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Stockdill ML, King A, Johnson M, Karim Z, Cooper D, Armstrong TS. The relationship between social determinants of health and neurocognitive and mood-related symptoms in the primary brain tumor population: A systematic review. Neurooncol Pract 2024; 11:226-239. [PMID: 38737608 PMCID: PMC11085846 DOI: 10.1093/nop/npae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Social determinants of health (SDOH) impact cancer-related health outcomes, including survival, but their impact on symptoms is less understood among the primary brain tumor (PBT) population. We conducted a systematic review to examine the relationships between SDOH and neurocognitive and mood-related symptoms among the PBT population. PubMed, EMBASE, and CINAHL were searched using PROGRESS criteria (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, and social capital) on March 8th, 2022. Two individuals screened and assessed study quality using the NHLBI Assessment Tool for Observational Cohort and Cross-sectional Studies. Of 3006 abstracts identified, 150 full-text articles were assessed, and 48 were included for a total sample of 28 454 study participants. Twenty-two studies examined 1 SDOH; none examined all 8. Four studies measured place of residence, 2 race/ethnicity, 13 occupation, 42 gender, 1 religion, 18 education, 4 socioeconomic status, and 15 social capital. Fifteen studies assessed neurocognitive and 37 mood-related symptoms. While higher education was associated with less neurocognitive symptoms, and among individuals with meningioma sustained unemployment after surgery was associated with depressive symptoms, results were otherwise disparate among SDOH and symptoms. Most studies were descriptive or exploratory, lacking comprehensive inclusion of SDOH. Standardizing SDOH collection, reducing bias, and recruiting diverse samples are recommended in future interventions.
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Affiliation(s)
- Macy L Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Amanda King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Morgan Johnson
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Zuena Karim
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Diane Cooper
- National Institutes of Health Library, National Institutes of Health, Bethesda, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive and psychological outcomes in meningioma survivors: Individual changes over time and radiation dosimetry. Neurooncol Pract 2024; 11:157-170. [PMID: 38496914 PMCID: PMC10940838 DOI: 10.1093/nop/npad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influences neurocognitive and psychological outcomes. Results Most (range = 41%-93%) survivors demonstrated stable-albeit often below average-neurocognitive and psychological trajectories, although some also exhibited improvements (range = 0%-31%) or declines (range = 0%-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2 = 0.462) and cerebellum (partial R2 = 0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2 = 0.367) and trait anxiety (partial R2 = 0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to the quality of survivorship in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neurosciences, and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Roland N, Neumann A, Hoisnard L, Duranteau L, Froelich S, Zureik M, Weill A. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ 2024; 384:e078078. [PMID: 38537944 PMCID: PMC10966896 DOI: 10.1136/bmj-2023-078078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess the risk of intracranial meningioma associated with the use of selected progestogens. DESIGN National case-control study. SETTING French National Health Data System (ie, Système National des Données de Santé). PARTICIPANTS Of 108 366 women overall, 18 061 women living in France who had intracranial surgery for meningioma between 1 January 2009 and 31 December 2018 (restricted inclusion periods for intrauterine systems) were deemed to be in the case group. Each case was matched to five controls for year of birth and area of residence (90 305 controls). MAIN OUTCOME MEASURES Selected progestogens were used: progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and intrauterine levonorgestrel. For each progestogen, use was defined by at least one dispensation within the year before the index date (within three years for 13.5 mg levonorgestrel intrauterine systems and five years for 52 mg). Conditional logistic regression was used to calculate odds ratio for each progestogen meningioma association. RESULTS Mean age was 57.6 years (standard deviation 12.8). Analyses showed excess risk of meningioma with use of medrogestone (42 exposed cases/18 061 cases (0.2%) v 79 exposed controls/90 305 controls (0.1%), odds ratio 3.49 (95% confidence interval 2.38 to 5.10)), medroxyprogesterone acetate (injectable, 9/18 061 (0.05%) v 11/90 305 (0.01%), 5.55 (2.27 to 13.56)), and promegestone (83/18 061 (0.5%) v 225/90 305 (0.2 %), 2.39 (1.85 to 3.09)). This excess risk was driven by prolonged use (≥one year). Results showed no excess risk of intracranial meningioma for progesterone, dydrogesterone, or levonorgestrel intrauterine systems. No conclusions could be drawn concerning dienogest or hydroxyprogesterone because of the small number of individuals who received these drugs. A highly increased risk of meningioma was observed for cyproterone acetate (891/18 061 (4.9%) v 256/90 305 (0.3%), odds ratio 19.21 (95% confidence interval 16.61 to 22.22)), nomegestrol acetate (925/18 061 (5.1%) v 1121/90 305 (1.2%), 4.93 (4.50 to 5.41)), and chlormadinone acetate (628/18 061 (3.5%) v 946/90 305 (1.0%), 3.87 (3.48 to 4.30)), which were used as positive controls for use. CONCLUSIONS Prolonged use of medrogestone, medroxyprogesterone acetate, and promegestone was found to increase the risk of intracranial meningioma. The increased risk associated with the use of injectable medroxyprogesterone acetate, a widely used contraceptive, and the safety of levonorgestrel intrauterine systems are important new findings.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Anke Neumann
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Léa Hoisnard
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
| | - Lise Duranteau
- Department of Medical Gynaecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, 94270, Le Kremlin-Bicêtre, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière University Hospital, Paris-Cité University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
- University Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
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Machetanz K, Wang SS, Oberle L, Tatagiba M, Naros G. Sex Differences in Vestibular Schwannoma. Cancers (Basel) 2023; 15:4365. [PMID: 37686642 PMCID: PMC10486905 DOI: 10.3390/cancers15174365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Vestibular schwannoma (VS) are equally common in men and woman. A number of epidemiological studies have reported on sex-specific aspects of incidence, tumor size, tinnitus and hearing loss. However, data on sex-specific, pre- and post-surgically quality of life (QoL) are rare. The objective of the present study was to determine sex-specific aspects on QoL in VS. Health-related QoL was analyzed in 260 patients (112 male/148 female) with unilateral sporadic VS using general (SF-36: general Short-Form Health Survey), disease-specific (PANQOL: Penn Acoustic Neuroma Quality-of-Life Scale, PANQOL) and symptom-specific (DHI: Dizziness Handicap Inventory; HHI: Hearing Handicap Inventory; THI: Tinnitus Handicap Inventory; FDI: Facial Disability Index) QoL questionnaires. Sex differences were evaluated pre- and postoperative by multi- and univariate analyses based on 200 preoperative and 88 postoperative questionnaires. Female patients were significantly more affected by dizziness, headaches, reduced energy and anxiety. Energy and balance changed similarly in both sexes after surgery. However, postoperative women tended to be more affected by facial palsy and headaches than men. Despite the greater physical impairment, general health improved equivalently or even more in female patients than in males. In conclusion, self-rated QoL in VS is significantly affected by sex and surgery. This should be taken into account when counseling VS patients regarding observation, radiotherapy, and surgery.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, 72074 Tuebingen, Germany
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Legmouz M, El Ouahabi A, Boulbaroud S, Azzaoui F. A SCARE-compliant case report of recurrent meningioma in a 75-year-old patient after 10 years of surgical resection. Ann Med Surg (Lond) 2023; 85:1162-1165. [PMID: 37113867 PMCID: PMC10129188 DOI: 10.1097/ms9.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/12/2023] [Indexed: 04/29/2023] Open
Abstract
Meningiomas are intracranial extracerebral tumors derived from arachnoid cells of the neural crest. They represent ∼20% of primary intracranial tumors and are seen as more common in elderly patients and women. Recurrence of meningioma can be observed during the early years after surgical treatment, but their occurrence within 10 years is rare. Case presentation In this report, the authors discuss a case of a 75-year-old patient with a recurrence of a frontal meningioma after 10 years of successful surgical resection. Our patient was a female who presented amnesia and memory lapses associated with several weeks of progressive heaviness of the lower limbs accompanied by speech heaviness, intense headaches, asthenia, consciousness disorder, and tonic-clonic convulsive seizures for 10 days. The patient had previously been treated for a benign meningioma by surgical excision. Imaging was performed, and recurrent frontal meningioma was retained as a final diagnosis. The patient underwent a successful total resection of her frontal tumor. Clinical discussion Recurrent tumors after complete surgical removal of meningiomas are rare and may be associated with microscopic residues. The more radical the surgery, the lower the risk of observing a recurrence. Adjuvant radiotherapy can be proposed, but the evidence is still lacking. Careful follow-up of all patients with or without complete surgical resection is therefore recommended. Conclusion This case illustrates the importance of suspecting recurrence of meningioma in adult patients after successful surgical excision, even after 10 years of free disease. Clinicians should be aware of long-term meningioma recurrence in this population, and imaging is key for a positive diagnosis.
