1
|
Lam CS, Lee CP, Chan JWY, Cheung YT. Patterns and factors associated with the prescription of psychotropic medications after diagnosis of cancer in Chinese patients: A population-based cohort study. Pharmacoepidemiol Drug Saf 2024; 33:e5754. [PMID: 38362653 DOI: 10.1002/pds.5754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/17/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Patients with cancer may be prescribed psychotropic medications to address their psychiatric symptoms and disorders. This study examined the patterns and factors associated with the prescription of psychotropics after cancer diagnosis using a population-based database in Hong Kong. METHODS Patients who were diagnosed with malignant cancer and had no documented psychiatric diagnosis or psychotropic medications prior to cancer diagnosis, were included. Multivariable log-binomial models were used to explore the associations between predictive factors and psychotropic medications use. RESULTS Among 9337 patients, 1868 patients (20.0%) were newly prescribed with psychotropic medications after cancer diagnoses, most commonly hypnotics (50.3%) and antidepressants (32.8%). About one-third (31.4%) were prescribed chronic psychotropics (≥90 days). Approximately 48.3% of patients who were prescribed psychotropic medications received their prescriptions within 1 year after diagnosed with cancer. Only 18.6% of those prescribed psychotropic medications had a registered psychiatric diagnosis. Patients with multiple comorbidities (adjusted risk ratio[aRR] = 2.74; CI = 2.46-3.05) and diagnosed with oral (aRR = 1.89; CI = 1.52-2.35) or respiratory cancers (aRR = 1.62; CI = 1.36-1.93) were more likely to be prescribed psychotropics. CONCLUSIONS The use of psychotropic medication is common (20%) among patients with cancer. Our findings highlight the importance of identification and documentation of psychiatric needs among patients with cancer.
Collapse
Affiliation(s)
- Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chui Ping Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
2
|
Dai D, Coetzer H, Zion SR, Malecki MJ. Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population. Cancer Control 2022; 29:10732748221140691. [DOI: 10.1177/10732748221140691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Multimorbidity is common in patients with breast cancer, thus increasing the complexity of cancer care and economic burden, worsening their prognosis and quality of life. The prevalence of multimorbidity and its influence on psychological distress among patients with breast cancer have not been well characterized. Objectives To examine the prevalence of multimorbidity and its associations with anxiety and depression among newly diagnosed patients with breast cancer. Methods We conducted a retrospective observational cohort study using a large administrative claims database. Patients with breast cancer (ICD-10-CM: C50.x) were identified during the study period (1/1/2017-12/31/2020). The index date was defined as the diagnosis date of breast cancer. Demographics and comorbid conditions were assessed using data within 12 months prior to the index date. Multimorbidity was defined as the presence of ≥2 comorbid conditions. Anxiety and depression were examined using data within 12 months after the index date. Multivariable logistic regressions were performed to examine the associations between multimorbidity and anxiety and depression, adjusting for sociodemographic factors. Results Of the 6392 patients with newly diagnosed breast cancer, 86.9% had multimorbidity at the time of breast cancer diagnosis. The median number of comorbid conditions was 5. Overall, 27.7% experienced anxiety, and 21.9% experienced depression in the first year following breast cancer diagnosis. An increased number of comorbid conditions was associated with elevated prevalence of both anxiety and depression. After adjusting for possible confounding factors, number of comorbid conditions was significantly associated with risk of anxiety (adjusted odds ratio [95% confidence interval (CI)]: 1.17 [1.15-1.19]), and depression (1.24 [1.21-1.26]); all P < .0001. Conclusions Multimorbidity was highly prevalent among patients with breast cancer and was strongly associated with increased risk of anxiety and depression in the first year following breast cancer diagnosis. The presence of multimorbidity, anxiety, and depression should be considered in the context of clinical decision making to optimize cancer care and improve mental health and quality of life.
