# Regional and Temporal Variation in Receipt of Gabapentinoid and SSRI/SNRI Therapy Among Older Cancer Survivors in the United States

## TL;DR

This study examines how the use of gabapentinoids and antidepressants changed over time and varied by region among older cancer survivors in the US.

## Contribution

The study provides new insights into regional and temporal trends in prescribing gabapentinoids and SSRIs/SNRIs as alternatives to opioids and benzodiazepines for older cancer survivors.

## Key findings

- Gabapentinoid and SNRI use increased over time while opioid and benzodiazepine use declined.
- Prescribing patterns varied significantly by region and opioid-naïve status.
- All regions saw an increase in gabapentinoid prescriptions from 2013 to 2018, with a decline in 2020.

## Abstract

Many older cancer survivors experience pain and anxiety, which are often treated with opioids and benzodiazepines. However, due to concerns about the risk of these medications, doctors have increasingly prescribed alternatives such as gabapentinoids (e.g., gabapentin) and antidepressants such as SSRIs and SNRIs. While these medications are becoming more common, little is known about how their use has changed over time and whether prescribing patterns vary across different regions in the USA. We analyzed data from SEER-Medicare on older patients diagnosed with breast, colorectal, lung, or prostate cancer who had survived at least five years after diagnosis. Our results showed that the use of gabapentinoids and SNRIs increased over time, while opioid and benzodiazepine use declined. These findings highlight important shifts in medication use among older cancer survivors. Differences between regions suggest that prescribing practices vary across the country, which may reflect differences in medical training, policies, or care accessibility.

Opioids and benzodiazepines (BZD) are commonly prescribed for older cancer survivors with co-occurring pain and anxiety. The prescribing rate of gabapentinoids (GABA), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) in the general population has increased as opioid/BZD alternatives, but little is known on temporal/regional trends in use of these alternatives among older cancer survivors. A retrospective cohort study using SEER-Medicare data was conducted. Patients aged ≥ 66 years, diagnosed with breast, colorectal, prostate, or lung cancer as their first cancer diagnosis any time from 2000 to 2015 and who were alive more than 5 years after cancer diagnosis, were eligible for inclusion. Temporal trends varied by region (p < 0.0001) and opioid-naïve status (p < 0.0001). Compared to 2013, GABA and SNRI use increased, while BZD and opioid use decreased. All regions experienced declines in opioid use. From 2013 to 2018, all regions saw an increase in GABA use, with a decline in 2020. GABA prescriptions increased more in opioid-naïve groups compared to non-opioid-naïve patients. The yearly trends in GABA and SSRI/SNRI use varied by region among older cancer survivors. Clinical practice variation suggests needs for further research on improving consistency and quality of cancer care.