Use of psychotropic drugs among older patients with bladder cancer in the United States

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.

Mental health screening and diagnosis in cancer patients: Impact on mortality and suggestion of racial bias

“…As the authors note, this cannot be determined from the study because of the inability to account for stage and prior treatment. However, among patients with bladder cancer, higher prescription rates were observed with higher stage bladder cancer (with the exception of stage IV disease) 18 …”

“…Prior work examining psychiatric resource use as a surrogate of disease severity, showed that increasing level of precancer diagnosis psychiatric resource use (none vs outpatient vs emergency room) was associated with worse cancer‐specific and overall survival 5 . A recent study by Jazzar et al 18 evaluated prescription patterns in patients with bladder cancer using Surveillance, Epidemiology, and End Results data with and without existing psychiatric history, finding that 53% of patients were prescribed a psychotropic drug within 2 years of bladder diagnosis. Those with a history of psychiatric disease were more likely to have a psychotropic prescription following their diagnosis, indicating that clinicians should be aware of this history and its presumable increased risk of mental health diagnosis or exacerbation during and after cancer diagnosis.…”

“…There is a paucity of work assessing the role of race in psychotropic drug prescription pattern among cancer patients. Black patients with bladder cancer have been shown to be less likely to receive a prescription compared with White patients 18 . Chen et al 17 provide a more comprehensive evaluation of race as a factor in mental health diagnosis and psychotropic drug prescription patterns, showing that minority patients were less likely to receive a mental health diagnosis or prescription for a psychotropic drug across cancer sites.…”

“…However, antidepressants are still a mainstay of treatment, as recommendations for pharmacologic therapy in cancer patients generally mirrors treatment in the general population. Jazzer et al 18 found that the adherence rate of antidepressants in patients with bladder cancer was low, with a 3‐month adherence rate of only 30%. Similar findings have been seen in breast cancer, with 1‐year adherence rates of 57% with further prescription discontinuation over time 21 .…”