Pearson Sallie-Anne, Abrahamowicz Michal, Srasuebkul Preeyaporn, Buckley Nicholas Allan
Faculty of Pharmacy and Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
Pharmacoepidemiol Drug Saf. 2015 Jun;24(6):600-9. doi: 10.1002/pds.3753. Epub 2015 Apr 8.
We assessed the impact of a cancer diagnosis and its timing on antidepressant initiation. We also examined patterns of, and factors associated with, new antidepressant treatment in cancer patients.
We followed 61 067 antidepressant-naive Australian Government Department of Veterans' Affairs clients. We used multivariable Cox proportional hazards models with time-varying covariates to compare antidepressant initiation in clients with and without cancer and to assess how initiation varies with time from diagnosis, adjusting for sociodemographic characteristics, health service use and co-morbidities.
17.2% (995/5795) of cancer patients initiated antidepressants and, on average, was more likely to initiate treatment than non-cancer controls with similar characteristics (initiation rate 9/100 person-years, 95% confidence interval: 8.5-9.6 vs 6.6/100 person-years, 95% confidence interval: 6.5-6.7). The peak initiation period was 12 weeks before and 16 weeks after diagnosis; cancer patients were 42% more likely to commence therapy than non-cancer patients (adjusted hazard ratio = 1.4, 1.2 to 1.7). Cancer patients with co-morbid disease, dispensed opioids, corticosteroids or anxiolytics and to whom death was approaching were more likely to initiate treatment. Median duration of antidepressant therapy was 16 weeks.
New antidepressant treatment is more common in cancer populations than in cancer-free populations. Treatment was most commonly initiated around diagnosis time, a period when cancer drug treatments also commence. The timing of peak antidepressant uptake suggests treatment may be for short-term adjustment reactions, better managed without drugs. Durations of treatment are shorter than recommended for depression.
我们评估了癌症诊断及其时机对抗抑郁药起始治疗的影响。我们还研究了癌症患者新抗抑郁药治疗的模式及相关因素。
我们对61067名未使用过抗抑郁药的澳大利亚退伍军人事务部客户进行了跟踪研究。我们使用带有随时间变化协变量的多变量Cox比例风险模型，比较患癌和未患癌客户的抗抑郁药起始治疗情况，并评估起始治疗如何随诊断时间而变化，同时对社会人口统计学特征、医疗服务使用情况和合并症进行了调整。
17.2%（995/5795）的癌症患者开始使用抗抑郁药，平均而言，与具有相似特征的非癌症对照组相比，其开始治疗的可能性更高（起始率为9/100人年，95%置信区间：8.5 - 9.6 vs 6.6/100人年，95%置信区间：6.5 - 6.7）。起始治疗的高峰期为诊断前12周和诊断后16周；癌症患者开始治疗的可能性比非癌症患者高42%（调整后风险比 = 1.4，1.2至1.7）。患有合并症、使用阿片类药物、皮质类固醇或抗焦虑药以及临近死亡的癌症患者更有可能开始治疗。抗抑郁药治疗的中位持续时间为16周。
新抗抑郁药治疗在癌症人群中比在无癌人群中更为常见。治疗最常在诊断时开始，而这也是癌症药物治疗开始的时期。抗抑郁药使用高峰期的时机表明，治疗可能是针对短期调整反应，无需药物即可更好地管理。治疗持续时间短于抑郁症的推荐时长。
