Racial disparities in depressive symptom prevalence and selective serotonin reuptake inhibitor (SSRI) utilization in cancer patients: An analysis from ECOG E2Z02: Symptom Outcomes and Practice Patterns (SOAPP).

Abstract

6076 Background: Rates of diagnosis and treatment of depression in primary care vary widely by race. It is unclear whether such disparity exists in oncology. Methods: 3106 patients with cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites in a longitudinal study of symptoms. Patient-reported depressed mood (PRD) on a 0-10 numerical rating scale and clinician-reported psychological distress (CRD) were used to identify depressive patients at baseline. Patients also rated depressed mood 4-5 weeks after baseline. A 2-point change was considered clinically significant for change in PRD. Logistic regression models were used to examine the effect of race on prevalence of depression and antidepressant use. Ordinal logistic regression models examined the effect of race on changes in depression. Results: Of the 3106 patients, 2648 were white, 364 were black, and 94 were other race. At baseline, 20% had moderate/severe PRD; CRD was 28%. Black patients had higher rates of depression than whites, but the difference was not significant after adjusting for other covariates (PRD: 24% vs. 20%, adjusted OR=1.1, P=0.6; CRD: 30% vs. 27%, adjusted OR=1.06, P=0.8). Improvement in depressed mood varied by baseline PRD score (57% with severe depression, 51% with moderate, and 14% with mild). In patients with moderate/severe depression at baseline, blacks were less likely to have depression improvement than whites (adjusted OR=0.41, P=0.008 for moderate depression, adjusted OR=0.35, P=0.01 for severe depression). Among patients with depression defined by CRD, 29% were taking an SSRI (blacks: 14%, whites: 31%), Blacks were less likely to take an SSRI than whites (adjusted OR=0.38, P=0.01). Conclusions: Less than one third of patients with depressive symptoms are taking SSRI antidepressants. Black race is not only associated with less improvement in depressive symptoms over time but also lower probability of SSRI utilization.