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Affiliation(s)
- Maria Legmouz
- Laboratory of Biology and Health, Faculty of Science, Ibn Tofail University, Kenitra
- Corresponding author. Address: Laboratory of Biology and Health, Faculty of Science, Ibn Tofail University, Kenitra 16000, Morocco. Tel: +212 621 65 04 60. E-mail address: (M. Legmouz)
| | - Abdessamad El Ouahabi
- Neurosurgery Department, Hospital of Specialties, Ibn Sina University Hospital, Rabat
| | - Samira Boulbaroud
- Laboratory of Biology, Polydisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Fatimazahra Azzaoui
- Laboratory of Biology and Health, Faculty of Science, Ibn Tofail University, Kenitra
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Zamanipoor Najafabadi AH, Dirven L, Drummond KJ, Taphoorn MJB. Health-Related Quality of Life in Intracranial Meningioma: Current Evidence and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:235-252. [PMID: 37432632 DOI: 10.1007/978-3-031-29750-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Historically, largely due to the good prognosis for survival, there has been little attention paid to the possible impact of meningiomas and their treatment on health-related quality of life (HRQoL). However, in the last decade there has been increasing evidence that patients with intracranial meningiomas suffer from long-term decreases in their HRQoL. Compared with controls and normative data, meningioma patients have worse HRQoL scores both before and after intervention and continuing long term (even after >4 years of follow-up). Overall, surgery results in improvements in many aspects of HRQoL. The limited available studies investigating the impact of radiotherapy suggest that this type of treatment decreases HRQoL scores, especially in the long term. There is however only limited evidence on additional determinants of HRQoL. Patients with anatomically complex skull base meningiomas and severe comorbidities, including epilepsy, report the lowest HRQoL scores. Other tumor and sociodemographic characteristics have shown weak associations with HRQoL. Furthermore, about one-third of caregivers of meningioma patients report caregiver burden, warranting interventions to improve caregiver HRQoL. As antitumor interventions may not improve HRQoL scores to be comparable to those of the general population, more attention should be paid to the development of integrative rehabilitation and supportive care programs for meningioma patients.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- University Neurosurgical Centre Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands.
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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7
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Kasper G, Hart S, Samuel N, Fox C, Das S. Anxiety and depression in patients with intracranial meningioma: a mixed methods analysis. BMC Psychol 2022; 10:93. [PMID: 35395829 PMCID: PMC8994241 DOI: 10.1186/s40359-022-00797-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background While diagnosis with a high-grade intracranial tumor is known to be associated with increased psychosocial burden, the burdens associated with meningioma are less well described. This study aimed to investigate the mental health burden in patients with meningiomas who have undergone surgical resection or serial observation, so as to identify and enhance awareness of gaps in care. Methods The Hospital Anxiety and Depression Scale (HADS) was administered to participants. Fisher’s Exact tests were performed to evaluate frequency distributions and t-tests were applied to compare postoperative and non-surgical patients’ HADS scores. Semi-structured interviews were completed on a subset of participants. Thematic analysis of interviews identified emerging themes. Results Thirty patients with intracranial meningiomas met inclusion criteria. The cohort’s mean age was 56.01 years and 66.67% were women (n = 20). Fourteen underwent surgery; sixteen were treated conservatively with observation. The average time since diagnosis of the sample was 37.6 months. Prevalence of mild to severe symptoms of anxiety was 28.6% amongst surgical management patients and 50% for active surveillance patients (p = 0.325). The prevalence of mild to severe symptoms of depression was 7.14% amongst surgical management patients and 6.25% for active surveillance patients (p = 0.533). Emerging themes from eight interviews reveal the influence of resilience, uncertainty and time, social support, interactions with medical experts, and difficulties during recovery on mental health. Conclusion The findings from the present study reveal that patients with meningiomas experience a significant mental health burden, illustrating the need for enhanced patient-centred care focusing on mental health. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00797-6.
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Affiliation(s)
- Graham Kasper
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shannon Hart
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nardin Samuel
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Colleen Fox
- Person-Centred Care, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Sunit Das
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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8
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Maurer R, McNutt S, Daggubati LC, Ba DM, Liu G, Leslie D, Goyal N, Zacharia BE. Mental health disorders in newly diagnosed non-functional pitutary adenoma under initial observation: an observational cohort study using the nationwide MarketScan database. Pituitary 2022; 25:85-91. [PMID: 34269977 DOI: 10.1007/s11102-021-01172-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Nonfunctioning pituitary adenomas account for 15-30% of pituitary tumors. Studies exploring the role of an intracranial tumor diagnosis, specifically nonfunctioning pituitary adenomas, on mental health disorders (MHDs) in patients have been limited. We characterize the incidence and factors affecting the development of MHDs in untreated pituitary adenomas. METHODS Utilizing a large-scale private payor database, MarketScan, we performed a retrospective study of patients with an untreated pituitary adenomas and corresponding MHD. RESULTS We found that in patients diagnosed with an untreated pituitary adenomas, approximately 15% were newly diagnosed with a MHD within 1 year of the pituitary adenoma diagnosis. Independent risk factors included female gender and substance abuse. Headaches, visual symptoms, and higher Charlson Co-morbidity indexes were also independently associated with a subsequent diagnosis of MHD. On multivariable analysis, patients in the pituitary tumor cohort were more likely to be diagnosed with a MHD than those in the matched cohort (aOR: 1.31, CI: 1.19-1.44). CONCLUSION By identifying risk factors, advanced screening can focus on non-operative pituitary adenoma patients at high-risk for the development of MHD.
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Affiliation(s)
- Robert Maurer
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Neurosurgery, Penn State Hershey Medical Center, 30 Hope Drive, Hershey, PA, 17033, USA
| | - Sarah McNutt
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Neurosurgery, Penn State Hershey Medical Center, 30 Hope Drive, Hershey, PA, 17033, USA
| | - Lekhaj C Daggubati
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Neurosurgery, Penn State Hershey Medical Center, 30 Hope Drive, Hershey, PA, 17033, USA
| | - Djibril M Ba
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Dr., MC H091, Hershey, PA, 17033, USA
- Department of Public Health Sciences, University Park, PA, 16802, USA
| | - Guodong Liu
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Dr., MC H091, Hershey, PA, 17033, USA
- Department of Public Health Sciences, University Park, PA, 16802, USA
| | - Douglas Leslie
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Dr., MC H091, Hershey, PA, 17033, USA
- Department of Public Health Sciences, University Park, PA, 16802, USA
| | - Neerav Goyal
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA
- Department of Neurosurgery, Penn State Hershey Medical Center, 30 Hope Drive, Hershey, PA, 17033, USA
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Dr., MC H091, Hershey, PA, 17033, USA
- Department of Public Health Sciences, University Park, PA, 16802, USA
| | - Brad E Zacharia
- College of Medicine, The Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA.
- Department of Neurosurgery, Penn State Hershey Medical Center, 30 Hope Drive, Hershey, PA, 17033, USA.
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Dr., MC H091, Hershey, PA, 17033, USA.
- Department of Public Health Sciences, University Park, PA, 16802, USA.
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Oteri V, Martinelli A, Crivellaro E, Gigli F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurg Rev 2021; 44:3047-3057. [PMID: 33608828 PMCID: PMC8593022 DOI: 10.1007/s10143-021-01498-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022]
Abstract
Preoperative anxiety is a common reaction exhibited by up to 80% of patients who are scheduled for surgical procedures and characterized by psychological and physical changes which may affect their perioperative period. Our aim is to report the most up-to-date evidence on preoperative anxiety in brain surgery patients through a systematic analysis of the studies produced in the last decades. We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. Data were extracted using the Population, Intervention, Comparison, Outcome framework and critically analyzed. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the Risk of bias (RoB) 2 and ROBINS tools, as was the methodological quality, following GRADE criteria. We included 27 articles, accounting for 2558 patients in twelve different countries. The prevalence of preoperative anxiety ranged from 17 up to 89%, higher in female patients. Preoperative anxiety was associated with lower quality of life and cognitive performance, higher need for information, poorer memory and attention, longer hospitalization, depressive symptoms, and increase of physical disability; no correlation with survival rate was found. Seven randomized controlled trials attested the efficacy of acupuncture, music therapy, virtual reality, and pharmacological support in lowering anxiety levels. Preoperative anxiety is a common phenomenon that could negatively affect the perioperative period of brain surgery patients: this is something that should not be neglected to achieve better care through early prevention and optimal management.
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Affiliation(s)
- Vittorio Oteri
- Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy.