Collapse
Affiliation(s)
- Dingwei Dai
- CVS Health Clinical Trial Services, LLC, Woonsocket, RI, USA
| | | | - Sean R. Zion
- Blue Note Therapeutics, Inc., San Francisco, CA, USA
| | | |
Collapse
|
3
|
Jazzar U, Bergerot CD, Shan Y, Wallis CJD, Freedland SJ, Kamat AM, Tyler DS, Baillargeon J, Kuo YF, Klaassen Z, Williams SB. Use of psychotropic drugs among older patients with bladder cancer in the United States. Psychooncology 2021; 30:832-843. [PMID: 33507622 DOI: 10.1002/pon.5641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/09/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Older patients diagnosed with cancer are at increased risk of physical and emotional distress; however, prescription utilization patterns largely remain to be elucidated. Our objective was to comprehensively assess prescription patterns and predictors in older patients with bladder cancer. METHODS A total of 10,516 older patients diagnosed with clinical stage T1-T4a, N0, M0 bladder urothelial carcinoma from 1 January 2008 to 31 December 2012 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare were analyzed. We used multivariable analysis to determine predictors associated with psychotropic prescription rates (one or more). Medication possession ratio (MPR) was used as an index to measure adherence in intervals of 3 months, 6 months, 1 year, and 2 years. Evaluation of psychotropic prescribing patterns and adherence across different drugs and demographic factors was done. RESULTS Of the 10,516 older patients, 5621 (53%) were prescribed psychotropic drugs following cancer diagnosis. Overall, 3972 (38%) patients had previous psychotropic prescriptions prior to cancer diagnosis, and these patients were much more likely to receive a post-cancer diagnosis prescription. Prescription rates for psychotropic medications were higher among patients with higher stage BC (p < 0.001). Gamma aminobutyric acid modulators/stimulators and serotonin reuptake inhibitors/stimulators were the highest prescribed psychotropic drugs in 21% of all patients. Adherence for all drugs was 32% at 3 months and continued to decrease over time. CONCLUSION Over half of the patients received psychotropic prescriptions within 2 years of their cancer diagnosis. Given the chronicity of psychiatric disorders with observed significantly low adherence to medications that warrants an emphasis on prolonged patient monitoring and further investigation.
Collapse
Affiliation(s)
- Usama Jazzar
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Cristiane D Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Distrito Federal, Brazil
| | - Yong Shan
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | - Stephen J Freedland
- Department of Urology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta, Georgia, USA
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| |
Collapse
|
4
|
Walsh RL, Lofters AK, Moineddin R, Krzyzanowska MK, Grunfeld E. The effect of comorbidity on primary care use during breast cancer chemotherapy: a population-based retrospective cohort study using CanIMPACT data. CMAJ Open 2021; 9:E331-E341. [PMID: 33795223 PMCID: PMC8034254 DOI: 10.9778/cmajo.20200166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with breast cancer visit their primary care physicians (PCPs) more often during chemotherapy than before diagnosis, but the reasons are unclear. We assessed the association between physical comorbidities and mental health history (MHH) and the change in PCP use during adjuvant breast cancer chemotherapy. METHODS We conducted a population-based, retrospective cohort study using data from the Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) project. Participants were women 18 years of age and older, who had received a diagnosis of stage I-III breast cancer in Ontario between 2007 and 2011 and had received surgery and adjuvant chemotherapy. We used difference-in-difference analysis using negative binomial modelling to quantify the differences in the 6-month rate of PCP visits at baseline (the 24-month period between 6 and 30 months before diagnosis) and during treatment (the 6 months from start of chemotherapy) between physical comorbidity and MHH groups. RESULTS Among 12 781 participants, the 6-month PCP visit rate increased during chemotherapy (mean 2.3 visits at baseline, 3.4 visits during chemotherapy). Patients with higher physical comorbidity levels or MHH visited their PCPs 4.2 or 1.7 more times, respectively, over 6 months compared to those with low physical comorbidity or no MHH at baseline and 2.5 or 1.1 more times, respectively, over 6 months during treatment. During treatment, the adjusted 6-month rate of PCP visits more than doubled in the group with the fewest physical comorbidities or no MHH compared with baseline (rate ratio 2.52, 95% confidence interval [CI] 2.43-2.61). This increase was lower in those with MHH (rate ratio 1.81, 95% CI 1.68-1.96) and in the highest physical comorbidity group (rate ratio 1.16, 95% CI 1.07-1.28). INTERPRETATION Patients with breast cancer who have more physical comorbidities and MHH have a higher frequency of PCP visits during adjuvant chemotherapy but lower absolute and relative increases in visits compared with baseline. Therefore, PCPs can expect to see their patients with fewer physical comorbidities and no MHH more often during chemotherapy. Primary care physicians can plan for their patients with high physical comorbidity levels and MHH to continue having frequent appointments while they undergo chemotherapy, and they can expect their patients with low physical comorbidity levels and no MHH to increase the frequency of their visits during chemotherapy, and should be prepared to provide breast cancer-related care to these patients.
