The Use of an Electronic Patient Record System to Identify Advanced Cancer Patients and Antidepressant Drug Use

Purpose: Psychiatric morbidity is common in cancer patients toward the end of life. In this study, we demonstrate the use of an electronic patient record system to identify patients with advanced cancer, and then analyze practice patterns regarding the use of antidepressants. Patients and Methods: Using electronic patient records from January 1986 to December 1996, we identified 17,476 patients with possible cancer. Patients were identified by virtue of having any one of eight markers. We used an iterative process to modify the specificity of these markers, and an advanced cancer cohort was assembled consisting of 1185 patients. Results: A random sample of 200 written medical records were reviewed, of which 157 records (78.5%) were retrieved. Extracted information was reviewed by an oncologist, and patients were classified as follows: (1) no evidence of cancer; (2) evidence of cancer with an expected survival of less than or equal to 24 months; or (3) evidence of cancer with an expected survival of more than 24 months. Overall, 86% of the advanced cancer sample assembled from electronic records was correctly classified as advanced cancer by the review of the written records. Overall, 16% of all 1185 patients with advanced cancer were exposed to at least one antidepressant, with 3% of patients exposed to a selective serotonin-reuptake inhibitor, 10% exposed to a tricyclic antidepressant at a dose of greater than 25 mg, and 4% exposed to a low dose of a tricyclic antidepressant. Conclusion: The electronic patient record can be used to assemble an advanced cancer cohort for the purpose of studying palliative care practice patterns. Antidepressants are seldom part of the palliative management of this population.