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DEPRESSION COMMON AFTER SURGERY FOR HIGH-GRADE BRAIN TUMORS, UVa STUDY FINDS

Patients who have surgery for serious or high-grade brain tumors can suffer depression right after surgery and symptoms of depression can continue for at least six months after the operation, according to a study of nearly 600 brain tumor patients in a recent issue of the journal Neurosurgery. 

“This observational study supports the hypothesis that clinically important depression is a common complication in patients with high-grade brain tumors,” said Dr. Edward R. Laws, Jr., study co-investigator and professor of neurological surgery at the University of Virginia Health System. “We found that survival after surgery was shorter and complications were more common among patients who were depressed than those who were not,” Laws said.

Physicians enrolled 598 patients suffering from grade III or grade IV gliomas at more than fifty clinical sites in the U.S. and Canada in a three-year study. A glioma is a malignant tumor arising in the brain’s glial cells, the supporting tissue of the nervous system.

Ninety-three percent of patients reported symptoms consistent with depression immediately following an operation for a brain tumor. The symptoms persisted at 3-month and 6-month follow-up visits to their physician.  But, physicians did not report depressive symptoms as readily as their patients. Depression was reported by doctors in just 15 percent of brain tumor patients, increasing to 22 percent at both 3- and 6-month follow-up visits. 

“Depression in brain tumor patients is more common than physicians think but often gets overlooked,” said study co-investigator Elana Farace, a neuropsychologist and assistant professor of neurological surgery at U.Va. “More attention should be paid to depression in these patients, since it negatively impacts quality of life and relates to length of survival. Depressed patients do not appear to live as long, and that is true for brain tumor patients, as well as those with other diseases such as cancer and heart disease,” Farace said.

The study authors say the difference between what patients and physicians report when it comes to depression may be because the illness is not a high priority for physicians, who are focused more on diagnosis, treatment, prognosis, wound-healing and neurological assessment. Physicians may be paying more attention to post-operative physical problems rather than emotional impairment. Depression symptoms such as poor appetite and low energy, commonly seen in brain tumor patients, may also be a result of medical treatment instead of depression. “While it is normal for a patient to feel sad, a complete loss of hope for the future and/or the inability to feel happy about anything is a sign that patients are depressed rather than sad,” Farace said.

For this study, physician-reported depression was based on clinical evaluations of patients using criteria from the Diagnostic and Statistical Manual of Mental Disorders.  Patients were depressed if they exhibited markedly diminished interest or pleasure in almost all activities, most of the day, for over 14 days. Patients may also have experienced symptoms of worthlessness, guilt, impaired concentration, significant weight loss or gain, insomnia, decreased energy or recurrent thoughts of death or suicide.

Patient-reported depression was based on self-reported responses to questions on a data sheet. Patients were defined as possibly experiencing major depression if they answered “yes” to certain questions such as: “In the past year, have you had 2 weeks or more during which you felt sad, blue or depressed; or when you lost all interest or pleasure in things that you cared about or enjoyed?” and “Have you felt depressed or sad much of the time in the past year?”

The authors concluded that the results highlight the importance of psychological care in the treatment of brain tumor patients. The study can be found in the February 2004 issue of Neurosurgery found online at http://www.neurosurgery-online.com/home2.html.

March 25, 2004