PF471 DEPRESSION AND ANXIETY IN HODGKIN LYMPHOMA SURVIVORS: A DANISH NATIONWIDE COHORT STUDY OF 896 PATIENTS
Authors: A. Kiesbye Øvlisen, L. Hjort Jakobsen, K. Hay Kragholm, M. Hutchings, B. Himmelstrup, H. Frederiksen, D. Stoltenberg, M. Bøgsted, L.S. Granfelt Østgård, M. Tang Severinsen, T. El‐Galaly
Journal: HemaSphere (2019)

Background: Cancer‐related psychological distress may lead to depression and anxiety among survivors. Previous studies point to a high risk among different age groups depending on type and nature of the preceding cancer. Despite the vast majority of patients with Hodgkin Lymphoma (HL) becomes long‐term survivors, the risk of mental health problems in the era of modern combined modality treatments, is not well described. Aims: The first aim of this study was to compare the use of psychotropic drugs (PD); antidepressants, anxiolytics, and antipsychotics as proxies for depression and anxiety among HL patients and a matched background population. The second aim was to analyse PD prescriptions according to time elapsed since inclusion. Methods: All Danish HL patients, including classical and lymphocyte predominant HL, diagnosed in the period 2005–2015 were retrieved from the Danish Lymphoma Registry (LYFO). Patient data were merged with the Danish National Prescription Registry for prescriptions of PD (ATC codes N06a, N05a, and N05b). For each HL index patient, five persons were drawn at random from the Danish population matching on month and year of birth and sex. In addition, persons had to be alive at the date of diagnosis of the index patient and without PD prescriptions before that date. Cumulative incidences of first PD prescription was computed for the entire cohort and stratified on sex and age using the Aalen‐Johansen estimator with deaths before PD prescription as competing risk. The excess risk of PD among the patients compared to the general population was measured by the relative risk (RR) of PD within the first and second year after diagnosis, as well as between two and five years after diagnosis. The RR was estimated by Poisson regression. A multivariable Cox regression model were performed to analyse the impact of various clinical variables on risk of PD prescription. Results: A total of 896 HL patients were included (male:female ratio 1.7, median age 39 years) and follow‐up was 7.5 years. Overall, 204 HL patients (22.8%) received PD at some point after the date of diagnosis compared to 384 persons (8.6%) in the matched cohort. HL patients were more likely to receive PD (HR 3.4, 95% CI 2.8–4.0) compared to the background population (Figure 1). Higher age (HR 1.57, CI 1.07–2.32 for 31–60 year olds and HR 2.26, CI 1.47–3.46 for +61 year olds compared to 18–30 year olds), ECOG performance status ≥1 (HR 1.66, CI 1.21–2.27,), and advanced stage (stage III‐IV) (HR 1.56, CI 1.16–2.12) were associated with PD prescriptions for HL patients. RR of PD prescription was highest within the first year after diagnosis but gradually normalized for patients who did not receive PD in the first years (RR 8.3, P &lt; 0.01 within the first year; RR 5.2, P &lt; 0.01 within the second year; RR 1.1, P = 0.6 between two and five years). Summary/Conclusion: Patients diagnosed with HL face a high risk of depression and anxiety symptoms reflected by an increased use of PD use in the early period after diagnosis. However, few years into survivorship PD prescription rate normalized to that of the background population. Adolescent and young adult HL patients (≤30 years) had lower incidence of PD prescriptions as compared to elderly (≥31 years). Given the high number of PD prescriptions after HL diagnosis, screening for symptoms of depression and anxiety is warranted in the time after diagnosis and first years into survivorship. image