Psychotropic medication use in pediatric patients with cancer

BACKGROUND: Use of psychotropic medication in medically ill adults, in particular, patients with cancer, is common. While increased use of psychotropic medications in children and adolescents in the general population has been reported, little is known about the prescribing practices for these medications in medically ill children. OBJECTIVE: To examine the frequency and types of psychotropic medications used in a population of children and adolescents with cancer. DESIGN: Retrospective review of the National Institutes of Health Medical Information System. SETTING: Pediatric Oncology Branch of the National Cancer Institute, National Institutes of Health. PARTICIPANTS: Three hundred forty-seven patients aged 1 to 21 years who were enrolled in clinical research trials at the Pediatric Oncology Branch between January 2000 and December 2003. MAIN OUTCOME MEASURES: Psychotropic medication use was analyzed according to cancer diagnosis and patient age. RESULTS: Fourteen percent of identified patients had been prescribed at least 1 psychotropic medication at the time of National Cancer Institute clinical trial enrollment. The most commonly used medications were anticonvulsant agents (8%) and antidepressant medications (7%), in particular, selective serotonin reuptake inhibitors. Anxiolytic medications could not be accurately assessed because of their frequent use as antiemetic agents in many chemotherapy regimens. Psychostimulant use was rare. CONCLUSIONS: This study suggests that psychotropic medications are commonly prescribed to children and adolescents with cancer. Clinical safety and efficacy trials are needed in medically ill children at high risk for mood and anxiety symptoms.