TY - JOUR

T1 - Increased risk of antidepressant use in childhood cancer survivors

T2 - a Danish population-based cohort study

AU - Lund, Lasse Wegener

AU - Winther, J.F.

AU - Cederkvist, L

AU - Andersen, K K

AU - Dalton, S O

AU - Appel, C W

AU - Rechnitzer, C.

AU - Schmiegelow, K

AU - Johansen, C

N1 - Copyright © 2015 Elsevier Ltd. All rights reserved.

PY - 2015/3

Y1 - 2015/3

N2 - AIM: Childhood cancer survivors are at risk of both somatic and mental late effects, but large population-based studies of depression are lacking.METHODS: Risk of antidepressant use was evaluated in a population-based cohort of 5452 Danish children treated for cancer in 1975-2009 by linkage to the National Prescription Drug Database, which worldwide is the oldest nationwide registry of prescription medication. Hazard ratios (HRs) for antidepressant use were estimated in a Cox proportional hazards model stratified on sex, with population comparisons as referents.RESULTS: Overall, childhood cancer survivors were at increased risk of having antidepressants prescribed (HR, 1.4; 95% confidence interval (CI), 1.3-1.5). The excess absolute risk of antidepressant use was 2.5 per 1000 person-years (95% CI, 1.7-3.3), equivalent to an excess of 2.5 survivors for every 100 survivors followed for 10years. Increased HRs of 30-50% were seen for survivors of cancers of all main groups (haematological malignancies, central nervous system (CNS) and solid tumors); the highest risk was among children treated with haematopoietic stem cell transplantation (HR, 1.9; 95% CI, 1.2-3.1). Our data suggested that the risk was most pronounced for children treated in the most recent calendar periods (test for interaction between cancer and calendar periods: P<0.001), especially for survivors of haematological cancers (P=0.007). Interaction analysis of the effect of parental socioeconomic position and psychiatric disease on the association between childhood cancer and antidepressant use indicated no modifying effect.CONCLUSION: Childhood cancer survivors should be followed-up for depression. Our results indicate an increasing need for follow-up especially in survivors treated by more recent, intensive anticancer treatment.

AB - AIM: Childhood cancer survivors are at risk of both somatic and mental late effects, but large population-based studies of depression are lacking.METHODS: Risk of antidepressant use was evaluated in a population-based cohort of 5452 Danish children treated for cancer in 1975-2009 by linkage to the National Prescription Drug Database, which worldwide is the oldest nationwide registry of prescription medication. Hazard ratios (HRs) for antidepressant use were estimated in a Cox proportional hazards model stratified on sex, with population comparisons as referents.RESULTS: Overall, childhood cancer survivors were at increased risk of having antidepressants prescribed (HR, 1.4; 95% confidence interval (CI), 1.3-1.5). The excess absolute risk of antidepressant use was 2.5 per 1000 person-years (95% CI, 1.7-3.3), equivalent to an excess of 2.5 survivors for every 100 survivors followed for 10years. Increased HRs of 30-50% were seen for survivors of cancers of all main groups (haematological malignancies, central nervous system (CNS) and solid tumors); the highest risk was among children treated with haematopoietic stem cell transplantation (HR, 1.9; 95% CI, 1.2-3.1). Our data suggested that the risk was most pronounced for children treated in the most recent calendar periods (test for interaction between cancer and calendar periods: P<0.001), especially for survivors of haematological cancers (P=0.007). Interaction analysis of the effect of parental socioeconomic position and psychiatric disease on the association between childhood cancer and antidepressant use indicated no modifying effect.CONCLUSION: Childhood cancer survivors should be followed-up for depression. Our results indicate an increasing need for follow-up especially in survivors treated by more recent, intensive anticancer treatment.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Antidepressive Agents

KW - Case-Control Studies

KW - Child

KW - Child, Preschool

KW - Cohort Studies

KW - Denmark

KW - Depression

KW - Drug Prescriptions

KW - Female

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Male

KW - Neoplasms

KW - Proportional Hazards Models

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Survivors

KW - Time Factors

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1016/j.ejca.2015.01.001

DO - 10.1016/j.ejca.2015.01.001

M3 - Journal article

C2 - 25677304

VL - 51

SP - 675

EP - 684

JO - European Journal of Cancer, Supplement

JF - European Journal of Cancer, Supplement

SN - 0959-8049

IS - 5

ER -