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.
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