Psychiatric Comorbidity Among Terminally Ill Patients in General Practice in the Netherlands: a Comparison Between Patients with Cancer and Heart Failure

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2013 Jan 23

PMID 23336475

Citations 3

Authors

Chong Guan Ng

Ellen Dijkstra

Hugo Smeets

Marco P M Boks

Niek J de Wit

Affiliations

Soon will be listed here.

Abstract

Background: It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease.

Aim: To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally ill patients in the GP setting, comparing both patients with terminal cancer and heart failure.

Design And Setting: Retrospective cohort study using the Utrecht General Practitioner Research Network.

Method: Equally-sized groups of patients with terminal cancer and heart failure were randomly selected from the database of four general practices over the years 2005-2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical Therapeutic Chemical (ATC) Classification System codes.

Results: A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was 15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease and psychotropic drug prescription between patients with terminal cancer and heart failure.

Conclusion: The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure.

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References

Tinetti M, Fried T . The end of the disease era. Am J Med. 2004; 116(3):179-85. DOI: 10.1016/j.amjmed.2003.09.031. View

Farriols C, Ferrandez O, Planas J, Ortiz P, Mojal S, Ruiz A . Changes in the prescription of psychotropic drugs in the palliative care of advanced cancer patients over a seven-year period. J Pain Symptom Manage. 2012; 43(5):945-52. DOI: 10.1016/j.jpainsymman.2011.05.010. View

Mitchell A, Meader N, Davies E, Clover K, Carter G, Loscalzo M . Meta-analysis of screening and case finding tools for depression in cancer: evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group. J Affect Disord. 2012; 140(2):149-60. DOI: 10.1016/j.jad.2011.12.043. View

Mitchell A, Meader N, Symonds P . Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010; 126(3):335-48. DOI: 10.1016/j.jad.2010.01.067. View

Miovic M, Block S . Psychiatric disorders in advanced cancer. Cancer. 2007; 110(8):1665-76. DOI: 10.1002/cncr.22980. View

Fann J, Thomas-Rich A, Katon W, Cowley D, Pepping M, McGregor B . Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008; 30(2):112-26. DOI: 10.1016/j.genhosppsych.2007.10.008. View

Cullivan R, Crown J, Walsh N . The use of psychotropic medication in patients referred to a psycho-oncology service. Psychooncology. 1998; 7(4):301-6. DOI: 10.1002/(SICI)1099-1611(199807/08)7:4<301::AID-PON367>3.0.CO;2-I. View

Peterson L, Leipman M, Bongar B . Psychotropic medications in patients with cancer. Gen Hosp Psychiatry. 1987; 9(5):313-23. DOI: 10.1016/0163-8343(87)90062-4. View

Bruera E, Neumann C . The uses of psychotropics in symptom management in advanced cancer. Psychooncology. 1998; 7(4):346-58. DOI: 10.1002/(SICI)1099-1611(199807/08)7:4<346::AID-PON364>3.0.CO;2-8. View

10.

Breitbart W, Alici Y . Psycho-oncology. Harv Rev Psychiatry. 2009; 17(6):361-76. DOI: 10.3109/10673220903465700. View

11.

Lennie T, Moser D, Heo S, Chung M, Zambroski C . Factors influencing food intake in patients with heart failure: a comparison with healthy elders. J Cardiovasc Nurs. 2006; 21(2):123-9. DOI: 10.1097/00005082-200603000-00008. View

12.

Sweeney K, Heath I . A taxonomy of general practice. Br J Gen Pract. 2006; 56(526):386-8. PMC: 1837859. View

13.

Borgsteede S, Deliens L, Beentjes B, Schellevis F, Stalman W, van Eijk J . Symptoms in patients receiving palliative care: a study on patient-physician encounters in general practice. Palliat Med. 2007; 21(5):417-23. DOI: 10.1177/0269216307079821. View

14.

Ng C, Boks M, Zainal N, de Wit N . The prevalence and pharmacotherapy of depression in cancer patients. J Affect Disord. 2010; 131(1-3):1-7. DOI: 10.1016/j.jad.2010.07.034. View

15.

Freedenberg V, Thomas S, Friedmann E . Anxiety and depression in implanted cardioverter-defibrillator recipients and heart failure: a review. Heart Fail Clin. 2010; 7(1):59-68. DOI: 10.1016/j.hfc.2010.08.008. View

16.

Chochinov H . Depression in cancer patients. Lancet Oncol. 2002; 2(8):499-505. DOI: 10.1016/S1470-2045(01)00456-9. View

17.

Mishra S, Mohapatra P, Bhattacharya K, Gupta T, Agarwal J . Prevalence of psychiatric disorder in asymptomatic or minimally symptomatic cancer patients on treatment. J Cancer Res Ther. 2007; 2(3):136-9. DOI: 10.4103/0973-1482.27590. View

18.

Kanemoto K, Satoh H, Kagohashi K, Kurishima K, Ishikawa H, Ohtsuka M . Psychotropic drugs for terminally ill patients with respiratory disease. Tuberk Toraks. 2007; 55(1):5-10. View

19.

Reeve J . Protecting generalism: moving on from evidence-based medicine?. Br J Gen Pract. 2010; 60(576):521-3. PMC: 2894382. DOI: 10.3399/bjgp10X514792. View

20.

Van der Velden L, Francke A, Hingstman L, Willems D . Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data. BMC Palliat Care. 2009; 8:4. PMC: 2645375. DOI: 10.1186/1472-684X-8-4. View