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Weiss Lucas C, Renovanz M, Jost J, Sabel M, Wiewrodt D, Rapp M. Assessment Practice of Patient-Centered Outcomes in Surgical Neuro-Oncology: Survey-Based Recommendations for Clinical Routine. Front Oncol 2021; 11:702017. [PMID: 34458144 PMCID: PMC8386174 DOI: 10.3389/fonc.2021.702017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
The psycho-oncological burden related to the diagnosis of an intracranial tumor is often accompanied by neurocognitive deficits and changes in character, overall affecting health-related quality of life (HRQoL) and activities of daily living. Regular administration of adequate screening tools is crucial to ensure a timely detection of needs for support and/or specific interventions. Although efforts have been made to assure the quality of neuro-oncological care, clinical assessment practice of patient-reported outcomes (PROs) remains overall heterogeneous, calling for a concise recommendation tailored to neuro-oncological patients. Therefore, this survey, promoted by the German Society of Neurosurgery, was conducted to evaluate the status quo of health care resources and PRO/neurocognition assessment practices throughout departments of surgical neuro-oncology in Germany. 72/127 (57%) of registered departments participated in the study, including 83% of all university hospital units. A second aim was to shed light on the impact of quality assurance strategies (i.e., department certification as part of an integrative neuro-oncology cancer center; CNOC) on the assessment practice, controlled for interacting structural factors, i.e., university hospital status (UH) and caseload. Despite an overall good to excellent availability of relevant health care structures (psycho-oncologist: 90%, palliative care unit: 97%, neuropsychology: 75%), a small majority of departments practice patient-centered screenings (psycho-oncological burden: 64%, HRQoL: 76%, neurocognition: 58%), however, much less frequently outside the framework of clinical trials. In this context, CNOC affiliation, representing a specific health care quality assurance process, was associated with significantly stronger PRO assessment practices regarding psycho-oncological burden, independent of UH status (common odds ratio=5.0, p=0.03). Nevertheless, PRO/neurocognitive assessment practice was not consistent even across CNOC. The overall most commonly used PRO/neurocognitive assessment tools were the Distress Thermometer (for psycho-oncological burden; 64%), the EORTC QLQ-C30 combined with the EORTC QLQ-BN20 (for HRQoL; 52%) and the Mini-Mental Status Test (for neurocognition; 67%), followed by the Montreal Cognitive Assessment (MoCA; 33%). Accordingly, for routine clinical screening, the authors recommend the Distress Thermometer and the EORTC QLQ-C30 and QLQ-BN20, complemented by the MoCA as a comparatively sensitive yet basic neurocognitive test. This recommendation is intended to encourage more regular, adequate, and standardized routine assessments in neuro-oncological practice.
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Affiliation(s)
- Carolin Weiss Lucas
- Center of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tuebingen, Tuebingen, Germany.,Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Jost
- Department of Neurosurgery, Muenster University Hospital, Muenster, Germany
| | - Michael Sabel
- Department of Neurosurgery, Heinrich Heine University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Muenster University Hospital, Muenster, Germany
| | - Marion Rapp
- Department of Neurosurgery, Heinrich Heine University Hospital of Duesseldorf, Duesseldorf, Germany
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11
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Li Y, Ran G, Chen K, Shen X. Preoperative Psychological Burdens in Patients with Vestibular Schwannoma. Ann Otol Rhinol Laryngol 2021; 131:239-243. [PMID: 34032139 DOI: 10.1177/00034894211018915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess preoperative psychological burden in patients with vestibular schwannoma (VS). METHODS A total of 100 patients undergoing VS resection between September 2019 and June 2020 completed preoperative psychological screening. The Hospital Anxiety and Depression Scale (HADS) was applied the day before surgery, and a score >14 was considered clinically important. Univariate and multivariate logistic regression analyzes were used to identify risk factors associated with increased preoperative psychological stress. RESULTS Of the 100 patients who underwent VS resection, 44% were male, with a mean age of 45.9 years. Twenty-two (22%) had HADS scores >14. For the univariate analysis, risk factors associated with elevated psychological burden included time since diagnosis, number of symptoms, headache, vertigo, and nausea and/or vomiting. In the regression analysis, the number of symptoms and greater time from diagnosis to treatment correlated with higher preoperative psychological stress. CONCLUSION Nearly 1 in 4 patients with VS experienced clinically significant emotional burden preoperatively. Number of symptoms and greater time from diagnosis to treatment contributed to this psychological burden.
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Affiliation(s)
- Yufeng Li
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Guo Ran
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Kaizheng Chen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xia Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
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12
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Thurin E, Rydén I, Skoglund T, Smits A, Gulati S, Hesselager G, Bartek J, Henriksson R, Salvesen Ø, Jakola AS. Impact of meningioma surgery on use of antiepileptic, antidepressant, and sedative drugs: A Swedish nationwide matched cohort study. Cancer Med 2021; 10:2967-2977. [PMID: 33773085 PMCID: PMC8085957 DOI: 10.1002/cam4.3868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/30/2020] [Accepted: 03/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background Meningioma is the most common primary intracranial tumor and surgery is the main treatment modality. As death from lack of tumor control is rare, other outcome measures like anxiety, depression and post‐operative epilepsy are becoming increasingly relevant. In this nationwide registry‐based study we aimed to describe the use of antiepileptic drugs (AED), antidepressants and sedatives before and after surgical treatment of an intracranial meningioma compared to a control population, and to provide predictors for continued use of each drug‐group two years after surgery. Methods All adult patients with histopathologically verified intracranial meningiomas were identified in the Swedish Brain Tumor Registry and their data were linked to relevant national registries after assigning five matched controls to each patient. We analyzed the prescription patterns of antiepileptic drugs (AED), antidepressants and sedative drugs in the two years before and the two years following surgery. Results For the 2070 patients and 10312 controls identified the use of AED, antidepressants and sedatives was comparable two years before surgery. AED use at time of surgery was higher for patients than for controls (22.2% vs. 1.9%, p < 0.01), as was antidepressant use (12.9% vs. 9.4%, p < 0.01). Both AED and antidepressant use remained elevated after surgery, with patients having a higher AED use (19.7% vs. 2.3%, p < 0.01) and antidepressant use (14.8% vs. 10.6%, p < 0.01) at 2 years post‐surgery. Use of sedatives peaked for patients at the time of surgery (14.4% vs. 6.1%, p < 0.01) and remained elevated at two years after surgery with 9.9% versus 6.6% (p < 0.01). For all the studied drugs, previous drug use was the strongest predictor for use 2 years after surgery. Conclusion This nationwide study shows that increased use of AED, antidepressants and sedatives in patients with meningioma started perioperatively, and remained elevated two years following surgery.
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Affiliation(s)
- Erik Thurin
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Isabelle Rydén
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Skoglund
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Smits
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Sasha Gulati
- Department of Neurosurgery, St.Olavs University Hospital HF, Trondheim, Norway.,Institute of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Göran Hesselager
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Roger Henriksson
- Department of Radiation Sciences & Oncology, University of Umeå, Umea, Sweden
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asgeir S Jakola
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurosurgery, St.Olavs University Hospital HF, Trondheim, Norway
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13
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Zamanipoor Najafabadi AH, van der Meer PB, Boele FW, Taphoorn MJB, Klein M, Peerdeman SM, van Furth WR, Dirven L. Long-Term Disease Burden and Survivorship Issues After Surgery and Radiotherapy of Intracranial Meningioma Patients. Neurosurgery 2021; 88:155-164. [PMID: 32818258 PMCID: PMC7735868 DOI: 10.1093/neuros/nyaa351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 06/08/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many intracranial meningioma patients have an impaired health-related quality of life (HRQoL) and neurocognitive functioning up to 4 yr after intervention. OBJECTIVE To assess the long-term (≥5 yr) disease burden of meningioma patients. METHODS In this multicenter cross-sectional study, patients ≥5 yr after intervention (including active magnetic resonance imaging (MRI) surveillance) were included and assessed for HRQoL (Short-Form Health Survey 36), neurocognitive functioning (neuropsychological assessment), anxiety and depression (Hospital Anxiety and Depression Scale), and work productivity (Short Form-Health and Labour Questionnaire). Multivariable and propensity score regression analyses were used to compare patients and controls, and different treatment strategies corrected for possible confounders. Clinically relevant differences were reported. RESULTS At a median of 9 yr follow-up after intervention, meningioma patients (n = 190) reported more limitations due to physical (difference 12.5 points, P = .008) and emotional (13.3 points, P = .002) health problems compared with controls. Patients also had an increased risk to suffer from anxiety (odds ratio [OR]: 2.6, 95% CI: 1.2-5.7) and depression (OR: 3.7, 95% CI: 1.3-10.5). Neurocognitive deficits were found in 43% of patients. Although postoperative complications, radiotherapy, and reresection were associated with worse verbal memory, attention, and executive functioning when compared to patients resected once, the only clinically relevant association was between reresection and worse attention (–2.11, 95% CI: –3.52 to –0.07). Patients of working age less often had a paid job (48%) compared with the working-age Dutch population (72%) and reported more obstacles at work compared with controls. CONCLUSION In the long term, a large proportion of meningioma patients have impaired HRQoL, neurocognitive deficits, and high levels of anxiety or depression. Patients treated with 1 resection have the best neurocognitive functioning.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Florien W Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, United Kingdom.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin Klein
- Brain Tumor Center Amsterdam at Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Saskia M Peerdeman
- Department of Neurosurgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Wouter R van Furth
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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14
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Doglietto F, Vezzoli M, Biroli A, Saraceno G, Zanin L, Pertichetti M, Calza S, Agosti E, Aliaga Arias JM, Assietti R, Bellocchi S, Bernucci C, Bistazzoni S, Bongetta D, Fanti A, Fioravanti A, Fiorindi A, Franzin A, Locatelli D, Pugliese R, Roca E, Sicuri GM, Stefini R, Venturini M, Vivaldi O, Zattra C, Zoia C, Fontanella MM. Anxiety in neurosurgical patients undergoing nonurgent surgery during the COVID-19 pandemic. Neurosurg Focus 2020; 49:E19. [PMID: 33260119 DOI: 10.3171/2020.9.focus20681] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has forced many countries into lockdown and has led to the postponement of nonurgent neurosurgical procedures. Although stress has been investigated during this pandemic, there are no reports on anxiety in neurosurgical patients undergoing nonurgent surgical procedures. METHODS Neurosurgical patients admitted to hospitals in eastern Lombardy for nonurgent surgery after the lockdown prospectively completed a pre- and postoperative structured questionnaire. Recorded data included demographics, pathology, time on surgical waiting list, anxiety related to COVID-19, primary pathology and surgery, safety perception during hospital admission before and after surgery, and surgical outcomes. Anxiety was measured with the State-Trait Anxiety Inventory. Descriptive statistics were computed on the different variables and data were stratified according to pathology (oncological vs nononcological). Three different models were used to investigate which variables had the greatest impact on anxiety, oncological patients, and safety perception, respectively. Because the variables (Xs) were of a different nature (qualitative and quantitative), mostly asymmetrical, and related to outcome (Y) by nonlinear relationships, a machine learning approach composed of three steps (1, random forest growing; 2, relative variable importance measure; and 3, partial dependence plots) was chosen. RESULTS One hundred twenty-three patients from 10 different hospitals were included in the study. None of the patients developed COVID-19 after surgery. State and trait anxiety were reported by 30.3% and 18.9% of patients, respectively. Higher values of state anxiety were documented in oncological compared to nononcological patients (46.7% vs 25%; p = 0.055). Anxiety was strongly associated with worry about primary pathology, surgery, disease worsening, and with stress during waiting time, as expected. Worry about positivity to SARS-CoV-2, however, was the strongest factor associated with anxiety, even though none of the patients were infected. Neuro-oncological disease was associated with state anxiety and with worry about surgery and COVID-19. Increased bed distance and availability of hand sanitizer were associated with a feeling of safety. CONCLUSIONS These data underline the importance of psychological support, especially for neuro-oncological patients, during a pandemic.
