Prescription patterns for psychotropic drugs in cancer patients; A large population study in the Netherlands
Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands Psycho-Oncology
(Impact Factor: 2.44).
04/2013; 22(4). DOI: 10.1002/pon.3056
BACKGROUND: Psychotropic drugs are commonly prescribed for various psychological complaints in cancer patients. We aim to examine the prescription pattern in cancer patients of three common psychotropic drugs: benzodiazepine, antidepressant and antipsychotic. METHODS: This is a retrospective case-control study. Data were extracted from the Agis Health Database. This insurance database contains the healthcare consumption of 1.3 million inhabitants of the Netherlands. We analyzed the use of psychotropics in cancer patients and an equally sized randomly selected control group of noncancer patients from 2006 to 2008. Odds ratio (OR) were adjusted for age, gender, immigrant status, neighborhood socio-economic status, and premorbid medical condition. Additionally, the numbers of new user in the 3 months after cancer was diagnosed and in the 3 months before death were compared. RESULTS: A total of 113 887 cancer patients and 121 395 control subjects were included. Cancer patients were significantly more often prescribed psychotropic drugs (adjusted OR: benzodiazepines = 1.70, CI = 1.67-1.74; antidepressants = 1.38, CI = 1.34-1.42; and antipsychotics = 1.70, CI = 1.62-1.77). Lower socio-economic status, immigrant, and premorbid chronic medical conditions were significantly associated with higher risk of psychotropic use. Odds for a new prescription for all three psychotropic drugs were significantly less in the first 3 months after cancer diagnosis than the 3 months before death (benzodiazepine, OR = 0.673, CI = 0.647-0.705; antidepressant, OR = 0.592, CI = 0.544-0.644; antipsychotic, OR = 0.177, CI = 0.165-0.190) CONCLUSIONS: Psychotropic drug prescription is common in cancer patients, starts soon after diagnosis, and increases in the terminal stage. Prescription rates were significantly higher in patients from lower socio-economic group, immigrants, or with premorbid chronic medical condition.Copyright © 2012 John Wiley & Sons, Ltd.
Available from: Luigi Grassi
- "Regarding antidepressants, a study showed that survivors of childhood, adolescent, and young adult cancer (n ϭ 2,389) had an increased likelihood of using all categories of antidepressants, and of using drugs from two or more antidepressant categories, compared to birth-cohort and gendermatched randomly selected population (n ϭ 23,890) (Deyell et al., 2013). The tendency to prescribe psychotropic medications in the advanced phase of cancer and particularly before death was also pointed out in a recent retrospective case-control study including a total of 113,887 patients (Ng et al., 2013). This background supports the need for a comprehensive review of psychopharmacological research and clinical practice in oncology, that is now an invaluable and extremely important area of cancer care, better defi ned as ' psychopharmoncology ' as a concept integrating the special components of psychological and psychopharmacological treatment in oncology (Grassi & Riba, 2014). "
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ABSTRACT: Abstract At least 25-30% of patients with cancer and an even higher percentage of patients in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, adjustment disorders, sleep disorders and delirium. A number of studies have accumulated over the last 35 years on the use of psychotropic drugs as a pillar in the treatment of psychiatric disorders. Major advances in psycho-oncology research have also shown the efficacy of psychotropic drugs as adjuvant treatment of cancer-related symptoms, such as pain, hot flushes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. The knowledge about pharmacokinetics and pharmacodynamics, clinical use, safety, side effects and efficacy of psychotropic drugs in cancer care is essential for an integrated and multidimensional approach to patients treated in different settings, including community-based centres, oncology, and palliative care. A search of the major databases (MEDLINE, Embase, PsycLIT, PsycINFO, the Cochrane Library) was conducted in order to summarize relevant data concerning the efficacy and safety of pharmacotherapy for cancer-related psychiatric disorders in cancer patients across the trajectory of the disease.
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ABSTRACT: It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease.
To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally ill patients in the GP setting, comparing both patients with terminal cancer and heart failure.
Retrospective cohort study using the Utrecht General Practitioner Research Network.
Equally-sized groups of patients with terminal cancer and heart failure were randomly selected from the database of four general practices over the years 2005-2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical Therapeutic Chemical (ATC) Classification System codes.
A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was 15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease and psychotropic drug prescription between patients with terminal cancer and heart failure.
The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure.
Available from: Marco PM Boks
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ABSTRACT: The lack of universal criteria makes diagnosing clinical depression in cancer patients a challenging task. We therefore review the current state of evidence regarding such diagnostic criteria for major depressive disorder in cancer patients.
We conducted a literature search for studies which compare two or more sets of diagnostic criteria for depression in cancer patients. The results were extracted and summarized.
Three original studies were included in this review. One study supported the use of substitutive (Endicott) criteria. Another study showed the potential of an increased threshold approach and one had no conclusive findings.
There was no standard reference test and precise definition of alternative criteria in these studies. There are no recognized diagnostic criteria for depression in cancer patients despite an apparent need for such criteria.
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