Collapse
Affiliation(s)
- Rachel L Walsh
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.
| | - Aisha K Lofters
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Rahim Moineddin
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Monika K Krzyzanowska
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Eva Grunfeld
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| |
Collapse
|
5
|
Vyas A, Alghaith G, Hufstader-Gabriel M. Psychotropic polypharmacy and its association with health-related quality of life among cancer survivors in the USA: a population-level analysis. Qual Life Res 2020; 29:2029-2037. [PMID: 32207028 DOI: 10.1007/s11136-020-02478-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Cancer survivors that use multiple psychotropic medications are at an increased risk of psychotropic polypharmacy. We examined the association between psychotropic polypharmacy and health-related quality of life (HRQoL) among cancer survivors living in the USA. METHODS We used the Medical Expenditure Panel Survey (MEPS) data for 2010, 2012, and 2014 to identify adult cancer survivors. Psychotropic polypharmacy was defined as use of at least two classes of psychotropic prescription medications. The physical component summary (PCS) and the mental component summary (MCS) were obtained from the 12-item Short Form Health Survey version 2 to measure HRQoL. Adjusted ordinary least square regressions were performed to evaluate the association between psychotropic polypharmacy and HRQoL. RESULTS Among 31 million US cancer survivors (weighted from a sample of 2609), 16.3% reported psychotropic polypharmacy. Lung cancer survivors had the highest prevalence of psychotropic polypharmacy (22.5%), followed by survivors of breast cancer (17.8%), colorectal, and other gastrointestinal cancers (16.0%). The unadjusted PCS and MCS scores for those with psychotropic polypharmacy were significantly lower than those without psychotropic polypharmacy, overall, and for each cancer type. In multivariable regressions, cancer survivors with psychotropic polypharmacy had significantly lower PCS scores (β = - 3.63, p < 0.0001) and MCS scores (β = - 2.28, p = 0.0138) compared to those without psychotropic polypharmacy. CONCLUSION Cancer survivors requiring multiple psychotropic medications have poorer quality of life.
Collapse
Affiliation(s)
- Ami Vyas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA.
| | - Ghadah Alghaith
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA.,Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | | |
Collapse
|
6
|
Gauthier M, Conte C, Palmaro A, Patras De Campaigno E, De Barros S, Huguet F, Laurent G, Lapeyre‐Mestre M, Despas F. Psychotropic drug initiation in patients diagnosed with chronic myeloid leukemia: a population‐based study in France. Fundam Clin Pharmacol 2020; 34:612-622. [DOI: 10.1111/fcp.12544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/13/2019] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Martin Gauthier
- Département d’Hématologie Institut Universitaire du Cancer‐Oncopole 1 Avenue Irène Joliot‐Curie 31059 Toulouse Cedex France
| | - Cécile Conte
- Service de Pharmacologie Médicale et Clinique CHU de Toulouse 37 allées Jules Guesde 31000 Toulouse France
- UMR1027 Inserm Université Paul Sabatier Toulouse France
- Service de Pharmacologie Médicale et Clinique Faculté de Médecine Université Paul Sabatier Toulouse France
| | - Aurore Palmaro
- Service de Pharmacologie Médicale et Clinique CHU de Toulouse 37 allées Jules Guesde 31000 Toulouse France
- UMR1027 Inserm Université Paul Sabatier Toulouse France
- Service de Pharmacologie Médicale et Clinique Faculté de Médecine Université Paul Sabatier Toulouse France
- INSERM CIC 1436 Toulouse Centre d’Investigation Clinique de Toulouse Centre Hospitalier Universitaire de Toulouse France
| | - Emilie Patras De Campaigno
- Service de Pharmacologie Médicale et Clinique CHU de Toulouse 37 allées Jules Guesde 31000 Toulouse France