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Affiliation(s)
- Francesco Doglietto
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Marika Vezzoli
- 2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia
| | - Antonio Biroli
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Giorgio Saraceno
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Luca Zanin
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | - Stefano Calza
- 2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia
| | - Edoardo Agosti
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,4Neurosurgery, University of Insubria, Varese
| | - Jahard Mijail Aliaga Arias
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,5Neurosurgery, Cremona Hospital, Cremona
| | | | | | | | | | | | - Andrea Fanti
- 8Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo
| | | | - Alessandro Fiorindi
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | | | | | - Elena Roca
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | | | | | | | - Oscar Vivaldi
- 9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | - Costanza Zattra
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | - Cesare Zoia
- 10Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia; and
| | - Marco Maria Fontanella
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
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15
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Psychological Burden in Meningioma Patients under a Wait-and-Watch Strategy and after Complete Resection Is High-Results of a Prospective Single Center Study. Cancers (Basel) 2020; 12:cancers12123503. [PMID: 33255551 PMCID: PMC7761113 DOI: 10.3390/cancers12123503] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Asymptomatic meningiomas are found in 1–2% of cranial MRIs. Most of them demonstrate no or minimal growth and are observed with follow-up imaging. However, the patients face a diagnosis of a brain tumor. So far, there is no established distress screening for such patients. In this study, we evaluated the psychological burden of patients with small asymptomatic meningiomas and compared it with patients after complete meningioma resection and excellent postoperative outcome. We found a high prevalence of anxiety and depression symptoms in both study groups. This demonstrates that even patients with benign asymptomatic intracranial tumors might be under significant distress and need psychooncological support. Abstract The diagnosis of intracranial meningiomas as incidental findings is increasing by growing availability of MRI diagnostics. However, the psychological distress of patients with incidental meningiomas under a wait-and-watch strategy is unknown. Therefore, we aimed to compare the psychosocial situation of meningioma patients under wait-and-watch to patients after complete resection to bridge this gap. The inclusion criteria for the prospective monocenter study were either an incidental meningioma under a wait-and-watch strategy or no neurologic deficits after complete resection. Sociodemographic, clinical, and health-related quality of life and clinical data were assessed. Psychosocial factors were measured by the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and the Short Form (SF-36). A total of 62 patients were included (n = 51 female, mean age 61 (SD 13) years). According to HADS, the prevalence of anxiety was 45% in the postoperative and 42% in the wait-and-watch group (p = 0.60), and depression was 61% and 87%, respectively (p = 0.005). In total, 43% of patients under wait-and-watch and 37% of patients in the postoperative group scored ≥6 on the DT scale. SF-36 scores were similar in all categories except general health (p = 0.005) and physical component aggregate score (43.7 (13.6) vs. 50.5 (9.5), (p = 0.03), both lower in the wait-and-watch group. Multivariate analysis revealed the wait-and-watch strategy was associated with a 4.26-fold higher risk of a pathological depression score based on HADS (p = 0.03). This study demonstrates a high prevalence of psychological distress in meningioma patients. Further evaluation is necessary to identify the patients in need of psychooncological support.
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16
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Renovanz M, Hickmann AK, Nadji-Ohl M, Keric N, Weimann E, Wirtz CR, Singer S, Ringel F, Coburger J. Health-related quality of life and distress in elderly vs. younger patients with high-grade glioma-results of a multicenter study. Support Care Cancer 2020; 28:5165-5175. [PMID: 32060706 PMCID: PMC7546979 DOI: 10.1007/s00520-020-05354-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/06/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Half of all newly diagnosed patients with glioblastoma are > 65 years still with a poor prognosis. Preserving quality of life is of high importance. However, patient reported outcome (PRO) data in this patient group is rare. The aim was to compare health-related quality of life (HRQoL) and distress between elderly and younger patients with high-grade glioma (HGG). METHODS We used baseline data of a prospective study where HGG patients were enrolled from 4 hospitals. Distress was measured using the distress thermometer (DT), HRQoL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) plus brain module (BN20). We compared distress and HRQoL by age (≥ 65 vs. < 65 years), gender, performance score, and time since diagnosis using multivariate linear and logistic regressions. RESULTS A total of n = 93 (30%) out of n = 309 patients were ≥ 65 years (mean 70 years, range 65-86 years). Mean DT score of elderly patients (5.2, SD 2.6) was comparable with younger patients (4.9, SD 2.6). Elderly patients reported significantly lower global health (GHS, mean elderly vs. younger; 50.8 vs. 60.5, p = 0.003), worse physical (56.8 vs. 73.3, p < 0.001) and lower cognitive functioning (51.1 vs. 63.2, p = 0.002), worse fatigue (52.5 vs. 43.5, p = 0.042), and worse motor dysfunction (34.9 vs. 23.6, p = 0.030). KPS and not age was consistently associated with HRQoL. CONCLUSION Physical functioning was significantly reduced in the elderly compared with younger HGG patients, and at the same time, emotional functioning and DT scores were comparable. KPS shows a greater association with HRQoL than with calendric age in HGG patients reflecting the particular importance for adequate assessment of HRQoL and general condition in elderly patients.
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Affiliation(s)
- Mirjam Renovanz
- Department of Neurosurgery, University Medical Center, Mainz, Germany.
- Division of Neuro-Oncology, University Medical Center Tubingen, Tübingen, Germany.
| | | | - Minou Nadji-Ohl
- Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Center, Mainz, Germany
| | - Elke Weimann
- Department of Neurology, RKH Kliniken Ludwigsburg, Ludwigsburg, Germany
| | | | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Mainz, Germany
| | - Jan Coburger
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
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17
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Jarvis CA, Lin M, Ding L, Julian A, Giannotta SL, Zada G, Mack WJ, Attenello FJ. Comorbid depression associated with non-routine discharge following craniotomy for low-grade gliomas and benign tumors - a nationwide readmission database analysis. Acta Neurochir (Wien) 2020; 162:2671-2681. [PMID: 32876766 DOI: 10.1007/s00701-020-04559-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Prior studies have demonstrated elevated rates of depression in patients with malignant brain tumor; however, the prevalence and effect on surgical outcomes in patients with low-grade gliomas (LGG) and benign brain tumors (BBT) remain unknown. Readmission and non-routine discharge, which includes discharge to skilled nursing, rehabilitative, and other inpatient facilities, are well-established quality of care indicators. We sought to analyze the association between comorbid depression and non-routine discharge, readmission, and other post-operative inpatient outcomes in patients with LGG and BBT. METHODS The Nationwide Readmissions Database from 2010 to 2014 was retrospectively queried to select for surgically treated patients with LGG and BBT. Multivariable logistic regression models adjusting for patient and hospital characteristics were used to determine the effects of comorbid depression on post-operative outcomes. Interaction of gender and depression on non-routine disposition was analyzed. RESULTS We identified 31,654 craniotomies for resection of BBT and LGG (2010-2014). The majority of patients (64.1%) were female. The rate of depression comorbid with BBT and LGG was 11.9%. Depression was associated with non-routine discharge after surgery (OR 1.19, p 0.0002*), but was not associated with increased morbidity, mortality, or readmission at 30 or 90 days. The rate of comorbid depression was higher among female than male patients (14.0 vs. 8.0%). Depression in males was associated with a 38% increased likelihood of non-routine disposition (p = 0.0002*), while depression in females was associated with a 13% increased likelihood of non-routine disposition (p = 0.03*). CONCLUSION Depression is prevalent in patients with LGG and BBT and is associated with increased risk of non-routine discharge following surgical intervention. The increased likelihood of non-routine disposition is greater for males than that for females. Awareness of the risk factors for depression may aid in early screening and intervention and improve overall patient outcomes.
