Evidence map›Paper›PMID 32831062›Full record

ArticleBMC cancer2020

Post-diagnostic antipsychotic use and cancer mortality: a population based cohort study.

Blánaid M Hicks, John Busby, Ken Mills, Francis A O'Neil, Stuart A McIntosh, Shu-Dong Zhang, Fabio Giuseppe Liberante, Chris R Cardwell

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC cancer, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Review
  8. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 3 countries.

Blánaid M HicksCentre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland. B.Hicks@qub.ac.uk.ORCID http://orcid.org/0000-0002-5730-9469
John BusbyCentre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland.
Ken MillsCentre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland.
Francis A O'NeilCentre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland.
Stuart A McIntoshCentre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland.
Shu-Dong ZhangNorthern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, University of Ulster, C-TRIC Building, Altnagelvin Area Hospital, Londonderry, UK.
Fabio Giuseppe LiberanteCentre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland.
Chris R CardwellCentre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland.
Royal Victoria Eye and Ear Hospital · IEQueen's University Belfast · GBUniversity of Ulster · GB

Funding

Cancer Research UK 18225Cancer Research UK 22185Cancer Research UK C37316/A18225
6 · The paper itself

Abstract

backgroundMany antipsychotics elevate prolactin, a hormone implicated in breast cancer aetiology however no studies have investigated antipsychotic use in patients with breast cancer. This study investigated if antipsychotic use is associated with an increased risk of cancer-specific mortality among breast cancer patients.

methodsA cohort of 23,695 women newly diagnosed with a primary breast cancer between 1st January 1998 and 31st December 2012 was identified from the UK Clinical Practice Research Datalink linked to English cancer-registries and followed for until 30th September 2015. Time-dependent Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer-specific mortality comparing use of antipsychotics with non-use, overall, and by prolactin elevating activitiy. Analyses were repeated restricting to patients with a history of severe mental illness to control for potential confounding by indication.

resultsIn total 848 patients were prescribed an antipsychotic and of which 162 died due to their breast cancer. Compared with non-use, antipsychotic use was associated with an increased risk of breast-cancer specific mortality (HR 2.25, 95%CI 1.90-2.67), but this did not follow a dose response relation. Restricting the cohort to patients with severe mental illness attenuated the association between antipsychotic use and breast cancer-specific mortality (HR 1.11, 95%CI 0.58-2.14).

conclusionsIn this population-based cohort of breast cancer patients, while the use of antipsychotics was associated with increased breast cancer-specific mortality, there was a lack of a dose response, and importantly null associations were observed in patients with severe mental illness, suggesting the observed association is likely a result of confounding by indication. This study provides an exemplar of confounding by indication, highlighting the importance of consideration of this important bias in studies of drug effects in cancer patients.

Indexed as

AgedAntipsychotic AgentsBreast NeoplasmsConfounding Factors, EpidemiologicDrug PrescriptionsFemaleFollow-Up StudiesHumansMental DisordersMiddle AgedProportional Hazards ModelsRegistriesRisk FactorsSeverity of Illness IndexSurvival AnalysisUnited KingdomAntipsychotic AgentsAntipsychoticsBreast cancerProlactinSurvival

Identifiers

PMID32831062
PMCPMC7446212
OpenAlexW3080275451

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.