- UMR1027 Inserm Université Paul Sabatier Toulouse France
- Service de Pharmacologie Médicale et Clinique Faculté de Médecine Université Paul Sabatier Toulouse France
| | - Sandra De Barros
- Service de Pharmacologie Médicale et Clinique CHU de Toulouse 37 allées Jules Guesde 31000 Toulouse France
- Service de Pharmacologie Médicale et Clinique Faculté de Médecine Université Paul Sabatier Toulouse France
| | - Françoise Huguet
- Département d’Hématologie Institut Universitaire du Cancer‐Oncopole 1 Avenue Irène Joliot‐Curie 31059 Toulouse Cedex France
| | - Guy Laurent
- Département d’Hématologie Institut Universitaire du Cancer‐Oncopole 1 Avenue Irène Joliot‐Curie 31059 Toulouse Cedex France
- UMR1027 Inserm Université Paul Sabatier Toulouse France
| | - Maryse Lapeyre‐Mestre
- Service de Pharmacologie Médicale et Clinique CHU de Toulouse 37 allées Jules Guesde 31000 Toulouse France
- UMR1027 Inserm Université Paul Sabatier Toulouse France
- Service de Pharmacologie Médicale et Clinique Faculté de Médecine Université Paul Sabatier Toulouse France
- INSERM CIC 1436 Toulouse Centre d’Investigation Clinique de Toulouse Centre Hospitalier Universitaire de Toulouse France
| | - Fabien Despas
- Service de Pharmacologie Médicale et Clinique CHU de Toulouse 37 allées Jules Guesde 31000 Toulouse France
- UMR1027 Inserm Université Paul Sabatier Toulouse France
- Service de Pharmacologie Médicale et Clinique Faculté de Médecine Université Paul Sabatier Toulouse France
- INSERM CIC 1436 Toulouse Centre d’Investigation Clinique de Toulouse Centre Hospitalier Universitaire de Toulouse France
| |
Collapse
|
7
|
Jayani R, Rosko A, Olin R, Artz A. Use of geriatric assessment in hematopoietic cell transplant. J Geriatr Oncol 2019; 11:225-236. [PMID: 31761694 DOI: 10.1016/j.jgo.2019.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
Hematopoietic cell transplant (HCT) is an important aspect of treatment for many hematologic malignancies. As cancer is a disease associated with aging, and hematologic malignancies are no exception, rates of autologous and allogeneic HCT utilization in older adults are on the rise. The most common indications for autologous HCT are multiple myeloma and lymphoma, and for allogenic HCT are acute myeloid leukemia and myelodysplastic syndrome. Older adults into their eighth decade of life can have favorable outcomes after autologous and allogeneic HCT, at least among select patients. Evaluation of older adults prior to HCT can be aided by utilizing a geriatric assessment (GA). GA can identify areas of vulnerability in older adults prior to HCT not captured by more traditional measures. In the future, GA may be utilized to guide interventions prior to HCT to improve outcomes of older adults. Further studies are needed to expand the paucity of data in utilizing GA to identify three groups of patients: those who clearly benefit from HCT, those who would clearly be harmed, and those who might benefit but would require additional support during and after HCT.
Collapse
Affiliation(s)
- Reena Jayani
- Moffitt Cancer Center, Blood and Marrow Transplant and Cellular Immunotherapy Program, 12902 USF Magnolia Dr, Tampa, FL 33612, United States of America; Vanderbilt University Medical Center, Division of Hematology and Oncology, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232-6307, United States of America.
| | - Ashley Rosko
- The Ohio State University, Department of Internal Medicine, Division of Hematology, 460 W 10th Ave, Columbus, OH 43210, United States of America.
| | - Rebecca Olin
- University of California San Francisco, Department of Medicine, Division of Hematology/Oncology, 400 Parnassus Ave., Fourth Floor, San Francisco, CA 94143, United States of America.
| | - Andrew Artz
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, 1500 E. Duarte Road, Duarte, CA 91010, United States of America.
