title: Pediatric oncologists' practices of prescribing selective serotonin reuptake inhibitors (SSRIs) for children and adolescents with cancer: a multi-site study.
abstract: OBJECTIVE
  To survey pediatric oncologists regarding prescription of selective serotonin reuptake inhibitors (SSRIs) and related medications for the treatment of depression and anxiety disorders in children with cancer. Specifically, we sought to determine (a) how frequently pediatric oncologists prescribed SSRIs and what were the most commonly prescribed agents; (b) how decisions were made to prescribe, particularly whether mental health professionals were consulted; (c) how patients were monitored while on the agents; and (d) how the FDA black box warning has affected prescribing practices.
  
  
  METHODS
  Oncologists from nine children's cancer centers (N = 151) from across the U.S. were surveyed, responding to either on-line or paper versions of a questionnaire developed for this study.
  
  
  RESULTS
  A majority of oncologists (71%) reported prescribing SSRIs for their patients. Oncologists reported difficulties differentiating symptoms of depression from aspects of cancer treatment. Mental health practitioners are consulted occasionally but not routinely, and oncologists reported a need for increased mental health resources. Approximately half of oncologists (51%) reported that the FDA black box warning had not affected their practice. In addition, only 28% reported monitoring patients on SSRIs at FDA recommended intervals, and only 9% indicated assessing for suicidality.
  
  
  CONCLUSIONS
  Prescription of SSRIs is a common practice of pediatric oncologists, often without consultation with mental health professionals. Post-prescription monitoring appears to be suboptimal, and does not follow FDA guidelines.
authors.affiliation: Department of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA. sean.phipps@stjude.org
authors.forename: Sean
authors.initials: S
authors.lastname: Phipps
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Buckholdt
authors.forename: Laly
authors.initials: L
authors.lastname: Fernandez
authors.forename: Lori
authors.initials: L
authors.lastname: Wiener
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Kupst
authors.forename: Avi
authors.initials: A
authors.lastname: Madan-Swain
authors.forename: Larry
authors.initials: L
authors.lastname: Mullins
authors.forename: Rhonda
authors.initials: R
authors.lastname: Robert
authors.forename: Olle Jane
authors.initials: OJ
authors.lastname: Sahler
authors.forename: Nicole
authors.initials: N
authors.lastname: Vincent
authors.forename: Robert B
authors.initials: RB
authors.lastname: Noll
mesh_terms: D000293:Adolescent; D002648:Child; D003866:Depressive Disorder / Q000517:prevention & control*; D011307:Drug Prescriptions; D019983:Guideline Adherence; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D014481:United States; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence; D000092864:Suicide Prevention
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors