Saranrat Wittayanukorn

Prevalence of depressive symptoms and predictors of treatment among U.S. adults from 2005 to 2010

OBJECTIVES To determine nationally representative estimates of the prevalence of depressive symptoms and factors associated with treatment among those with moderate to severe symptoms. METHODS A cross-sectional, retrospective analysis of adults age≥18 years in the 2005-2010 National Health and Nutrition Examination Survey data who responded to the Patient Health Questionnaire (PHQ-9) was conducted (n=13,320). Depressive symptoms and severity were defined by PHQ-9 scores. Depression treatment was defined as either receiving antidepressants or seeing a mental health professional. Multivariable logistic regression analyses using population weights identified factors associated with having depressive symptoms and receipt of any treatment. RESULTS The prevalence of depressive symptoms increased from 20.92% to 25.66% over 6 years. Among patients with moderate to severe depression, 38.66% received treatment. Multivariable analyses found that being female, other Hispanic, younger age, having certain chronic comorbidities or previous hospitalization, no health insurance and in poverty status were associated with having depressive symptoms (P<.05). Among patients with moderate to severe depression, being female, white, younger age, having comorbidities (arthritis and hypertension) or previous hospitalization were associated with receipt of treatment (P<.05). CONCLUSIONS The prevalence of depressive symptoms is high, and only a small portion of patients with moderate to severe depression received treatments. Treatment disparities exist and need improvement.

Cardiotoxicity in targeted therapy for breast cancer: A study of the FDA adverse event reporting system (FAERS).

Purpose Cancer chemotherapy-induced cardiotoxicity is concerning. Certain anthracyclines and targeted therapies are known to have potential for cardiotoxicity, but existing trial evidence is inadequate to understand real-world patterns of cardiotoxicity with newer targeted therapies and their common combinations with older agents. This study evaluated chemotherapy-related cardiotoxicity reports for targeted therapies and their combinations in breast cancer patients. Methods The US Food and Drug Administration Adverse Event Reporting System (FAERS) database from January 2004 through September 2012 was used to summarize characteristics of reported cardiotoxicity events and their health outcomes. Disproportionality analyses with reporting odds ratios (ROR) and 95% confidence intervals (95% CI) were conducted to detect event signals using a case/non-case method for each targeted therapy and combination. Results A total of 59,739 cases of cardiotoxicity reports were identified; 937 cases identified targeted therapy as the suspect drug. Trastuzumab had the highest number of reports followed by bevacizumab and lapatinib. Proportions of reports of death and disability outcomes for each targeted therapy were approximately 20–25% of the total reports of serious events. Trastuzumab had the highest ROR as a single agent (ROR = 5.74; 95% CI = 5.29–6.23) or combination use of cyclophosphamide (ROR = 16.83; 95% CI = 13.32–21.26) or doxorubicin (ROR = 17.84; 95% CI = 13.77–23.11). Relatively low cardiotoxicity reporting rates were found with lapatinib, regardless of use with combination therapy. Conclusions Analysis of FAERS data identified signals for adverse cardiotoxicity events with targeted therapies and their combinations. Practitioners should consider factors that may increase the likelihood of cardiotoxicity when assessing treatment. Findings support continued surveillance, risk factor identification, and comparative studies.

Interventions for adherence with oral chemotherapy in hematological malignancies: A systematic review

BACKGROUND Poor adherence to treatment for chronic diseases including some hematological malignancies impedes health outcomes and increases costs. Oral chemotherapy is an emerging trend that raises concern about nonadherence problems in these targeted patients. OBJECTIVES This systematic literature review explores evidence and gaps in the literature regarding interventions to enhance adherence with prescribed oral chemotherapy in patients with hematological malignancies. METHODS Searches of databases and abstracts from conferences were performed for 1987 to January 2013 using a modified Cochrane method. Studies measuring interventions to improve adherence alone or together with clinical, humanistic, and economic outcomes were included. Assessment of methodological quality was performed for each retained study. RESULTS The literature search generated 6 studies that met inclusion criteria. Four of these reported a statistically significant increase in the adherence outcome, compared with baseline. Tailored and educational interventions were widely used among the retained studies. Post-intervention adherence rates were 41-96.1%; intervention groups yielded higher rates than comparison groups. Two studies reported statistically significant improvement in clinical outcomes (cytogenetic response and survival time). One study reported that severity of illness was associated with survival time but not with adherence. Studies that used both tailored and educational interventions showed significant relationship between adherence and clinical outcomes; however, the study that used dosage simplification did not. None of the studies explored humanistic or economic outcomes. CONCLUSIONS Interventions to improve adherence with oral chemotherapies in hematological malignancies remain limited. Though they were heterogeneous in nature, interventions tested in the retained studies suggested a positive impact on the adherence outcome; some established a significant relationship between adherence and clinical outcomes. The results yielded limited evidences regarding characteristics of a specific intervention, but supported a general structure for methods to improve adherence and other outcomes in real-life settings. Further rigorous methodological studies are needed to fully examine impact on adherence and clinical outcomes.

