Introduction
Stress promotes cancer progression
Non-pharmacological strategies to reduce stress
Mindfulness-based interventions
Acupuncture
Natural products
Support groups and psychology counseling
Exercise
Pharmacological management to suppress stress-induced β-AR signaling pathway
Preclinical studies using pharmacologic blockade
Clinical studies using pharmacological blockade
Study | Population | Timing of β-blocker use | Breast cancer outcomes |
---|---|---|---|
Childers et al. | Meta-analysis of 7 studies: systematic review using Cochrane library and PubMed | - | No statistically significant reduction in breast cancer recurrence. Significant reduction in breast cancer death (HR 0.50; 95% CI 0.32–0.80). No significant effect of β-blockers on all-cause mortality (HR, 1.02; 95% CI, 0.75–1.37) [35] |
Ganz et al. | LACE (Life After Cancer Epidemiology) cohort: Early stage invasive breast cancer | β-blocker use in the year prior to or after breast cancer diagnosis | β-blocker use was associated with lower hazard of recurrence (HR 0.86) and cause-specific mortality (HR 0.76) but not statistically significant [193] |
Melhem-Bretrandt et al. | Retrospective analysis in breast cancer patients receiving neoadjuvant chemotherapy | β-blocker use at the start of neoadjuvant chemotherapy | β-blocker intake was associated with a significantly better RFS (HR 0.52, 95% CI 0.31 to 0.88) but not OS. Among patients with TNBC, β-blocker intake was associated with improved RFS (HR 0.30; 95% CI 0.10 to 0.87; p = 0.027) but not OS. [194] |
Powe et al. | Retrospective study in patients with operable breast cancer | β-blocker use prior to cancer diagnosis | β-blocker-treated patients showed a significant reduction in metastasis development (p = 0.026), tumor recurrence (p = 0.001), and longer disease-free interval (p = 0.01). In addition, there was a 57% reduced risk of metastasis (hazards ratio = 0.430; 95% CI = 0.200–0.926, p = 0.031), and a 71% reduction in breast cancer mortality after 10 years (Hazards ratio = 0.291; 95% CI = 0.119–0.715, p = 0.007) [195]. |