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Affiliation(s)
- Casey A Jarvis
- Keck School of Medicine, University of Southern California, 1200 North State St. Suite 3300, Los Angeles, CA, 90033, USA.
| | - Michelle Lin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alex Julian
- Keck School of Medicine, University of Southern California, 1200 North State St. Suite 3300, Los Angeles, CA, 90033, USA
| | - Steven L Giannotta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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18
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Maurer R, Daggubati L, Ba DM, Liu G, Leslie D, Goyal N, Zacharia BE. Mental health disorders in patients with untreated meningiomas: an observational cohort study using the nationwide MarketScan database. Neurooncol Pract 2020; 7:507-513. [PMID: 33014391 DOI: 10.1093/nop/npaa025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Meningiomas are the most common primary tumor of the CNS. Studies investigating the impact of a brain tumor diagnosis on mental health disorders (MHDs) in patients have been limited. The objective of this work is to characterize the incidence and factors affecting the presence of MHDs in untreated meningiomas. Methods Using a large-scale private payer database, MarketScan, we performed a retrospective study of patients with an untreated meningioma and corresponding MHD. Results We found that in patients diagnosed with an untreated meningioma, approximately 16% were diagnosed with an MHD within 1 year of the diagnosis of the meningioma. Conclusion By identifying risk factors, appropriate screening can focus on patients at high-risk for the development of MHD.
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Affiliation(s)
- Robert Maurer
- The Pennsylvania State University, College of Medicine.,Department of Neurosurgery, Penn State Hershey Medical Center
| | - Lekhaj Daggubati
- The Pennsylvania State University, College of Medicine.,Department of Neurosurgery, Penn State Hershey Medical Center
| | - Djibril M Ba
- The Pennsylvania State University, College of Medicine.,Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center.,Department of Public Health Sciences, Penn State University, State College, Pennsylvania
| | - Guodong Liu
- The Pennsylvania State University, College of Medicine.,Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center.,Department of Public Health Sciences, Penn State University, State College, Pennsylvania
| | - Douglas Leslie
- The Pennsylvania State University, College of Medicine.,Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center.,Department of Public Health Sciences, Penn State University, State College, Pennsylvania
| | - Neerav Goyal
- The Pennsylvania State University, College of Medicine.,Department of Neurosurgery, Penn State Hershey Medical Center
| | - Brad E Zacharia
- The Pennsylvania State University, College of Medicine.,Department of Neurosurgery, Penn State Hershey Medical Center
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19
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Keng A, Stewart DE, Sheehan KA. Examining the Neuropsychiatric Sequelae Postsurgical Resection of Adult Brain Tumors Through a Scoping Review. PSYCHOSOMATICS 2020; 61:209-219. [DOI: 10.1016/j.psym.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
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20
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Feasibility, Safety and Effects of a One-Week, Ski-Based Exercise Intervention in Brain Tumor Patients and Their Relatives: A Pilot Study. J Clin Med 2020; 9:jcm9041006. [PMID: 32252441 PMCID: PMC7231125 DOI: 10.3390/jcm9041006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
A brain tumor diagnosis poses a significant psychological burden and it severely impacts quality of life (QOL), both in patients and relatives. However, comprehensive strategies addressing QOL in this setting remain rare. Here, we aim to share our findings of a one-week ski exercise intervention, with emphasis on feasibility, safety, QOL, and physical exercise. The intervention consisted of week-long daily ski sessions with professional ski guides as well as dedicated physicians present. The participants were handed questionnaires, including distress and QOL items before, during, and after the intervention. Using fitness watches, exercise intensity was also tracked at these timepoints. During the intervention, patients were checked for adverse events daily. Fifteen participants, nine patients after multidisciplinary treatment, and six relatives were included in the study. Additionally, 13 children participated in the exercise, but not in the study. All of the participants completed the entire program. No severe adverse events were documented during daily checks. There was a strong increase in quantified activity and QOL with a corresponding decrease in distress during the intervention, and, partly, afterwards. This prospective brain tumor rehabilitation study demonstrates the feasibility and safety of challenging ski exercise in brain tumor patients. The findings also underline the exercise-mediated QOL benefits, emphasizing the need for more comprehensive brain tumor rehabilitation programs.
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Verbruggen LC, Hudson MM, Bowers DC, Ronckers CM, Armstrong GT, Skinner R, Hoving EW, Janssens GO, van der Pal HJH, Kremer LCM, Mulder RL. Variations in screening and management practices for subsequent asymptomatic meningiomas in childhood, adolescent and young adult cancer survivors. J Neurooncol 2020; 147:417-425. [PMID: 32088813 DOI: 10.1007/s11060-020-03436-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/13/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Childhood, adolescent and young adult (CAYA) cancer survivors treated with cranial radiotherapy are at risk for developing subsequent meningiomas. There is insufficient evidence concerning the benefits and harms of screening for subsequent meningiomas, and uncertainty about the most appropriate clinical management of asymptomatic meningiomas. Data describing current clinical decision-making is essential to formulate surveillance recommendations. METHODS We created an online survey to identify the current international clinical practice regarding screening for and management of subsequent asymptomatic meningiomas among CAYA cancer survivors. Fifty-nine physicians from North America and Europe with expertise relevant to meningiomas were invited to participate. RESULTS Thirty-four physicians (58%) completed the survey. The reported number of CAYA cancer survivors that physicians are willing to screen to detect one meningioma varied widely from 0 to 750 (median 50). Physicians expressed concerns regarding harms from MRI screening, including risks of unnecessary interventions (n = 25, 73%) and overdiagnosis (n = 19, 56%). Growth pattern (n = 33, 97%), location (n = 31, 91%) and size (n = 29, 85%) were endorsed as the most important factors influencing the decision to treat asymptomatic meningiomas. A challenging location (n = 14, 52%), indolent tumor growth pattern (n = 13, 48%), and absence of symptoms (n = 12, 44%) were endorsed as the main reasons to monitor without intervention. CONCLUSIONS There is international variation in opinions and clinical practice regarding screening for subsequent asymptomatic meningiomas among at risk CAYA cancer survivors. Decision-making regarding interventions of asymptomatic meningiomas are largely driven by clinical characteristics. These valuable insights into current clinical practice will inform surveillance guidelines for CAYA cancer survivors.
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Affiliation(s)
- Lisanne C Verbruggen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Melissa M Hudson
- Departments of Epidemiology and Cancer Control, and Oncology, St. Jude Children's Research Hospital, Memphis, USA
| | - Daniel C Bowers
- Department of Pediatric Hematology-Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.,Institute for Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Gregory T Armstrong
- Departments of Epidemiology and Cancer Control, and Oncology, St. Jude Children's Research Hospital, Memphis, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology and Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Eelco W Hoving
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Leontine C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Quality of life and emotional burden after transnasal and transcranial anterior skull base surgery. Acta Neurochir (Wien) 2019; 161:2527-2537. [PMID: 31602535 DOI: 10.1007/s00701-019-04062-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze psychopathological outcome and health-related quality of life (QOL) for cohorts of patients undergoing transcranial or transnasal anterior skull base surgery. METHODS A prospective study of patients undergoing elective surgery for various entities of the anterior skull base was performed. Evaluation for depression (ADS-K score) and anxiety (PTSS, STAI-S, STAI-T, and ASI-3 scores) was done before surgery, at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative quality of life as measured by the SF-36 and EuroQol questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined and compared between transnasal and transcranial subgroups. RESULTS We included 54 patients scheduled for surgery of a pituitary adenoma or meningioma of the anterior skull base between January 2013 and July 2017. Of these, a cohort of 40 (74.1%) completed follow-up interviews after 3 and 12 months. There were 60.0% female patients, median age was 57 years. 57.5% of patients had a meningioma and were operated transcranially, while 42.5% of patients received transnasal surgery for pituitary adenoma. The proportion of pathological anxiety scores significantly decreased from 75.0 to 45.0% (p = 0.002), without difference between transnasal and transcranial subgroups. After 3 months, mean EuroQol VAS score non-significantly increased by 0.07 (p = 0.236) across the entire cohort without significant difference between transcranial and transnasal subgroups (p = 0.478). The transnasal cohort tended to score higher in anxiety scores, whereas the transcranial cohort demonstrated higher depression scores without significant difference, respectively. The individually declared emotional burden significantly decreased from 6.7 to 4.0 on the ten-point Likert scale (p < 0.001) equally for both subgroups (transnasal, - 2.3; transcranial, - 3.0; p = 0.174). On last examination, about half of the patients in each subgroup (41.2% vs. 52.2%; p = 0.491) expressed a considerable recovery of preoperative bodily complaints such as headaches, dizziness, and unrest defined as a score of at least 8 on the Likert scaled item. CONCLUSION Both transnasal and transcranial approaches yield favorable postoperative QOL and psychopathological outcomes. The postoperative increase in QOL is partly influenced by preoperative expression of mental distress, which tends to resolve postoperatively.
