Because depression in patients with brain cancer is a common but often overlooked condition, oncologists should screen patients for depression regularly, according to an article in CNS Oncology (2015; doi:10.2217/cns.14.60).
The authors also proposed that more studies be completed to explore the efficacy of antidepressant treatments, as well as the value of depression biomarkers for future brain tumor research.
“Psychological distress is an important complication in patients with brain tumors, but often remains undiagnosed and untreated,” said senior author Adomas Bunevicius MD, PhD, of Lithuanian University of Health Sciences in Kaunas, Lithuania. “Methodologically rigorous studies aiming to identify the most optimal depression screening tools for patients with brain tumor are lacking. As a consequence, to date there are no evidence-based depression diagnostic algorithms.”
The authors proposed that implementing reliable depression screening algorithms in the routine neuro-oncology setting could improve recognition of depression, and ultimately, improve patient outcomes. The article reviews available screening tools and recommends the use of The Hospital Anxiety and Depression Scale – Depression subscale and Patient Health Questionnaire.
The authors recommended that patients who screen positive for depression be referred for detailed psychiatric assessment prior to initiating antidepressive treatment. The authors expressed the urgent need for further methodologically rigorous studies investigating psychometric properties of depression scales. Studies evaluating the efficacy of antidepressive treatments and the clinical value of depression biomarkers are also important avenues for future research endeavors in brain tumor patients.
“We believe that studies aiming to improve identification and management of psychological distress should be considered a priority in the field of neuro-oncology,” said Bunevicius. “Such knowledge could significantly improve quality of life and clinical outcomes for patients suffering from these devastating disorders.”
The reasons cited for a deeper focus on depression in patients with brain tumor are two-fold. First of all, patient-centered outcomes, including symptoms of psychological distress, are increasingly being used as secondary outcomes measured in clinical trials. Therefore, accurately identifying brain tumor patients suffering from psychological distress is becoming increasingly important in both clinical practice and in research studies.
In addition, and perhaps more important to the individual patients, depression carries serious health risks for those with brain tumors. Studies have associated greater depressive symptom severity with shorter overall survival of brain tumor patients, and depressive symptoms have been linked to numerous health-related aspects of quality of life.
Furthermore, depression predicts cognitive impairment and puts survivors at increased risk for suicide ideation. Therefore depression should be actively sought and managed in patients with an established diagnosis of a brain tumor.