Use of psychotropic medications by US cancer survivors

Center for Applied Health Research, Scott & White, Temple, TX, USA. .
Psycho-Oncology (Impact Factor: 2.44). 11/2012; 21(11). DOI: 10.1002/pon.2039
Source: PubMed


OBJECTIVES: This study aimed to describe national utilization of psychotropic medications by adult cancer survivors in the USA and to estimate the extra use of psychotropic medications that is attributable to cancer survivorship. METHODS: Prescription data for 2001-2006 from the Medical Expenditure Panel Survey (MEPS) were linked to the data identifying cancer survivors from the National Health Interview Survey, the MEPS sampling frame. The sample was limited to adults 25 years of age and older. Propensity score matching was used to estimate the effects of cancer survivorship on utilization of psychotropic medications by comparing cancer survivors and other adults in MEPS. Utilization was measured as any use during a calendar year and the number of prescriptions purchased (including refills). Analyses were stratified by gender and age, distinguishing adults younger than 65 years from those 65 years and older. RESULTS: Nineteen percent of cancer survivors under age 65 years and 16% of survivors age 65 years and older used psychotropic medications. Sixteen percent of younger survivors used antidepressants, 7% used antianxiety medications. For older survivors, utilization rates for these two drug types were 11% and 7%, respectively. The increase in any use attributable to cancer amounted to 4-5 percentage points for younger survivors (p < 0.05) and 2-3 percentage points for older survivors (p < 0.05), depending on gender. CONCLUSION: Increased use of psychotropic medications by cancer survivors, compared with other adults, suggests that survivorship presents ongoing psychological challenges. Copyright © 2011 John Wiley & Sons, Ltd.

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Available from: Rajeshwari Punekar, May 22, 2015
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    • "Even though these rates appear to be high, a consistent difference to a systematically matched sample from general population data is still controversial. The existing data suggest that “survivorship presents ongoing psychological challenges” [7]. "
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    ABSTRACT: Background Over the past thirty years a number of studies have suggested that antidepressants can be effective in the treatment of depressive symptoms in patients with cancer. The aim of this paper was to review randomized controlled trials (RCTs) and to perform a meta-analysis in order to quantify their overall effect. Methods Pubmed and the Cochrane libraries were searched for the time period between 1980 and 2010. Results Nine RCTs were identified and reviewed. Six of them (with a total of 563 patients) fulfilled the criteria for meta-analysis, but exhibited an unclear risk for bias. The estimated effect size was 1.56 with 95% CI: 1.07- 2.28 (p= 0.021). There were no differences in discontinuation rates between antidepressants and placebo groups (RR= 0.86 with 95% CI 0.47- 1.56, p=0.62). Conclusions This meta-analysis suggests that antidepressants can be effective in treating depressive symptoms beside clinical depression. When considering the risk of side effects and interactions and the heterogeneity among the mostly small studies, a general recommendation cannot be made until well-controlled studies are conducted.
    BMC Psychiatry 05/2013; 13(1):140. DOI:10.1186/1471-244X-13-140 · 2.21 Impact Factor
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    ABSTRACT: The medications known as antidepressants are the group of psychotropic drugs used most often in psycho-oncology for their wide spectrum of action, ranging from mood improvement to the control of anxiety and pain. Antidepressants are drugs that act on the whole body rather than just the central nervous system. They also modulate the hormonal and immune systems, particularly normalizing stress-induced alterations. In oncology, the choice of an antidepressant must involve consideration of the symptoms and the dimensional aspects more than strict diagnostic criteria. A careful evaluation of the balance between effectiveness and safety, considering the possibility of interactions between antidepressants and oncological treatments, is crucial. In that context, this paper discusses each class of antidepressant relative to the present research literature concerning the specific use of each drug in oncological patients, noting that criteria of effectiveness and safety can differ from those established for the general psychiatric population without organic comorbidity. Finally, some aspects of the use of antidepressants in the treatment of patients with pain will be discussed, as these drugs exert an intrinsic antalgic activity even when depressed mood is not present. Indeed, antidepressants act not only on the somatic modulation of pain, but are also effective on the emotional and cognitive aspects of pain, therefore intensifying the analgesic activity of traditional painkillers.
    01/2012; 1(2):179-202. DOI:10.1615/NeuropatholDiseases.v1.i2.60
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    ABSTRACT: Purpose The aim of this study is to assess mental health services utilization and expenditures associated with cancer history using a nationally representative sample in the US. Methods We used data from the 2008-2011 Medical Expenditure Panel Survey and multivariate regression models to assess mental health services use and expenditures among cancer survivors compared to individuals without a cancer history, stratified by age (18-64 and ≥65 years) and time since diagnosis (≤1 vs. >1 year). Results Among adults aged 18-64, compared with individuals without a cancer history, cancer survivors were more likely to screen positive for current psychological distress and depression regardless of time since diagnosis; survivors diagnosed >1 year ago were more likely to use mental health prescription drugs; those diagnosed within 1 year reported significantly lower annual per capita mental health drug expenditure and out-of-pocket mental health expenditure, while those diagnosed >1 year presented significantly higher annual per capita mental health expenditure. No significant differences in mental health expenditures were found among adults aged 65 or older. Conclusions Mental health problems presented higher health and economic burden among younger and longer-term survivors than individuals without a cancer history. This study provides data for monitoring the impact of initiatives to enhance coverage and access for mental health services at the national level. Implications for cancer survivors Early detection and appropriate treatment of mental health problems may help improve quality of cancer survivorship.
    Journal of Cancer Survivorship 08/2014; 9(1). DOI:10.1007/s11764-014-0392-0 · 3.30 Impact Factor

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