Antidepressant Use in Cancer Patients May Affect Length of Hospital Stay

Advanced cancer patients with depressive symptoms not on antidepressants may experience an extended length of stay when hospitalized. Although future studies in this area are needed to determine the effect of antidepressant use on hospital length of stay, researchers report that during their study they found that cancer patients with a documented history of depressive symptoms prior to hospital admission experienced an extended hospital stay, particularly in those patients not taking antidepressant medications.  

This study was led by Risa L. Wong, MD, of Massachusetts General Hospital and Harvard Medical School, and published in The Oncologist.

“When you consider the significant additional stressors on patients and their families during lengthy hospital admissions, including sleep deprivation, possible malnutrition, and separation from familiar surroundings and support systems, an intervention that can lessen this additional burden is highly valuable,” said Jennifer Reid, MD, assistant professor of clinical psychiatry and medical director of outpatient services in the department of psychiatry at the Perelman School of Medicine at the University of Pennsylvania.

Researchers conducted a chart review of advanced cancer patients who were undergoing an unplanned hospitalization from September 2014 through May 2016. During their review, they evaluated chart documentation of pre-admission depressive symptoms, specifically within the 3 months prior to the unplanned admission. Antidepressant use was also evaluated and documented.

Of the patients enrolled in the study, the most commonly encountered cancers included advanced gastrointestinal cancer (32%), lung cancer (18.3%), and genitourinary cancer (10.9%), with other cancer types including melanoma, breast cancer, lymphoma, gynecologic malignancies, sarcoma, and cancer of unknown primary. Of the patient charts evaluated, 126 (12.2%) were found to have pre-admission symptoms of depression, with 288 (27.8%) documented patients receiving pre-admission antidepressant medications.

Researchers found a correlation between depressive symptoms and length of hospital stay. Study findings reported a hospital length of stay of 7.25 days vs 6.13 days in those patients with symptoms of depression. Interestingly, those not receiving antidepressant medications experienced the longest hospital stay of 7.88 days vs 6.11 days. There was no correlation between depressive symptoms and hospital length of stay in patients who were taking antidepressant medications (6.57 vs 6.17 days; P = .578).

Wong and colleagues reported that although additional research in this area is needed, “collectively, these data support the association between untreated depressive symptoms and poor outcomes in patients with cancer,” they wrote.

“This study supports the practice of treating symptoms of depression with antidepressant medications, even in advanced cancer, as a way to optimize overall quality of life for our patients, and allow them to maintain the highest level of dignity throughout their illness course,” said Reid.