Depression treatment among elderly cancer patients

BACKGROUND: We examine depression treatment patterns among elderly with cancer and analyze its association with demographic, socio-economic characteristics and health status. METHODS: A cross-sectional design with merged data from Medicare Current Beneficiary Survey(MCBS) annually from 2000-2005 and Medicare fee-for-service claims. Depression was based on ICD-9-CM codes. Antidepressant use was identified from self-reports; psychotherapy visits were extracted using current procedural terminology codes. Among all individuals with cancer and depression, we categorized depression treatment into three groups: 1) antidepressants only; 2) psychotherapy with or without antidepressant; and 3) no depression treatment. Chi-square tests and multinomial logistic regressions were performed to analyze the association between depression treatment and demographic, socio-economic characteristics and health status. All analyses accounted for complex survey design of the MCBS. STUDY SAMPLE: Medicare beneficiaries who reported they were ever told they had cancer and were diagnosed with depression (N = 865) were included. RESULTS: Overall,57% of the sample had antidepressant treatment only;19% had psychotherapy with or without antidepressant; and24% had no depression treatment. Multinomial logistic regression revealed non-white and those with less than high school education were less likely to receive antidepressants and/or psychotherapy. Those living in non-metropolitan areas were less likely to receive treatment for depression. CONCLUSIONS: Our study documented very low rates of psychotherapy among elderly with cancer. We found disparities in depression treatment in non-white and less educated groups. Policy and clinical efforts should focus on reasons for such low rates of treatment and develop interventions to reduce and ultimately eliminate racial disparities in depression treatment.