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Epidemiology

Statin use and survival among women with ovarian cancer: an Australian national data-linkage study

Abstract

Background

Five-year ovarian cancer survival rates are below 50%; there is considerable interest in whether common medications like statins may improve survival.

Methods

We identified women diagnosed with ovarian cancer in Australia from 2003 to 2013 through the Australian Cancer Database and linked these records to national medication and death databases. We used Cox proportional hazards regression to estimate hazard ratios (HR) and confidence intervals (CI) for associations between statins and survival.

Results

Pre-diagnosis statin use was not associated with survival overall but was associated with better survival among women with endometrioid cancers. Statin use after diagnosis was associated with better ovarian cancer-specific survival (OVS, HR = 0.87, 95%CI 0.81–0.94), but this association was largely restricted to women who started using statins after their cancer diagnosis (OVS HR = 0.68, 0.57–0.81 vs. HR = 0.94, 0.87–1.01 for continuing users). The association was strongest for endometrioid cancers (OVS HR = 0.48, 0.29–0.77).

Conclusions

Use of statins may confer a survival benefit for women with ovarian cancer but it is impossible to rule out bias in observational studies. Particularly problematic are reverse causation where disease status affects statin use, confounding by indication and the absence of data for women with normal cholesterol levels. A randomised trial is required to provide definitive evidence.

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Fig. 1: Flowchart showing derivation of the study cohort.

Data availability

The datasets used for the current study are not publicly available due to privacy issues. Strict access restrictions apply to linked data such that they can only be accessed by approved study investigators.

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Acknowledgements

We acknowledge the Australian Capital Territory Cancer Registry; New South Wales Central Cancer Registry and Ministry of Health; Chief Health Officer of the Northern Territory; Queensland Department of Health; South Australia Health, Government of South Australia; Director of Public Health Tasmania; Victorian Cancer Registry; Western Australia Cancer Registry and Commonwealth Department of Health for allowing access to their data. We also thank the Data Linkage Group at the Australian Institute of Health and Welfare (AIHW) for their help with facilitating and performing the data linkage. This project was approved by all relevant human research ethics committees (QIMR Berghofer Medical Research Institute HREC; AIHW HREC; ACT Health HREC, 3 August 2015; NSW Population and Health Services Research Ethics Committee; SA Health Human Research Ethics Committee; Human Research Ethics Committee (Tasmania) Network; Cancer Council Victoria Human Research Ethics Committee).

Funding

This work was supported by the National Health and Medical Research Council (NHMRC) of Australia (GNT1073898). P.M.W. was supported by a fellowship from the NHMRC (GNT1173346).

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Authors

Contributions

Jia-Li Feng: Data analysis, interpretation of results, editing and review of the final manuscript; Suzanne Dixon-Suen: Project design, interpretation of results, editing and review of the final manuscript; Susan Jordan: Project design, interpretation of results, editing and review of the final manuscript; Penelope Webb: Funding acquisition, project design, supervision, interpretation of results, drafting and revising the manuscript.

Corresponding author

Correspondence to Penelope M. Webb.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Human Research Ethics Committees at QIMR Berghofer Medical Research Institute (P2061), the Australian Institute of Health and Welfare (EO2014-3-116) and all relevant data custodians. The study was performed in accordance with the Declaration of Helsinki and the authors did not have any access to identifying information for individuals. Individual consent was not obtained.

Consent to publish

Not applicable.

Competing interests

P.M.W. has received grant funding from Astra Zeneca for an unrelated ovarian cancer study. The remaining authors have declared no competing interests.

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Feng, JL., Dixon-Suen, S.C., Jordan, S.J. et al. Statin use and survival among women with ovarian cancer: an Australian national data-linkage study. Br J Cancer 125, 766–771 (2021). https://doi.org/10.1038/s41416-021-01460-4

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