Treatment of Major Depressive Disorder in Japanese Patients with Cancer: A Matched Cohort Study Using Employer-Based Health Insurance Claims Data

Abstract

Background and Objective Patients with cancer are at high risk of major depressive disorder (MDD), but little is known about their MDD treatment. We investigated the use of antidepressants and other drugs for MDD after cancer diagnosis, and patient characteristics associated with their use. Methods Adults with a new cancer diagnosis were matched to cancer-free patients using a Japanese employee health insurance database (JMDC); this exploratory analysis included only cohort patients diagnosed with MDD between 6 months before and 12 months after the cancer diagnosis index month. Initial prescription frequencies of antidepressants and other MDD medications were compared between cancer and cancer-free groups and analyzed according to age, sex, and hospital characteristics. Results Compared with the cancer-free group (n = 4097), significantly fewer patients in the cancer group (n = 1199) were prescribed antidepressants {622 (51.9%) [95% CI 49.0-54.7] vs 2385 (58.2%) [95% CI 56.7-59.7]}, particularly selective serotonin reuptake inhibitors. In contrast, prescription of other medications, especially antipsychotics and anxiolytics (tandospirone, hydroxyzine), was more frequent in the cancer group than in the cancer-free group. In the cancer group, women were prescribed antidepressants (mostly selective serotonin reuptake inhibitors) and other medications (mostly benzodiazepines) more than men. Antidepressant prescription decreased with age; patients aged < 40 years had the highest selective serotonin reuptake inhibitor and the lowest conventional antidepressant prescription rate compared with patients aged 40-64 years and ≥ 65 years. Lower selective serotonin reuptake inhibitor and benzodiazepine prescription rates were seen in large (≥ 100 beds) hospitals and in hospitals where patients received their cancer diagnosis. Conclusions These results suggest Japanese patients with cancer may be undertreated for MDD compared with cancer-free patients. However, when prescribed, medications may be chosen according to patient needs, including avoiding adverse effects and drug-drug interactions.

Impact of Depression Onset and Treatment on the Trend of Annual Medical Costs in Japan: An Exploratory, Descriptive Analysis of Employer-Based Health Insurance Claims Data

“…As of April 2020, the JMDC database included cumulative data from approximately 7.3 million Japanese individuals (* 5.8% of the population), mainly comprising company employees and their family members [22]. The JMDC database has been used extensively as a real-world data source for epidemiological and health economic analyses [23][24][25][26][27].…”

Boys Don't Cry: Examining Sex Disparities in Behavioral Oncology Referral Rates for AYA Cancer Patients

“…As such, interventions aimed at exploring providers socialized gendered expectations and attitudes toward mental health and help seeking may be effective to increase awareness of potential biases. These may include provider education about the cost of unresolved psychosocial adversity in males and females alike, and the impact of dismissing male psychosocial distress and the prevalence of working-age men with cancer who go without having their psychiatric problems treated due to a variety of factors (Akechi et al, 2020 ). These interventions may help to reduce provider bias and increase their willingness to acknowledge, explore, and validate emotional concerns and refer to appropriate behavioral oncology services for all AYA cancer patients, including men.…”