Differences in discontinuation of statin treatment in women and men with advanced cancer disease

Abstract

BackgroundStatins are often discontinued in patients with advanced cancer since the net effect of treatment is considered negative. However, guidelines concerning discontinuation of statin treatment are lacking. The aim of this study was to investigate any differences in time of discontinuation of statin treatment between men and women with advanced cancer disease.MethodsMedical records from 195 deceased palliative cancer patients from a previous study cohort were reviewed. Patients treated with statins 2 years before death were identified as “statin users.” The time of discontinuation of statin therapy was identified and correlated to time of death. Only patients that had incurable cancer disease at time of statin discontinuation were included in the analysis.ResultsFifty-four patients were identified as statin users, 29 women and 25 men. The average time span between discontinuation of statin treatment and time of death was significantly longer in women than in men, 10 months compared to 4 months (p < 0.01), with a range of 1–24 months among women and 1–12 months for men. All patients died due to their cancer disease. More men than women had a history of stroke or cardiac infarction (p = 0.02). There were no differences in age, socioeconomic factors, or survival time from study inclusion between men and women. There was no difference in self-assessed quality of life (QoL) between statin users who had discontinued statin treatment and those who are still on treatment. Men generally assessed their QoL lower than women in this study (p = 0.03).ConclusionStatin treatment was discontinued earlier in women than in men in patients with advanced cancer. The data suggest that statins may be discontinued earlier in men as well, since earlier discontinuation did not affect cardiovascular mortality.

Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

“…The results from this study, is in concordance with our previous, smaller study, which showed that statins were discontinued earlier in women than in men [ 18 ]. However, in that study patients with advanced cancer two years before death were included and they followed for the two last years in life compared to the last year in life in this study.…”

“…In the present study, there was no difference in cardiovascular events or cardiovascular mortality between men and women after statin discontinuation. This is also in line with earlier studies showing that statin discontinuation in palliative care patients do not affect mortality or cardiovascular events [ 12 , 18 ].…”

“…The results presented here are in line with previous studies indicating that statins can be safely discontinued in patients with advanced cancer with limited life-time expectancy [ 11 , 12 , 18 ]. However, men and women are different populations and results from men might not necessarily be applicable on women.…”

“…In the study by Kutner et al, statin cessation was associated with improved QoL [ 12 ]. In our previous study there was no difference in self-assessed QoL between patients who continued and who had discontinued statin treatment [ 18 ]. The question whether statin treatment affects QoL or not is an important issue in the palliative care setting, but unfortunately, we had no data on this in the present, retrospective study.…”

“…Interestingly, few studies have examined sex-differences in discontinuation of statin treatment. In a small pilot-study ( n = 52) from a palliative unit in Stockholm, Sweden, we previously reported that statin treatment was terminated significantly earlier in women than in men [ 18 ]. In this study, there were no differences in age, socioeconomic factors or indication for statin treatment that could explain the difference in time-point for statin termination.…”