| |
Collapse
|
8
|
Vyas AM, Kogut SJ, Aroke H. Real-World Direct Health Care Costs Associated with Psychotropic Polypharmacy Among Adults with Common Cancer Types in the United States. J Manag Care Spec Pharm 2019; 25:555-565. [PMID: 31039063 PMCID: PMC10397647 DOI: 10.18553/jmcp.2019.25.5.555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychotropic polypharmacy is not uncommon among cancer patients and may contribute to the increased direct health care cost burden in this population. OBJECTIVE To estimate average direct health care costs in the year following cancer diagnosis among cancer patients receiving psychotropic polypharmacy compared with those without psychotropic polypharmacy, using a multivariable analysis framework. METHODS A retrospective cross-sectional study was conducted among patients aged 18 years and older diagnosed with the most commonly occurring cancers (breast, prostate, lung, and colorectal) in the United States during 2011-2012 using the deidentified Optum Clinformatics Data Mart commercial claims database. Psychotropic polypharmacy was defined as concurrent use of 2 or more psychotropic medications for at least 90 days. Direct health care costs in the year following cancer diagnosis were estimated as total medical payments made by the health plans and were derived from claims files. A generalized linear regression model with log-link function and gamma distribution was used to model average direct health care costs, controlling for baseline patient demographic and clinical covariates. RESULTS Average annual direct health care costs for cancer patients with psychotropic polypharmacy ($53,497; SD $72,590) were higher than those without psychotropic polypharmacy ($38,255; SD $59,844), with an unadjusted average cost difference of $15,242 (P < 0.0001). In the adjusted regression model, the average difference in costs shrunk to $5,888 but remained notable. When examined by type of cancer, average direct health care costs for all cancer patients with psychotropic polypharmacy were significantly higher than those for patients without psychotropic polypharmacy, except for colorectal cancer patients. CONCLUSIONS Overall health care costs were higher among cancer patients with psychotropic polypharmacy compared with those without psychotropic polypharmacy. Our findings support the need for future research to better understand the benefits and risks of psychotropic polypharmacy, given its potential to cause adverse health outcomes and avoidable health care utilization and costs for this vulnerable patient population. DISCLOSURES This study was funded by the American Association of Colleges of Pharmacy (AACP) New Investigator Award mechanism, which was received by Vyas. Aroke was partially supported by the AACP grant for conducting data analysis of the study. Kogut is partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and the AACP. The authors report no conflicts of interest. An abstract of this study was presented as a poster at the American Association of Colleges of Pharmacy Annual Meeting on July 22, 2018, in Boston, MA.
Collapse
Affiliation(s)
- Ami M. Vyas
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Stephen J. Kogut
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| | - Hilary Aroke
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston
| |
Collapse
|
9
|
Aroke HA, Vyas AM, Buchanan AL, Kogut SJ. Prevalence of Psychotropic Polypharmacy and Associated Healthcare Resource Utilization during Initial Phase of Care among Adults with Cancer in USA. Drugs Real World Outcomes 2019; 6:73-82. [PMID: 31020617 PMCID: PMC6520416 DOI: 10.1007/s40801-019-0153-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The use of psychotropic medications is not uncommon among patients with newly diagnosed cancer. However, the impact of psychotropic polypharmacy on healthcare utilization during the initial phase of cancer care is largely unknown. METHODS We used a claims database to identify adults with incident breast, prostate, lung, and colorectal cancers diagnosed during 2011-12. Psychotropic polypharmacy was defined as concurrent use of two or more psychotropic medication classes for at least 90 days. A multivariable logistic regression was performed to identify significant predictors of psychotropic polypharmacy. Multivariable Poisson and negative binomial regressions were used to assess the associations between psychotropic polypharmacy and healthcare utilization. RESULTS Among 5604 patients included in the study, 52.6% had breast cancer, 30.6% had prostate cancer, 11.4% had colorectal cancer, and 5.5% had lung cancer. During the year following incident cancer diagnosis, psychotropic polypharmacy was reported in 7.4% of patients, with the highest prevalence among patients with lung cancer (14.4%). Compared with patients without psychotropic polypharmacy during the initial phase of care, patients with newly diagnosed cancer with psychotropic polypharmacy had a 30% higher rate of physician office visits, an 18% higher rate of hospitalization, and a 30% higher rate of outpatient visits. The rate of emergency room visits was similar between the two groups. CONCLUSION Psychotropic polypharmacy during the initial phase of cancer care was associated with significantly increased healthcare resource utilization, and the proportion of patients receiving psychotropic polypharmacy differed by type of cancer. IMPACT Findings emphasize the importance of evidence-based psychotropic prescribing and close surveillance of events causing increased healthcare utilization among patients with cancer receiving psychotropic polypharmacy.
