ABSTRACT

Symptoms of fatigue, cognitive deficits, depression and changes in personality and behavior are frequently reported in patients with glioma. These symptoms have a large impact on the everyday life of patients and their partners and can contribute to a decrease in quality of life. While guidelines are available for managing most of these symptoms, these guidelines are often not suitable for the brain tumor patient population, as this population has very specific problems and needs. Obtaining more evidence on the effectiveness of existing and new interventions targeting fatigue, cognitive deficits, depression, and changes in personality and behavior in this population is advised. Screening combined with adequate referral to supportive care professionals has the potential to decrease the disease burden of glioma patients and their partners.

Brain functioning such as cognitive performance depends on the functional interactions between brain areas, namely, the functional brain networks. The functional brain networks of a group of patients with brain tumors are measured before and after tumor resection. In this work, we perform a weighted network analysis to understand the effect of neurosurgery on the characteristics of functional brain networks. Statistically significant changes in network features have been discovered in the beta ͑13-30 Hz͒ band after neurosurgery: the link weight correlation around nodes and within triangles increases which implies improvement in local efficiency of information transfer and robustness; the clustering of high link weights in a subgraph becomes stronger, which enhances the global transport capability; and the decrease in the synchronization or virus spreading threshold, revealed by the increase in the largest eigenvalue of the adjacency matrix, which suggests again the improvement of information dissemination.

Depression is one of the leading causes of global disability, and a considerable hidden morbidity among patients with glioma. In this narrative review, we summarise what is currently known about depression in glioma, the main unanswered questions and the types of studies that should be prioritised in order to find out. We conclude by calling for a prospective Phase II study of antidepressants in depressed glioma patients, to test methodologies for a multicentre randomised controlled trial.

Cognitive deficits in brain tumor patients are reflected in whole-brain network disturbances. Possible future clinical use of these findings mostly concerns prognostics and tailoring treatment strategies.

Health-related quality of life (HRQOL) is a multidimensional concept used to measure patients' functioning and well-being. In recent decades, HRQOL has become an important (secondary) outcome measure in clinical trials for brain tumor patients. It could be questioned, however, whether HRQOL is the only useful outcome measure for assessing the level of functioning and well-being of these patients. As described in this review, several general methodological issues can hamper the interpretation of HRQOL data collected in the oncology setting. Additionally, because brain tumor patients have a progressive brain disease resulting in cognitive impairments, patient-reported outcomes may not always be the most informative and accurate measures of HRQOL in brain tumor patients. Supplementary or alternative measures, such as proxy-rated HRQOL measures and measures of instrumental activities of daily living, may provide a more complete picture of brain tumor patients' functioning in daily life.

We read Litofsky and Resnick's timely and useful review of depression in brain tumour patients with interest [1]. The authors identified screening for depression as an issue requiring future study. Because screening is often targeted at high-risk groups, it is important to study the risk factors for depression in brain tumour patients.The authors state that female gender is a risk factor for depression in glioma. It is true that some groups have found women with brain tumours to be more likely than men to become depressed [2,3]. However other researchers have not, including one of the authors of the review [4][5][6].We sent a questionnaire to the GP of each glioma patient on our hospital database (Edinburgh, UK), asking whether their patient had suffered depression both before and since the diagnosis of glioma. The diagnosis of depression was based on the clinical judgement of each GP. Response rate was 68% (100/147; 55% male). A pre-glioma (past medical) history of depression was significantly more likely in women (12/45 women compared with 3/55 men; P = 0.004, Fisher's Exact Test). However following glioma presentation the sex difference in depression disappeared and men were equally as likely as women to experience depression (12/55 and 12/45 respectively; P = 0.64).Female gender is not a proven risk factor for depression in glioma. Since general population surveys consistently report that depression is twice as common in women [7], studies reporting a more equal sex distribution for depression in brain tumours may even suggest a relatively increased risk for men.We agree that depression in glioma is a fertile field for research. For now we suggest that men and women with glioma should be considered at equal risk of developing depression, and that efforts should therefore be made to include them equally in any proposed screening programmes.

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