Abstract
6132 Background: Antidepressant (AD) therapy may be initiated in cancer patients for affective or anxiety disorders, or management of symptoms. Practice patterns vary, and prescribing trends are poorly understood. Methods: Retrospective cohort study using outpatient prescribing data and routine clinical data available through the computerized data system at our comprehensive cancer center (CC). Results: Whereas the CC patient population “at risk” for AD exposure increased by 19% between 1998 and 2001( from 46, 081 to 54,902 patients), there was a 37% increase in the number of patients who filled an AD prescription at the CC pharmacy (p<0.0001). In the AD cohort of 2001, there was a preponderance of women (58.5%) and Caucasian (76%) patients and 65.5% were in the 40–65 yr. age category. Also noted was a significant association between gender and race (p<0.0001) in this group. Only 34.6% had an ICD-9 coded diagnosis related to depression or anxiety, and 246/1782 (13.8%) of patients were prescribed an AD by a psychiatrist. Patients with AD from psychiatrists had a higher median yearly total AD cost ($203.52 vs. $72.49, p<0.00001), and more physician visits per year (median 13.5 vs. 10.0, p<0.00001). When considering the larger cohort of 4,841 patients who received an opioid and/or an AD prescription in 2001, the odds of receiving an AD were significantly increased in women, even adjusting for age-category and race (odds ratio 1.60, 95% CI 1.42–1.81). Finally, the category of AD prescribed shifted between 1998–2001 away from tricyclics (TCA) towards serotonin-reuptake inhibitors (SSRI) and other newer AD (p<0.0001). Conclusions: AD prescribing is increasing at our CC and women are more likely to receive an AD. Most AD are prescribed by non-psychiatrists and without a coded diagnosis related to depression or anxiety. There is increasing use of newer antidepressants, and psychiatrists have unique prescribing trends at our CC. No significant financial relationships to disclose.
Published Version
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