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Wagner A, Shiban Y, Lange N, Joerger AK, Hoffmann U, Meyer B, Shiban E. The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas. J Neurosurg 2019; 131:1840-1847. [PMID: 30641847 DOI: 10.3171/2018.8.jns181343] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/09/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Meningiomas are the most common intracranial neoplasm. Evidence concerning surgical management and outcome is abundant, while the implications for the quality of life (QOL) of a patient confronted with the diagnosis and undergoing surgery are unclear. The authors conducted a prospective study to evaluate QOL in relation to psychological comorbidities comorbidities. METHODS A prospective study of patients undergoing elective surgery for the removal of an intracranial meningioma was performed. The authors evaluated depression (Allgemeine Depressionsskala K score) and anxiety (Post-Traumatic Stress Scale-10 [PTSS-10]; State Trait Anxiety Inventory-State Anxiety and -Trait Anxiety [STAI-S and STAI-T]; and Anxiety Sensitivity Index-3 [ASI-3]) scores before surgery and at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative QOL as measured by the 36-Item Short Form Health Survey and EQ-5L questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined. RESULTS A total of 78 patients undergoing resection of a meningioma between January 2013 and September 2017 participated in the preoperative psychological screening and 71 patients fully completed postoperative follow-up examination after 1 year of follow-up. At presentation, 48 patients (67.7%) had abnormal anxiety scores, which decreased to 29.6% (p = 0.003). On follow-up at 12 months, mean EQ-5L visual analog scale scores were significantly lower in patients with pathological scores on the PTSS-10 (0.84 vs 0.69; p = 0.004), STAI-S (0.86 vs 0.68; p = 0.001), and STAI-T (0.85 vs 0.71; p = 0.011). Neurological status (modified Rankin Scale) improved slightly and showed some correlation with psychological comorbidities QOL scores (p = 0.167). There was a nonsignificant increase of EQ-5L scores over the period of follow-up (p = 0.174) in the repeated-measures analysis. In the regression analysis, impaired QOL and physical disability on follow-up correlated with elevated preoperative anxiety and depression levels. CONCLUSIONS The QOL and physical disability of patients undergoing resection of an intracranial meningioma highly depend on preoperative anxiety and depression levels. Stress and anxiety scores generally decrease after the resection, which leads us to conclude that there is a tremendous emotional burden caused by an upcoming surgery, necessitating close psychooncological support in order to uphold functional outcome and health-related QOL in the postoperative course.
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Affiliation(s)
- Arthur Wagner
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | - Youssef Shiban
- 2Department of Clinical Psychology, Private University of Applied Sciences, Göttingen, Germany
| | - Nicole Lange
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | | | - Ute Hoffmann
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | - Bernhard Meyer
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | - Ehab Shiban
- 1Department of Neurosurgery, Technische Universität München, Munich; and
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Pinzi V, Fariselli L, Marchetti M, Scorsetti M, Navarria P. Stereotactic Radiotherapy for Parasagittal and Parafalcine Meningiomas: Patient Selection and Special Considerations. Cancer Manag Res 2019; 11:10051-10060. [PMID: 31819638 PMCID: PMC6889965 DOI: 10.2147/cmar.s187371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022] Open
Abstract
Treatment options for intracranial meningiomas are surgical resection alone, surgery followed by adjuvant radiation therapy (RT), or exclusive RT. Parasagittal and parafalcine meningiomas are a subgroup of meningeal disease located close to the vascular structures. Considering the frequent venous invasion, a complete resection is not possible in the majority of cases, and even if a Simpson Grade I resection can be performed, the risk of recurrence is relevant. To date, few studies are focused on parasagittal and parafalcine meningiomas. Because of their specific related issues, particular considerations on decision-making process, outcome, and toxicity follow-up are mandatory. In fact, parasagittal and parafalcine meningiomas require a clear-cut radiological assessment, as well as a tailored toxicity risk evaluation. Moreover, similarly to other meningioma sites, also for parasagittal and parafalcine ones, a standardization of local control, toxicity, and quality of life evaluation is needed in order to lead to a pooled analysis of the results. In this context, our aim was to review the literature data regarding the role of both single-session and multisession radiosurgery (RS), and stereotactic radiotherapy (SRT) for parasagittal and parafalcine meningioma management, summarizing available data on safety and efficacy. It was also discussed how RS and SRT can be performed in a setting of evolving views concerning the treatment paradigm of the parasagittal and parafalcine meningiomas.
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Affiliation(s)
- V Pinzi
- Neurosurgery Department, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - L Fariselli
- Neurosurgery Department, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - M Marchetti
- Neurosurgery Department, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - P Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
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Meningioma and psychiatric symptoms: An individual patient data analysis. Asian J Psychiatr 2019; 42:94-103. [PMID: 30999261 DOI: 10.1016/j.ajp.2019.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
Meningioma is a slow-growing benign tumor arising from meninges and is usually asymptomatic. Though neuropsychiatric symptoms are common in patients with brain tumors, they often can be the only manifestation in cases of meningioma. Meningiomas might present with mood symptoms, psychosis, memory disturbances, personality changes, anxiety, or anorexia nervosa. The diagnosis of meningioma could be delayed where only psychiatric symptoms are seen. A comprehensive review of the literature and individual patient data analysis was conducted, which included all case reports, and case series on meningioma and psychiatric symptoms till September 2018 with the search terms "meningioma" and "psychiatric symptoms/ depression/ bipolar disorder/mania/ psychosis/ obsessive-compulsive disorder". Search engines used included PubMed, MEDLINE, PsycINFO, Cochrane database and Google Scholar. Studies reported varied psychiatric symptoms in cases with meningioma of differing tumor site, size and lateralization. Factors which led to a neuroimaging work-up included the occurrence of sudden new or atypical psychiatric symptoms, a lack of response to typical line of treatment and the presence of neurological signs or symptoms such as headache, seizures, diplopia, urinary incontinence etc. This review emphasizes on the need of neurological examination and neuroimaging in the patients presenting to psychiatry especially with atypical symptoms.
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Williams T, Brechin D, Muncer S, Mukerji N, Evans S, Anderson N. Meningioma and mood: exploring the potential for meningioma to affect psychological distress before and after surgical removal. Br J Neurosurg 2019; 33:383-387. [PMID: 30829086 DOI: 10.1080/02688697.2019.1571163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Much of the research exploring psychological distress with meningioma stem from studies including several brain tumour types (including malignant tumours) meaning that focus on meningioma is limited and that conclusions are based on small samples. Moreover, contradictory findings have been reported regarding the effects of meningioma on mood. Here, the authors present a study exploring pre and post mood scores in meningioma only patients using a sample size larger than any previous research attempt. Method: The Hospital Anxiety and Depression Scale (HADS) was used as an objective measure of mood in a clinical sample of 184 UK patients pre and post meningioma removal surgery. Repeated measures designs were used to assess for significant differences in depression and anxiety scores before and after surgery, chi-squared analyses were used to establish for clinically significant change. Results: The study revealed a significant decrease, and a medium effect size, in mean depression scores after surgery to remove the meningioma (p = .002, g = 0.35). However, no significant effect was found following meningioma removal and anxiety scores (p = .113, g = 0.17). Discussion: No significant effects were determined between mood and meningioma location. A discussion of the findings, and potential implications, is presented.
