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

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.