohort study utilizing linked healthcare databases in Ontario, Canada. Patients were aged 66 or older with newly diagnosed diabetes and a subsequent diagnosis of incident kidney cancer. Receipt of metformin, statins or NSAIDs was defined using prescription claims. The primary outcome was all-cause mortality and the secondary outcome was cancer-specific mortality. We used multivariable Cox proportional hazard regression, with medication use modeled with time-varying and cumulative exposure analyses to account for intermittent use. During the 14-year study period, we studied 613 patients. Current statin use was associated with a markedly reduced risk of death from any cause (adjusted hazard ratio 0.74; 95% CI 0.59-0.91) and death due to kidney cancer (adjusted hazard ratio 0.71; 95% CI 0.51-0.97). However, survival was not associated with current use of metformin or NSAIDs, or cumulative exposure to any of the medications studied. Among diabetic patients with kidney cancer, survival outcomes are associated with active statin use, rather than total cumulative use. These findings support the use of randomized trials to confirm whether diabetics with kidney cancer should be started on a statin at the time of cancer diagnosis to improve survival outcomes.
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada.
Madhur
M
Nayan
Institute for Clinical Evaluative Sciences, Toronto, Canada.
Erin M
EM
Macdonald
Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
David N
DN
Juurlink
Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Management, Policy and Evaluation, University of Toronto, Toronto, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Canada.
Peter C
PC
Austin
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada.
Antonio
A
Finelli
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada.
Girish S
GS
Kulkarni
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada. Electronic address: rob.hamilton@uhn.ca.
Robert J
RJ
Hamilton
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000970:Antineoplastic Agents
Anti-inflammatory agents; Diabetes mellitus; Hydroxymethylglutaryl-CoA reductase inhibitors; Kidney neoplasms; Metformin; Non-steroidal; Survival