Collapse
Affiliation(s)
- Hilary A Aroke
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| | - Ami M Vyas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA.
| | - Ashley L Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| | - Stephen J Kogut
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| |
Collapse
|
10
|
Fervaha G, Izard JP, Tripp DA, Rajan S, Leong DP, Siemens DR. Depression and prostate cancer: A focused review for the clinician. Urol Oncol 2019; 37:282-288. [DOI: 10.1016/j.urolonc.2018.12.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/03/2018] [Accepted: 12/22/2018] [Indexed: 12/14/2022]
|
11
|
Reich M, Bondenet X. Place des psychotropes en oncologie. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
What type and dose of antidepressants are cancer and non-cancer inpatients being prescribed: a retrospective case-control study at an Australian tertiary hospital. Support Care Cancer 2017; 26:625-634. [DOI: 10.1007/s00520-017-3876-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 09/10/2017] [Indexed: 12/14/2022]
|
13
|
Hawkins NA, Soman A, Buchanan Lunsford N, Leadbetter S, Rodriguez JL. Use of Medications for Treating Anxiety and Depression in Cancer Survivors in the United States. J Clin Oncol 2016; 35:78-85. [PMID: 28034075 DOI: 10.1200/jco.2016.67.7690] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose This study used population-based data to estimate the percentage of cancer survivors in the United States reporting current medication use for anxiety and depression and to characterize the survivors taking this type of medication. Rates of medication use in cancer survivors were compared with rates in the general population. Methods We analyzed data from the National Health Interview Survey, years 2010 to 2013, identifying cancer survivors (n = 3,184) and adults with no history of cancer (n = 44,997) who completed both the Sample Adult Core Questionnaire and the Adult Functioning and Disability Supplement. Results Compared with adults with no history of cancer, cancer survivors were significantly more likely to report taking medication for anxiety (16.8% v 8.6%, P < .001), depression (14.1% v 7.8%, P < .001), and one or both of these conditions combined (19.1% v 10.4%, P < .001), indicating that an estimated 2.5 million cancer survivors were taking medication for anxiety or depression in the United States at that time. Survivor characteristics associated with higher rates of medication use for anxiety included being younger than 65 years old, female, and non-Hispanic white, and having public insurance, a usual source of medical care, and multiple chronic health conditions. Survivor characteristics associated with medication use for depression were largely consistent with those for anxiety, with the exceptions that insurance status was not significant, whereas being widowed/divorced/separated was associated with more use. Conclusion Cancer survivors in the United States reported medication use for anxiety and depression at rates nearly two times those reported by the general public, likely a reflection of greater emotional and physical burdens from cancer or its treatment.
Collapse
Affiliation(s)
- Nikki A Hawkins
- Nikki A. Hawkins, Natasha Buchanan Lunsford, Steven Leadbetter, and Juan L. Rodriguez, Centers for Disease Control and Prevention; and Ashwini Soman, Northrop Grumman, Atlanta GA
| | - Ashwini Soman
- Nikki A. Hawkins, Natasha Buchanan Lunsford, Steven Leadbetter, and Juan L. Rodriguez, Centers for Disease Control and Prevention; and Ashwini Soman, Northrop Grumman, Atlanta GA
| | - Natasha Buchanan Lunsford
- Nikki A. Hawkins, Natasha Buchanan Lunsford, Steven Leadbetter, and Juan L. Rodriguez, Centers for Disease Control and Prevention; and Ashwini Soman, Northrop Grumman, Atlanta GA
| | - Steven Leadbetter
- Nikki A. Hawkins, Natasha Buchanan Lunsford, Steven Leadbetter, and Juan L. Rodriguez, Centers for Disease Control and Prevention; and Ashwini Soman, Northrop Grumman, Atlanta GA
| | - Juan L Rodriguez
- Nikki A. Hawkins, Natasha Buchanan Lunsford, Steven Leadbetter, and Juan L. Rodriguez, Centers for Disease Control and Prevention; and Ashwini Soman, Northrop Grumman, Atlanta GA
| |
Collapse
|
14
|
Sanjida S, Janda M, Kissane D, Shaw J, Pearson SA, DiSipio T, Couper J. A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients. Psychooncology 2016; 25:1002-16. [PMID: 26775715 DOI: 10.1002/pon.4048] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/19/2015] [Accepted: 11/12/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics. METHODS PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted. RESULTS Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4%; 95% CI = 4.3-12.5), more common in female (22.6%; 95% CI = 16.0-31.0) or breast cancer patients (22.6%; 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens. CONCLUSIONS There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Saira Sanjida
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - David Kissane
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Tracey DiSipio
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Jeremy Couper
- Department of Psychiatry, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| |
Collapse
|