Prescription of Psychotropic Medications in Patients with Cancer: A Population-based Study in Hong Kong

Background: Patients with cancer are at-risk of psychological distress, sleep disturbances, and psychiatric disorders. Psychotropic medications may be prescribed to address the related symptoms. Little is known about the local prescribing practices for these medications among Chinese patients with cancer.

Objectives: To examine the prevalence and factors associated with the prescriptions of psychotropic medications after cancer diagnoses using a population-based electronic health database in Hong Kong.

Methods: The cohort consists of around 200,000 patients randomly selected from the patient populations who utilized the public healthcare services managed by the Hospital Authority in 2007 and 2017. Eligible patients included those who had a cancer diagnosis (ICD code C00-99), did not have any pre-existing mental, behavioral, and neurodevelopmental disorders (ICD code F00-99) or were not prescribed psychotropic medications prior to cancer diagnoses. The study focused on the prevalence of newly prescribed hypnotics, anxiolytic, antipsychotics, antidepressants, CNS stimulants and drugs for substance abuse (BNF code 4.1-4.4, 4.10) after cancer diagnoses. Logistic regression was used to explore the factors associated with psychotropic medication use, adjusting for age and sex. (SAS® Viya® for analysis)

Results: Among 10,022 eligible patients (Female: 51.8%; mean age at cancer diagnosis=63.6 [SD=15.8 years]), 1997 patients (19.8%) were newly prescribed with psychotropic medications after cancer diagnoses. The most common drug classes were hypnotics (n=970, 48.6%), antidepressants (n=638, 31.9%) and antipsychotics (n=611, 30.6%). The mean time to the first prescription of psychiatric medications was 3.3 years after cancer diagnoses. Among users of psychotropic medications, 17.8% (n=356) had a definite diagnosis of mental disorders, most commonly depressive disorders (6.2%) and adjustment disorders (3.2%). Female sex (odds ratio[OR]=1.20; confidence Interval[CI]=1.09-1.33) and patients who received public assistance (OR=1.32; CI=1.18-1.49) were more likely to be prescribed a psychotropic medication. Psychotropic medications were more likely to be prescribed in patients with cancers in the lip, oral cavity and pharynx (adjusted [aOR]=1.89; CI=1.55-2.30), respiratory organs (aOR=1.45; CI=1.25-1.68), while less likely in patients with breast cancer (aOR=0.82; CI=0.70-0.95).

Conclusions: This study suggests that approximately one-fifth of patients were newly prescribed a psychotropic medication after cancer diagnosis, and its use may be associated with certain types of cancer and a lower socioeconomic status. Future studies can examine the efficacy and safety of the use of psychotropic medications among local patients with cancer.