Race/ethnicity-stratified survival differences associated with psychotropic medication use in pancreatic cancer.

Abstract

12072 Background: Pancreatic cancer is linked to poor survival and a high burden of neuropsychiatric symptoms. Psychotropic medications are used to manage these symptoms, yet racial/ethnic disparities in use have been reported. The association between psychotropic use and survival in pancreatic cancer across racial and ethnic groups remains unclear. We evaluated race/ethnicity–stratified differences in 2-year survival associated with psychotropic use among older adults with pancreatic cancer. Methods: Retrospective cohort study using SEER–Medicare data (2007–2019) including patients aged ≥65 years with incident pancreatic cancer and continuous Medicare Parts A, B, and D coverage. Psychotropic use was defined as ≥1 Part D claim for antipsychotics, antidepressants, or anxiolytics. Overall survival was assessed using restricted mean survival time (RMST) up to 730 days post-diagnosis. RMST differences between users and non-users were compared within race/ethnicity strata (non-Hispanic White = NHW, non-Hispanic Black = NHB, Hispanic, Other) Sidak-adjusted chi-square tests. Results: Among 81,535 patients, 33.8% received at least one psychotropic medication. Overall psychotropic use was associated with a modest increase in RMST (+8.3 days), driven by antidepressants (+10.7 days) and anxiolytics (+26.8 days), while antipsychotic use was associated with shorter RMST (−13.7 days). RMST gains varied by race/ethnicity, with larger increases among NHB (+17.1 days) and Hispanic patients (+16.4 days), smaller gains among NHW (+4.1 days), and no benefit among Other races (−3.6 days). Antipsychotic-associated RMST deficits were greatest among NHB patients (−34.4 days). Antidepressants were associated with longer RMST across all groups whereas anxiolytic benefits were not observed among Other races. Conclusions: In this cohort of older adults with pancreatic cancer, psychotropic medication use was associated with modestly longer survival overall, largely attributable to antidepressants and anxiolytics, while antipsychotic use was associated with shorter survival. Survival associations varied by race and ethnicity, with larger gains among NHB and Hispanic patients. These findings underscore the importance of equitable recognition and management of neuropsychiatric symptoms and support further research incorporating symptom severity and medication use. RMST difference (days) comparing psychotropic users vs non-users stratified by race/ethnicity. Overall Cohort(N=81,535) NHW(N=59,059) NHB(N=8,015) Hispanic(N=8,993) Other(N=5,468) Any psychotropic 8.3 (1.8) 4.1 (2.2) 17.1 (6.0) 16.4 (5.7) −3.6 (7.4) Antipsychotics -13.7 (3.7) −14.4 (4.4) −34.4 (11.3) 6.2 (11.9) −17.0 (14.47) Antidepressants 10.7 (2.0) 6.6 (2.4) 16.3 (6.8) 16.2 (6.3) 21.1 (8.70) Anxiolytics 26.8 (2.36) 23.5 (2.7) 44.1 (9.1) 34.2 (7.8) −2.4 (10.02) Bolded values are statistically significant.