Brain Tumor Surgery: Study Investigates Connection between Depression and Survival

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

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

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

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

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

•The surgical management of 1,052 consecutive patients with malignant astrocytomas (WHO grade 3 or 4) performed at a single institution from 1995 to 2006 were reviewed.
•Of these 1,052 surgical procedures, 605 (58 percent) were for primary resection, 410 (39 percent) were for secondary resection, and 37 (3.5 percent) were for biopsy.
•For the purpose of this study, only patients taking anti-depressant medication for clinical depression at the time of surgery were classified as having “depression.” This equated to 49 patients (5 percent) of the total cases.