Patterns of antidepressant use in patients with cancer: An analysis from SOAPP (E2Z02: Symptom Outcomes and Practice Patterns).

Abstract

59 Background: Antidepressant (AD) use is common in outpatient oncology, but the pattern and determinants of prescribing for commonly used AD are unknown. Methods: 3,106 pts with cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites in a study of symptoms. Five depression case-finding methods were explored: 3 based on MDASI items reported by patients (1) sadness/depression>=4, (2) distress>=4, (3) interference with mood>=7 or enjoyment>=7; 2 based on clinician’s report (4) presence of psychological distress, (5) depression being listed as one of top 3 symptoms. AD use (excluding tricyclic antidepressants and psychostimulants) was examined by depression status. Logistic regression models were used to examine the effect of demographic and clinical characteristics on AD use. Results: Rates of depressive symptoms varied by casefinding method (1=29%, 2=28%, 3=14%, 4=24%, 5=11%); 47% (1,457) pts were defined as having depressive symptoms by at least one method. AD were prescribed in 25% of depressed pts compared to 14% of non-depressed pts. After adjusting for other covariates, factors associated with greater use of AD included depression (OR=1.7, p<0.01), family history of depression (OR=2.2, p<0.01), female sex (OR=1.8, P<0.01), younger age (OR=1.2, P=0.04), non-Hispanic White race (OR=2.0, p<0.01), prior chemo/immune/ hormonal treatment (OR=1.5, p<0.01), more concurrent medication use (OR=3.3, p<0.01), anxiolytics use (OR=2.0, p<0.01), sedative use (OR=2.1, p<0.01), receiving counseling (OR=1.6, p=0.04), patient’s perception of poor QOL (OR=1.3, p=0.02), duration of current treatment >1 year (OR=1.6, p<0.01), and being enrolled by a CCOP (OR=1.8, p=0.01). These significant associations remained regardless of the case-finding method used for depression. Conclusions: One-fourth of solid tumor pts with depressive symptoms are taking an AD. Antidepressant prescribing varies by type of institution, race/ethnicity, age, concomitant medication exposure and several other clinical factors. There is an opportunity to improve outcomes through quality improvement initiatives related to antidepressant prescribing.