# Prescription and use of psychoactive medications among cancer patients and associated factors in lower and upper middle-income countries: systematic review

## TL;DR

This review explores how psychoactive medications are prescribed to cancer patients in lower and upper middle-income countries and what factors influence their use.

## Contribution

The study systematically reviews factors influencing psychoactive medication use in cancer patients in LMICs, highlighting disparities and inappropriate prescriptions.

## Key findings

- Psychoactive medications like antidepressants and benzodiazepines are commonly prescribed to cancer patients in LMICs.
- Factors like comorbidities, polypharmacy, and socioeconomic disparities influence medication use and access.
- Underdiagnosis and undertreatment of mental health disorders are common, leading to poor psychological distress management.

## Abstract

To describe the prescription and use of psychoactive medications among cancer patients in low- and middle-income countries (LMICs) and explore the factors influencing their prescription and use.

This systematic review was conducted following the PRISMA guidelines. Six electronic databases were searched. We included observational studies that investigated the prescription and use of psychoactive medications among adult cancer patients in low- and middle-income countries (LMICs) according to the 2024 World Bank’s classification. Eligible studies specifically focused on the use of these medications for the management of psychological disorders in this population.

Ten studies were included in the systematic review. Psychoactive medications prescribed were antidepressants, benzodiazepines, non-benzodiazepine/Z-drugs, and antipsychotics (both typical/first-generation and atypical/second-generation). Several factors, such as comorbidities, polypharmacy, geographical disparities, and health insurance coverage, influenced the prescription and use of these medications. Potentially inappropriate use of antidepressants and benzodiazepines was observed, particularly among elderly patients with multimorbidity. Underdiagnosis and undertreatment of mental health disorders were also reported, often leading to inadequate management of psychological distress in cancer patients.

In conclusion, this review highlights the complexity of prescribing and using psychoactive medications among cancer patients. Their use is influenced by multiple factors, including comorbidities, polypharmacy in older adults, and socioeconomic disparities that affect access to healthcare.

The online version contains supplementary material available at 10.1007/s00520-025-10272-8.