Medical News Today News Article

Brain Tumor Surgery: Study Investigates Connection = Between=20 Depression And Survival

29 Apr = 2008

Depression=20 is one of the most common psychiatric disorders in the world = today.=20 It is estimated that in any given year, 5 to 9 percent of = the US=20 population is clinically depressed. Studies have shown that=20 depression negatively affects the immunological system, = alters the=20 body's response to malignancy, and may influence behavioral = factors=20 that impact recovery from disease.

Psychiatric = symptoms,=20 including depression, often occur in patients with malignant = brain=20 tumors. Research has linked these psychiatric symptoms to = tumor=20 location and extent of the disease. In the past decade, = studies have=20 suggested that there is a relationship between depression = and poor=20 outcome in patients undergoing craniotomy for brain lesions = as a=20 whole. This association has also been reported after = surgical=20 therapy of non-neurological disease.

Malignant brain=20 astrocytoma, also known as glioma or glioblastoma multiforme = (GBM),=20 is the most commonly diagnosed primary brain tumor. Glioma = is a=20 devastating brain cancer that typically results in death in = about=20 one year. The most effective therapies introduced over the = past=20 three decades have improved median survival by an average of = only=20 three months. Thus, identification of any reversible = morbidity=20 factors, which could potentially improve survival rates, = such as=20 depression, is of paramount importance.

Researchers = at Johns=20 Hopkins School of Medical in Baltimore analyzed the outcome = of 1,052=20 patients who underwent surgical resection and radiotherapy = for=20 glioma over a 10-year period. The results of this study, = Association=20 of Preoperative Depression and Survival after Resection of = Malignant=20 Brain Astrocytoma, will be presented by Matthew J. McGirt, = MD, 4:01=20 to 4:15 p.m. on Monday, April 28, 2008, during the 76th = Annual=20 Meeting of the American Association of Neurological Surgeons = in=20 Chicago. Co-authors are Frank J. Attenello, MS, Henry Brem, = MD,=20 Kaisorn L. Chaichana, BS, Muraya Gathinji, MS, Alessando = Olivi, MD,=20 Alfredo Quinones-Hinojosa, MD, Khoi Than, MD, and Jon D. = Weingart,=20 MD.

Currently, patient age, tumor grade, and = functional=20 status remain the known preoperative prognostic indicators = of=20 survival. "The goal of this research was to determine = whether=20 malignant glioma patients with a preoperative diagnosis of=20 depression have a lower survival rate irrespective of = treatment=20 modality or degree of disability," stated Dr. McGirt. The = research=20 encompassed the following methodology:

-- The = surgical=20 management of 1,052 consecutive patients with malignant = astrocytomas=20 (WHO grade 3 or 4) performed at a single institution from = 1995 to=20 2006 were reviewed.

-- Of these 1,052 surgical = procedures,=20 605 (58 percent) were for primary resection, 410 (39 = percent) were=20 for secondary resection, and 37 (3.5 percent) were for=20 biopsy.

-- For the purpose of this study, only = patients=20 taking anti-depressant medication for clinical depression at = the=20 time of surgery were classified as having "depression." This = equated=20 to 49 patients (5 percent) of the total=20 cases.

"Interestingly, all demographic and clinical=20 characteristics did not differ between depressed and = non-depressed=20 patients. However, patients already depressed at diagnosis = had a=20 significantly reduced survival compared to non-depressed = patients,"=20 stated Dr. McGirt. This was most notable in survival rates = beyond 12=20 months, suggesting that depression may be most detrimental = for=20 long-term survival." Detailed findings included the=20 following:

-- Regardless of patient functional status = prior=20 to surgery (KPS score), WHO Grade III vs. Grade IV tumor, = patient=20 age, or clinical presentation, those with depression had = more than a=20 40 percent increase in the relative risk of mortality versus = non-depressed patients. This association was independent of = degree=20 of resection or postoperative treatment modality.

-- = At 12=20 months post surgery, 41 percent of non-depressed patients = were=20 alive, while only 15 percent of depressed patients were=20 alive.

-- At 20 months post surgery, there were no = depressed=20 patients still alive, while 21 percent of non-depressed = patients=20 were still alive.

Although patients classified as = depressed=20 were diagnosed prior to neurosurgical evaluation in most = cases, it=20 is uncertain that their depression was not a response to the = recent=20 diagnosis of a terminal disease. Many patients with clinical = depression may have been undiagnosed and off medication, = lowering=20 the sensitivity of the classification scheme and resulting = in=20 inclusion of clinically depressed patients in the = non-depressed=20 cohort. Further research investigating the survival of = patients with=20 non-medicated versus medicated depression is warranted to = address=20 these variables.

"In conclusion, this study does = indicate=20 strong evidence that there is a connection between the = existence of=20 depression and survival rates in patients with malignant = brain=20 glioma. Recognizing and treating depression preoperatively = should be=20 looked at more closely as a means to maximize survival in = the=20 treatment of malignant brain tumors," remarked Dr.=20 McGirt.

Founded in 1931 as the Harvey Cushing = Society, the=20 American Association of Neurological Surgeons (AANS) is a = scientific=20 and educational association with more than 7,200 members = worldwide.=20 The AANS is dedicated to advancing the specialty of = neurological=20 surgery in order to provide the highest quality of = neurosurgical=20 care to the public. All active members of the AANS are = certified by=20 the American Board of Neurological Surgery, the Royal = College of=20 Physicians and Surgeons (Neurosurgery) of Canada or the = Mexican=20 Council of Neurological Surgery, AC. Neurological surgery is = the=20 medical specialty concerned with the prevention, diagnosis,=20 treatment and rehabilitation of disorders that affect the = entire=20 nervous system, including the spinal column, spinal cord, = brain and=20 peripheral nerves.

American Association of = Neurological=20 Surgeons (AANS)
5550 Meadowbrook Dr.
Rolling Meadows, = IL=20 60008
United States
http://www.neurosurgerytoday.org/=20

Article URL:=20 http://www.medicalnewstoday.com/articles/105601.php

Main News Category: Neurology / Neuroscience

Also Appears In: Cancer / Oncology,=20 Depression, Clinical Trials / Drug Trials,=20

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