April 30, 2015
The authors also propose that more studies be completed to explore the efficacy of anti-depression treatments, as well as the value of depression biomarkers for future brain tumour research.
“Psychological distress is an important complication in patients with brain tumours, but often remains undiagnosed and untreated,” said lead author Adomas Bunevicius MD, Lithuanian University of Health Sciences, Kaunas, Lithuania. “Methodologically rigorous studies aiming to identify the most optimal depression screening tools for patients with brain tumours are lacking. As a consequence, to date there are no evidence based depression diagnostic algorithms.”
The authors propose that implementation of reliable depression screening algorithms in routine neuro-oncology setting could improve recognition of depression, and ultimately, improve patient outcomes.
The authors reviewed available screening tools and recommends the use of The Hospital Anxiety and Depression Scale - Depression subscale and Patient Health Questionnaire. The authors also recommend that patients who screen positive for depression be referred for detailed psychiatric assessment prior to initiating anti-depressive treatment, and that further methodologically rigorous studies investigating psychometric properties of depression scales are urgently needed. Studies evaluating the efficacy of anti-depressive treatments and the clinical value of depression biomarkers are also important avenues for future research endeavours in patients with brain tumours.
“We believe that studies aiming to improve identification and management of psychological distress should be considered a priority in the field of neuro-oncology,” said Dr. Bunevicius. “Such knowledge could significantly improve quality of life and clinical outcomes for patients suffering from these devastating disorders.”
The reasons cited for a deeper focus on depression in patients with brain tumours are 2-fold. First of all, patient-centred outcomes, including symptoms of psychological distress, are increasingly being used as secondary outcome measured in clinical trials. Therefore, accurately identifying patients suffering from psychological distress is becoming increasingly important in both clinical practice and in research studies.
In addition, and perhaps more important to the individual patients, depression carries serious health risks for those with brain tumours. Studies have associated greater depressive symptom severity with shorter overall survival of patients with brain cancer, and depressive symptoms have been linked to numerous health-related aspects of quality of life. Furthermore, depression predicts cognitive impairment and puts survivors at increased risk for suicide ideation. Therefore depression should be actively sought and managed in patients with established diagnosis of a brain tumour.