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Brain Tumor
Surgery: Study investigates connection
between Depression and Survival
Newswise — Depression is one of the most
common psychiatric disorders in the world
today.
It is estimated that in any given year, 5 to
9 percent of the US population is clinically
depressed.
Studies have shown that depression
negatively affects the immunological system,
alters the body’s response to malignancy,
and may influence behavioral factors that
impact recovery from disease.
Psychiatric symptoms, including depression,
often occur in patients with malignant brain
tumors. Research has linked these
psychiatric symptoms to tumor location and
extent of the disease.
In the past decade, studies have suggested
that there is a relationship between
depression and poor outcome in patients
undergoing craniotomy for brain lesions as a
whole.
This association has also been reported
after surgical therapy of non-neurological
disease.
Malignant brain astrocytoma, also known as
glioma or glioblastoma multiforme (GBM), is
the most commonly diagnosed primary brain
tumor.
Glioma is a devastating brain cancer that
typically results in death in about one
year.
The most effective therapies introduced over
the past three decades have improved median
survival by an average of only three months.
Thus, identification of any reversible
morbidity factors, which could potentially
improve survival rates, such as depression,
is of paramount importance.
Researchers at Johns Hopkins School of
Medical in Baltimore analyzed the outcome of
1,052 patients who underwent surgical
resection and radiotherapy for glioma over a
10-year period.
The results of this study, Association of
Preoperative Depression and Survival after
Resection of Malignant Brain Astrocytoma,
will be presented by Matthew J. McGirt, MD,
4:01 to 4:15 p.m. on Monday, April 28, 2008,
during the 76th Annual Meeting of the
American Association of Neurological
Surgeons in Chicago. Co-authors are Frank J.
Attenello, MS, Henry Brem, MD, Kaisorn L.
Chaichana, BS, Muraya Gathinji, MS,
Alessando Olivi, MD, Alfredo
Quinones-Hinojosa, MD, Khoi Than, MD, and
Jon D. Weingart, MD.
Currently, patient age, tumor grade, and
functional status remain the known
preoperative prognostic indicators of
survival.
“The goal of this research was to determine
whether malignant glioma patients with a
preoperative diagnosis of depression have a
lower survival rate irrespective of
treatment modality or degree of disability,”
stated Dr. McGirt. The research encompassed
the following methodology:
•The surgical management of 1,052
consecutive patients with malignant
astrocytomas (WHO grade 3 or 4) performed at
a single institution from 1995 to 2006 were
reviewed.
•Of these 1,052 surgical procedures, 605 (58
percent) were for primary resection, 410 (39
percent) were for secondary resection, and
37 (3.5 percent) were for biopsy.
•For the purpose of this study, only
patients taking anti-depressant medication
for clinical depression at the time of
surgery were classified as having
“depression.” This equated to 49 patients (5
percent) of the total cases.
“Interestingly, all demographic and clinical
characteristics did not differ between
depressed and non-depressed patients.
However, patients already depressed at
diagnosis had a significantly reduced
survival compared to non-depressed
patients,” stated Dr. McGirt.
"This
was most notable in survival rates beyond 12
months, suggesting that depression may be
most detrimental for long-term survival.”
Detailed findings included the following:
•Regardless of patient functional status
prior to surgery (KPS score), WHO Grade III
vs. Grade IV tumor, patient age, or clinical
presentation, those with depression had more
than a 40 percent increase in the relative
risk of mortality versus non-depressed
patients. This association was independent
of degree of resection or postoperative
treatment modality.
•At 12 months post surgery, 41 percent of
non-depressed patients were alive, while
only 15 percent of depressed patients were
alive.
•At 20 months post surgery, there were no
depressed patients still alive, while 21
percent of non-depressed patients were still
alive.
Although patients classified as depressed
were diagnosed prior to neurosurgical
evaluation in most cases, it is uncertain
that their depression was not a response to
the recent diagnosis of a terminal disease.
Many patients with clinical depression may
have been undiagnosed and off medication,
lowering the sensitivity of the
classification scheme and resulting in
inclusion of clinically depressed patients
in the non-depressed cohort.
Further research investigating the survival
of patients with non-medicated versus
medicated depression is warranted to address
these variables.
“In conclusion, this study does indicate
strong evidence that there is a connection
between the existence of depression and
survival rates in patients with malignant
brain glioma.
Recognizing and treating depression
preoperatively should be looked at more
closely as a means to maximize survival in
the treatment of malignant brain tumors,”
remarked Dr. McGirt.
Founded in 1931 as the Harvey Cushing
Society, the American Association of
Neurological Surgeons (AANS) is a scientific
and educational association with more than
7,200 members worldwide.
The AANS is dedicated to advancing the
specialty of neurological surgery in order
to provide the highest quality of
neurosurgical care to the public.
All
active members of the AANS are certified by
the American Board of Neurological Surgery,
the Royal College of Physicians and Surgeons
(Neurosurgery) of Canada or the Mexican
Council of Neurological Surgery, AC.
Neurological surgery is the medical
specialty concerned with the prevention,
diagnosis, treatment and rehabilitation of
disorders that affect the entire nervous
system, including the spinal column, spinal
cord, brain and peripheral nerves.
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