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Affiliation(s)
- Tamsin Williams
- a Alder Hey Children's NHS Foundation Trust, Psychology, Developmental Paediatrics, ASD Pathway, Alder Hey Children's Hospital , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - Donald Brechin
- b Clinical Psychology, James Cook University Hospital , Middlesbrough , United Kingdom of Great Britain and Northern Ireland
| | - Steven Muncer
- c Clinical Psychology Department, Teesside University , Middlesbrough , UK
| | - Nitin Mukerji
- d Neurosurgery, James Cook University Hospital , Middlesbrough , United Kingdom of Great Britain and Northern Ireland
| | - Stephen Evans
- e York Teaching Hospital NHS Foundation Trust , York , United Kingdom of Great Britain and Northern Ireland
| | - Natasha Anderson
- f Surrey and Borders Partnership NHS Foundation Trust , Leatherhead , United Kingdom of Great Britain and Northern Ireland
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Post-traumatic stress disorders in patients with low-grade glioma and its association with survival. J Neurooncol 2019; 142:385-392. [DOI: 10.1007/s11060-019-03112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
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Social cognition in patients with intracranial tumors: do we forget something in the routine neuropsychological examination? J Neurooncol 2018; 140:687-696. [DOI: 10.1007/s11060-018-3000-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
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Kohli KM, Loewenstern J, Kessler RA, Pain M, Palmese CA, Bederson J, Shrivastava RK. Antidepressant use in patients with meningioma: is there an association with tumor recurrence? Neurosurg Focus 2018; 44:E14. [DOI: 10.3171/2018.3.focus17797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWith increasing general use of antidepressants (ADs), multiple studies have noted a small protective effect of ADs for patients with glioma, but their impact on meningioma has not been established. This study aims to evaluate the role of ADs in the context of additional clinical factors in relation to long-term risk of meningioma recurrence.METHODSOne hundred five patients with an intracranial meningioma presenting from 2011–2014 with at least 3 years of follow-up (median 4.2 years) after resection were reviewed. AD use along with demographics, tumor characteristics, and outcomes were recorded. Multivariate logistic regression was used to analyze the association of AD use with tumor recurrence, including other clinical measures significantly associated with recurrence as covariates.RESULTSTwenty-nine patients (27.4%) were taking ADs (27 selective serotonin reuptake inhibitors, 2 norepinephrine-dopamine reuptake inhibitors) prior to tumor recurrence. Their tumors largely affected the frontal (31.0%) or parietal lobe (17.2%) and were located in convexity, parasagittal, or falcine (CPF) areas more frequently than skull base areas relative to the tumors of non-AD users (p = 0.035). AD use was found to be an independent predictor of recurrence, in addition to subtotal resection and WHO grade II/III classification (p values < 0.05). The median time from AD prescription to tumor recurrence was 36.6 months (interquartile range [IQR] = 20.9–62.9 months) and median length of AD use was 41.4 months (IQR = 24.7–62.8 months).CONCLUSIONSAD use was an independent predictor of meningioma recurrence. This association may be due to mood or affective changes caused by tumor location in CPF regions that may be a sign of early recurrence. The finding calls attention to AD use in the management of patients with meningioma, and warrants further exploration of an underlying relationship.
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Affiliation(s)
| | | | | | | | | | | | - Raj K. Shrivastava
- Departments of 1Neurosurgery,
- 4Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
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Is Psychiatric Depression a Presenting Neurologic Sign of Meningioma? A Critical Review of the Literature with Causative Etiology. World Neurosurg 2018; 112:64-72. [PMID: 29360583 DOI: 10.1016/j.wneu.2018.01.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Benign meningiomas constitute 80%-90% of all meningiomas and represent the most common type of central nervous system tumor in adults. The vast majority of meningiomas are minimally symptomatic or asymptomatic early in their onset and thereby can often result in delayed diagnosis. Early diagnosis of meningioma is critical, as it can maximize treatment options and improve outcomes and survival. Although seizures and focal neurologic deficits are considered to be the most prevalent symptoms, depression also may be an important and significant sign. A subtle neurologic depression may be an even early presenting sign of meningioma and may precede more traditional presenting symptoms. METHODS We performed a comprehensive literature review that analyzes the results of prospective studies and case reports on this topic. RESULTS Our findings show evidence to suggest that depression may be correlated with meningioma presentation. Its prevalence is possibly increased with an anterior location of the tumor. CONCLUSIONS For patients who exhibit nuances of depression without a history of psychiatric illness, an index of suspicion for meningioma may be warranted.
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Huang J, Zeng C, Xiao J, Zhao D, Tang H, Wu H, Chen J. Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget 2017; 8:94932-94943. [PMID: 29212279 PMCID: PMC5706925 DOI: 10.18632/oncotarget.19843] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with brain tumor are in risk of depression or depressive symptoms, but the estimated prevalence varies between studies. The aim of this study is to get a proper summarized estimate of depression prevalence in brain tumor patients. METHODS Literature search on Pubmed, PsycINFO, and Cochrane library from January 1981 through October 2016. The prevalence of depression or depressive symptoms in brain tumor patients was estimated by screening scales and analyzed using stratified meta-analysis and subgroup analysis. The prevalence of depression level or symptoms during the follow-up periods was detected by secondary analysis. RESULTS Among the 37 studies included in this meta-analysis, 25 used a cross-sectional design and 12 used longitudinal study. The pooled prevalence was 21.7% (971/4518 individuals, 95 % confidence interval (CI) 18.2%-25.2%) for overall sample. Lower prevalence was detected in studies with sample size ≥100 than <100, lower grade tumor than high grade tumor, studies using clinician-rated depression scales than self-rated or non-depression-specific ones, and in patients from UK, Germany and Italy than USA. After analyzing 6 longitudinal studies, prevalence of depression remained no change in the follow-up periods. No significant differences were observed between study designs and tumor types. CONCLUSIONS The estimated prevalence of depression or depressive symptoms among brain tumor patients was 21.7%, affected by depression assessment type, sample size, tumor grade and country. Diagnosis and treatment of co-morbid depression in brain tumor patients need to be addressed in future studies for better life quality and oncology management.
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Affiliation(s)
- Jing Huang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Chao Zeng
- Department of Thoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Juxiong Xiao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Danwei Zhao
- Xiangya Medical School, Central South University, Changsha, Hunan, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
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Bunevicius A, Deltuva VP, Tamasauskas A. Association of pre-operative depressive and anxiety symptoms with five-year survival of glioma and meningioma patients: a prospective cohort study. Oncotarget 2017; 8:57543-57551. [PMID: 28915694 PMCID: PMC5593666 DOI: 10.18632/oncotarget.15743] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/12/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mental symptoms are common and associated with worse health status of brain tumor patients. We evaluated the association of pre-operative depressive and anxiety symptoms with 5-year mortality of glioma and meningioma patients. METHODS One-hundred and fifty-two patients (mean age 56.9±14.7 years, 69% women) were evaluated for functional status (Barthel index), and depressive and anxiety symptom severity (Hospital Anxiety and Depression scale or HADS). Patients were categorized as having mild, moderate or severe depressive/anxiety symptoms if they scored ≤7, 8-10 or ≥11 on the HADS, respectively. Information pertaining to histological diagnosis, extent of resection and adjuvant therapies were obtained from medical records. Follow-up continued through November, 2015. RESULTS Forty-three patients were diagnosed with high-grade glioma, 20 with low-grade glioma and 89 with meningioma. Moderate to severe depressive and anxiety symptoms were diagnosed in 28% and 36% of patients, respectively. In meningioma patients, survival was the shortest in patients with severe depressive symptoms (40.32±7.92 months) followed by patients with moderate (46.66±6.05 months) and mild (55.68±1.77 months) depressive symptoms (Log-Rank = 6.211, p = 0.045). After adjusting for patients' age, gender, functional status, extent of resection, history of depression, and tumor location, laterality and grade, severe depressive symptoms were associated with increased 5-year mortality risk of meningioma patients (HR = 7.083 [95%CI: 1.755-28.588], p = 0.006). Depressive and anxiety symptoms were not associated with mortality of glioma patients. CONCLUSIONS Depressive and anxiety symptoms are common in glioma and meningioma patients. Pre-operative depressive symptoms are associated with shorter survival of meningioma patients independently from clinical prognostic indicators.
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Affiliation(s)
- Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Abstract
Meningiomas are common, usually benign intracranial tumors. They grow slowly and can remain asymptomatic for many years. Meningiomas can present as mental disorders rather than with neurologic signs or symptoms. In this case report we describe a middle-aged man with a 2-year history of depressive disorder who was diagnosed with a large olfactory fossa meningioma after he developed mental status changes and urinary incontinence. After the tumor was removed, the patient's depressive symptoms resolved and his neurocognitive functions improved. We discuss the patient's neuropsychological and psychiatric profiles to identify symptoms and other clues that could expedite identification of meningiomas in patients with psychiatric disorders. Because olfactory fossa meningiomas can present as depressive disorder, we recommend brain imaging to rule out organic brain lesions in middle-aged and older patients with new-onset psychiatric symptoms. Although tumor removal brought improvement of our patient's mental state and neurocognitive functions, patients may not be able to recover their cognitive functions completely.