Factors associated with psychotropic prescriptions, psychiatric hospitalization, and spending among Medicare beneficiaries under 65

BACKGROUND Medicare beneficiaries under 65 are a medically heterogenous population with significant psychiatric health service utilization. Patterns of psychiatric health services utilization and spending have not been well studied in this population. OBJECTIVE To estimate and compare annual trends in psychotropic prescriptions, psychiatric hospitalization, and total Medicare spending between Medicare beneficiaries <65 and those ≥ 65. We also identified factors associated with these outcomes among Medicare beneficiaries under 65. METHODS This serial cross-sectional study used 2006-2009 Medicare Current Beneficiary Survey (MCBS) data linked with Medicare claims. Psychotropic prescription and psychiatric hospitalization were measured using claims data. Total annual Medicare spending included reimbursements from Medicare Parts A, B, and D. Repeated person-year data were analyzed using generalized estimating equation (GEE) models to examine associations between factors and outcomes among beneficiaries <65, controlling for covariates. RESULTS Over one-third of beneficiaries <65 used at least one psychotropic prescription annually. Annual prevalence of psychotropic prescription and psychiatric hospitalization was higher among beneficiaries <65 than those ≥ 65 (threefold and ten-fold, respectively), as well as Medicare spending. The annual prevalence of psychiatric hospitalization decreased over time among beneficiaries <65. Antidepressants were the most prevalently prescribed psychotropic drug class among beneficiaries <65. Factors associated with psychiatric services utilization and spending among beneficiaries <65 included demographics and health insurance access, self-reported health, smoking status, and comorbidities (all P < 0.05). CONCLUSIONS Our findings highlight the special psychiatric health care needs of Medicare beneficiaries under 65 and call for the attention of policy makers and clinicians to this understudied population.

Patterns of psychiatric emergency department utilization among community-dwelling Medicare beneficiaries under 65.

This study estimated patterns and trends in all-cause (any reason, including psychiatry related) and psychiatric emergency department (ED) utilization among Medicare beneficiaries under 65 who were residing in community settings (i.e., noninstitutionalized or in their own homes). Medicare beneficiaries under the age of 65 enrolled in Medicare for Social Security Disability Insurance (SSDI) due to permanent physical or mental disabilities are a population with poor health conditions and high utilization of health services; however, this vulnerable population has received limited attention from researchers and policymakers compared to the Medicare beneficiaries 65 years and older. Data from the 2002–2009 Medicare Current Beneficiary Survey (MCBS) with linked Medicare administrative claims data were used to select a total of 4,864 Medicare beneficiaries under the age of 65 with a total of 10,384 person-years (weighted n = 30,086,846 person-years). We found that trends in all-cause and psychiatric ED utilization among the young and disabled Medicare beneficiaries remained stable, but trends in the proportion of all-cause ED visits that were psychiatric related increased, and trends in the proportion of psychiatric ED visits resulting in a psychiatric inpatient stay decreased over time. Factors associated with a higher likelihood of psychiatric ED utilization included younger age, residence in the Northeast region, lower education level, Medicare–Medicaid dual eligibility, use of psychotropic medication, and greater number of chronic and psychiatric conditions. These findings highlight the need for policies, programs, and system interventions designed to reduce future psychiatric ED events and improve the access and quality of community mental health services for the community-dwelling, young, and disabled Medicare population.