Antidepressants to cancer patients during the last year of life--a population-based study

Although depression is common among incurable cancer patients, the prescription prevalence of antidepressants (ADs) to these patients is largely unknown. Aims were to examine the prescription prevalence of ADs in the last year of life in a 2-year national cancer death cohort and to examine its associations with sociodemographic and medical variables.

Nationwide, 20,627 cancer deaths in adults were identified by combining the Norwegian Central Population and Cancer Registries. Individual prescriptions of ADs in the 12 months prior to death were identified in the Norwegian Prescription Database. The study population consisted of 17,753 patients who died from cancer in 2005 and 2006, after excluding patients assumed to be hospitalized whose prescriptions were not registered in the Norwegian Prescription Database.

Twenty-two percent (N = 3836) had at least one prescription of ADs in their last year of life (men 19%/women 25%), compared with 6% in the general population (men 4%/women 8%). Patients who died within 1 year from diagnosis had lower prescription prevalence (20%) than patients with longer disease duration (23%) (p < 0.001). Prescription prevalence increased toward death for both genders, but the prevalence of first-time prescriptions in the last 6 months of life was similar across genders. About 10% of ADs were prescribed for the first time 30 days or less before death.

The prescription prevalence among cancer patients in the last year of life was almost four times higher than in the general population. One of 10 patients was prescribed with ADs so close to death that the clinical effects can be questioned.