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Hickmann AK, Nadji-Ohl M, Haug M, Hopf NJ, Ganslandt O, Giese A, Renovanz M. Suicidal ideation, depression, and health-related quality of life in patients with benign and malignant brain tumors: a prospective observational study in 83 patients. Acta Neurochir (Wien) 2016; 158:1669-82. [PMID: 27318813 DOI: 10.1007/s00701-016-2844-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) and psychosocial burden are of relevance in patients with intracranial tumors. We investigated the prevalence of suicidal ideation (SI), depression, and their association with HRQoL in patients with intra- (IA) and extraaxial (EA) tumors during the first 9 months after diagnosis. METHODS Patients were recruited immediately following surgery, and re-evaluated after 3, 6, and 9 months (EORTC QLQ-C30/BN20, Beck Depression Inventory (BDI) and Appendix). Patients with a personal history of psychological comorbidity were excluded. Sociodemographic and clinical data were evaluated. RESULTS IA patients had lower functioning scores and experienced more symptoms. Global Health Status was significantly lower at baseline (p = 0.038), but improved over time (p < 0.001). Seventeen patients (21.5 %) admitted to having had SI at least once during the study period (IA: n = 10/EA: n = 7). The highest rates were observed after 6 (IA: 18.8 %) and 9 months (EA: 10.0 %). Patients reporting SI had significantly higher BDI scores [p = 0.22 (baseline), p = 0.031 (3 months), p < 0.001 (6 months)]. After 6 months, HRQoL differed greatest between patients with and without SI. Most patients experienced good familial support (76 %). CONCLUSIONS Patients with intracranial tumors suffer from decreased HRQoL and SI regardless of histopathology. SI is associated with higher BDI scores, but not evident depression (BDI ≥ 18). Thus, patients should be screened specifically and regularly. Lower HRQoL and greatest prevalence of SI at 6 months may help clinicians to find the right time for careful monitoring of patients at risk.
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Affiliation(s)
- Anne-Katrin Hickmann
- Center for Endoscopic and Minimally Invasive Neurosurgery, Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland.
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
| | - Minou Nadji-Ohl
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Markus Haug
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Nikolai J Hopf
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
- Neurochirurgicum, Center for Endoscopic and Minimally Invasive Neurosurgery, Stuttgart, Germany
| | - Oliver Ganslandt
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
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Wenz H, Wenz R, Maros ME, Groden C, Schmieder K, Fontana J. The neglected need for psychological intervention in patients suffering from incidentally discovered intracranial aneurysms. Clin Neurol Neurosurg 2016; 143:65-70. [DOI: 10.1016/j.clineuro.2016.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
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Pranckeviciene A, Tamasauskas S, Deltuva VP, Bunevicius R, Tamasauskas A, Bunevicius A. Suicidal ideation in patients undergoing brain tumor surgery: prevalence and risk factors. Support Care Cancer 2016; 24:2963-70. [DOI: 10.1007/s00520-016-3117-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
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Bosnyák E, Kamson DO, Behen ME, Barger GR, Mittal S, Juhász C. Imaging cerebral tryptophan metabolism in brain tumor-associated depression. EJNMMI Res 2015; 5:56. [PMID: 26475140 PMCID: PMC4608955 DOI: 10.1186/s13550-015-0136-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/09/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression in patients with brain tumors is associated with impaired quality of life and shorter survival. Altered metabolism of tryptophan to serotonin and kynurenine metabolites may play a role in tumor-associated depression. Our recent studies with alpha[(11)C]methyl-L-tryptophan (AMT)-PET in brain tumor patients indicated abnormal tryptophan metabolism not only in the tumor mass but also in normal-appearing contralateral brain. In the present study, we explored if tryptophan metabolism in such brain regions is associated with depression. METHODS Twenty-one patients (mean age: 57 years) with a brain tumor (10 meningiomas, 8 gliomas, and 3 brain metastases) underwent AMT-PET scanning. MRI and AMT-PET images were co-registered, and AMT kinetic parameters, including volume of distribution (VD', an estimate of net tryptophan transport) and K (unidirectional uptake, related to tryptophan metabolism), were measured in the tumor mass and in unaffected cortical and subcortical regions contralateral to the tumor. Depression scores (based on the Beck Depression Inventory-II [BDI-II]) were correlated with tumor size, grade, type, and AMT-PET variables. RESULTS The mean BDI-II score was 12 ± 10 (range: 2-33); clinical levels of depression were identified in seven patients (33 %). High BDI-II scores were most strongly associated with high thalamic AMT K values both in the whole group (Spearman's rho = 0.63, p = 0.004) and in the subgroup of 18 primary brain tumors (r = 0.68, p = 0.004). Frontal and striatal VD' values were higher in the depressed subgroup than in non-depressed patients (p < 0.05); the group difference was even more robust when moderately/severely depressed patients were compared to patients with no/mild depression (frontal: p = 0.005; striatal: p < 0.001). Tumor size, grade, and tumor type were not related to depression scores. CONCLUSIONS Abnormalities of tryptophan transport and metabolism in the thalamus, striatum, and frontal cortex, measured by PET, are associated with depression in patients with brain tumor. These changes may indicate an imbalance between the serotonin and kynurenine pathways and serve as a molecular imaging marker of brain tumor-associated depression. TRIAL REGISTRATION ClinicalTrials.gov NCT02367469.
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Affiliation(s)
- Edit Bosnyák
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - David O Kamson
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Michael E Behen
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Geoffrey R Barger
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, 4160 John R., Suite 930, Detroit, MI, 48201, USA.
- Department of Oncology, Wayne State University, Detroit, MI, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
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Fontana J, Wenz R, Groden C, Schmieder K, Wenz H. The Preinterventional Psychiatric History as a Major Predictor for a Reduced Quality of Life After Treatment of Unruptured Intracranial Aneurysms. World Neurosurg 2015; 84:1215-22. [DOI: 10.1016/j.wneu.2015.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 11/25/2022]
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Are preoperative sex-related differences of affective symptoms in primary brain tumor patients associated with postoperative histopathological grading? J Neurooncol 2015; 126:151-156. [PMID: 26468140 DOI: 10.1007/s11060-015-1950-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Our objective was to explore the impact of the histopathological tumor type on affective symptoms before surgery among male and female patients with supratentorial primary brain tumors. A total of 44 adult patients were included in the study. Depression and anxiety were measured using the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory. Additionally, clinical interviews, including the Hamilton Depression Rating Scale (HDRS), were conducted. The general function of patients was measured with the Karnofsky Performance Status scale (KPS). All measures were obtained before surgery and therefore before the final histopathological diagnosis. All self-rating questionnaires but not the HDRS, showed significantly higher scores in female patients. The functional status assessed with the KPS was lower in female patients and correlated to the somatic part of the BDI. We further found a tendency for higher HDRS scores in male patients with a WHO grade 4 tumor stage compared to female patients. This finding was supported by positive correlations between HDRS scores and WHO grade in male and negative correlations between HDRS scores and WHO grade in female patients. In conclusion the preoperative evaluation of affective symptoms with self-rating questionnaires in patients with brain tumors may be invalidated by the patient’s functional status. Depression should be explored with clinical interviews in these patients. Sex differences of affective symptoms in this patient group may also be related to the malignancy of the tumor, but further studies are needed to disentangle this relationship.
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The pre-interventional psychiatric history – An underestimated confounder in benign intracranial lesions studies. Clin Neurol Neurosurg 2015. [PMID: 26196476 DOI: 10.1016/j.clineuro.2015.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wenz H, Wenz R, Ehrlich G, Groden C, Schmieder K, Fontana J. Patient characteristics support unfavorable psychiatric outcome after treatment of unruptured intracranial aneurysms. Acta Neurochir (Wien) 2015; 157:1135-45; discussion 1145. [PMID: 26007696 DOI: 10.1007/s00701-015-2451-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Previous studies demonstrated an unfavorable psychological outcome after treatment of unruptured intracranial aneurysms despite an objectively favorable clinical and radiological outcome. The current study was therefore designed to analyze the psychiatric vulnerability of this specific patient collective. MATERIALS AND METHODS Patients treated for a WHO grade I meningioma and incidental intracranial aneurysms in two German neurosurgical centers between 2007 and 2013 were screened for exclusion criteria including malignant/chronic diseases, recurrence of the tumor/aneurysm after more than 12 months and focal neurological deficits, among others. Seventy-five meningioma patients (M) and 56 incidental aneurysm patients (iA) met the inclusion criteria. The past medical psychiatric history, post-morbid personality characters and coping strategies were determined by questionnaires mailed to the patients in a printed version (Brief COPE, Big Five Personality Test). RESULTS Fifty-eight M and 45 iA patients returned the questionnaires. Patients with iA demonstrated significantly higher pre-interventional rates of depressive episodes (p = 0.002) and psychological supervision (p = 0.038). These findings were especially aggravated in iA patients who received their cranial imaging for unspecific symptoms such as dizziness, headaches or tinnitus (n = 33, history of depressions: 39.4%; previous psychological supervision: 33.3%). Furthermore, the analysis of the Big Five personality traits revealed remarkably elevated neuroticism scores in the iA collective. CONCLUSION The current study demonstrates an increased rate of positive pre-interventional psychiatric histories in the iA collective. Although those patients represent only a small subgroup, they still may play an important role concerning the overall outcome after iA treatment. Early detection and psychological support in this subgroup might help to improve the overall outcome. Further studies are needed to evaluate the influence of this new aspect on the multifactorial etiology of unfavorable psychiatric outcome after treatment of iA.
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