Depression in glioma: a primer for clinicians and researchers

Rooney, Alasdair G; Brown, Paul D.; Reijneveld, J.C.; Grant, Robin

doi:10.1136/jnnp-2013-306497

Cited by 67 publications

(49 citation statements)

References 70 publications

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“…Systematic screening and quantification for levels of depression and anxiety is imperative [55] and recommended in this group of patients, especially in case of physical decline and tumour progression. However, instruments should not be used as a substitute for in-depth conversations but rather function as guidance for clinicians that facilitate the dialogue with the patient [56].…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study

et al. 2015

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The diagnosis of a high-grade glioma usual is followed by functional impairment(s), cognitive decline and an impaired psycho-social well-being. This might well have a significant and negative impact on the health related quality of life. The purpose of this study was to explore physical activity levels, prevalence and severity of anxiety and depressive symptoms and health-related quality of life among patients with a highgrade glioma. This paper is based on a longitudinal mixed methods study. Patients (n = 30) completed questionnaires at 5 time points from time of diagnosis until the final follow-up after 1 year. Scores of Karnofsky Performance Status (KPS), physical activity, anxiety and depression and health-related quality of life (FACT-Br) are obtained. Patients' physical activity level and KPS decrease during the disease- and treatment trajectory. The majority of patients did not report any depressive symptoms, eight individuals (26.7 %) being depressed at various time points. Among a sub-group of participants who completed all study requirements for the entire study period the level of anxiety decreased significantly during the study. The FACT-Br sub-scale of emotional well-being increased significant, indicating a better HRQOL attend of followup. The diagnosis of a HGG leads to an ongoing functional decline measured as a decline of the KPS and a reduced physical activity during leisure time. Supportive care combined with rehabilitative and palliative approaches might well be valuable along the trajectory especially during the post-surgery period when anxiety is at its highest peak.

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Section: Discussionmentioning

confidence: 99%

Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study

et al. 2015

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“…The clinical significance of these remains to be clarified. One plausible clinical implication of brain serotonergic changes involves anxiety and depression, common comorbidities in glioma patients (30,31), with a potentially higher incidence in women (32). Thus, AMT-PET could be a useful imaging modality to clarify the role of abnormal brain serotonin synthesis, and their gender differences, in glioma-associated depression.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Tryptophan Metabolism in the Nontumoral Hemisphere in Patients with Malignant Glioma

et al. 2014

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Alpha-11C-methyl-L-tryptophan positron emission tomography (AMT-PET) allows evaluation of brain serotonin synthesis and can also track upregulation of the immunosuppressive kynurenine pathway in tumor tissue. Increased AMT uptake is a hallmark of World Health Organization grade III–IV gliomas. Our recent study also suggested decreased frontal cortical AMT uptake in glioma patients contralateral to the tumor. The clinical significance of extratumoral tryptophan metabolism has not been established. In the present study, we investigated clinical correlates of tryptophan metabolic abnormalities in the non-tumoral hemisphere of glioma patients. Methods Standardized AMT uptake values (SUV) and the uptake rate constant of AMT (K [mL/g/min], a measure proportional to serotonin synthesis in non-tumoral gray matter) were quantified in the frontal and temporal cortex as well as thalamus in the non-tumoral hemisphere in 77 AMT-PET scans of 66 patients (41 males; mean age: 55±15 years) with grade III–IV gliomas. These AMT values were determined pre-treatment in 35 and post-treatment in 42 patients and were correlated with clinical variables and survival. Results AMT uptake in the thalamus showed a moderate age-related increase pre-treatment (SUV, r=0.39, p=0.02) but decrease post-treatment (K, r=−0.33; p=0.057). Females had higher thalamic SUVs pre-treatment (p=0.037) and higher thalamic (p=0.013) and frontal cortical K values (p=0.023) post-treatment. In the post-treatment glioma group, high thalamic SUVs and high thalamo-cortical SUV ratios were associated with short survival in Cox regression analysis. The thalamo-cortical ratio remained strongly prognostic (p<0.01) when clinical predictors, including age, glioma grade, and time since radiotherapy were entered in the regression model. Long interval between radiotherapy and post-treatment AMT-PET as well as high radiation dose affecting the thalamus were associated with lower contralateral thalamic or cortical AMT uptake values. Conclusions These observations provide evidence for altered tryptophan uptake in contralateral cortical and thalamic brain regions in glioma patients after initial therapy, suggesting treatment effects on the serotonergic system. Low thalamic tryptophan uptake appears to be a strong, independent predictor of long survival in patients with previous glioma treatment.

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“…Diagnosis can be difficult as all the symptoms of a major depressive disorder, with the exception of suicidal thoughts, can be attributed to the tumor, its treatment, or both (242). Selective serotonin reuptake inhibitors may be considered as firstline treatment of depression, as they have not shown increased toxicity in glioma patients and they are not associated with increased incidence of seizures in the general population (242,243).…”

Section: Depressionmentioning

confidence: 99%

“…Selective serotonin reuptake inhibitors may be considered as firstline treatment of depression, as they have not shown increased toxicity in glioma patients and they are not associated with increased incidence of seizures in the general population (242,243). The benefit and feasibility of psychotherapy in treating depression and anxiety in glioma patients is uncertain (242).…”

Section: Depressionmentioning

confidence: 99%

Current Standards of Care in Glioblastoma Therapy

et al. 2017

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Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Regardless of ideal multidisciplinary treatment, including maximal surgical resection, followed by radiotherapy plus concomitant and maintenance temozolomide (TMZ), almost all patients experience tumor progression with nearly universal mortality and a median survival of less than 15 months. The addition of bevacizumab to standard treatment with TMZ revealed no increase in overall survival (OS) but improved progression-free survival (PFS). In newly diagnosed GBM, methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter has been shown to predict response to alkylating agents, as well asgnosis. Therefore, MGMT promoter status may have a crucial role in the choice of single modality treatment in fragile elderly population. No standard of care is established in recurrent or progressive GBM. Treatment alternatives may include supportive care, surgery, re-irradiation, systemic therapies, and combined modality therapy. Despite numerous clinical trials, the identification of effective therapies is complex because of the lack of appropriate control arms, selection bias, small sample sizes, and disease heterogeneity. Tumor-treating fields plus TMZ represent a major advance in the field of GBM therapy, and should be Standards of Care in Glioblastoma Therapy 198 considered for patients with newly diagnosed GBM with no contraindications. As a disease with such a poor prognosis, treatment of GBM should go beyond improving survival and aim at preserving and even improving the quality of life of both the patient and the caregiver.

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Depression in glioma: a primer for clinicians and researchers

Cited by 67 publications

References 70 publications

Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study

Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study

Clinical Significance of Tryptophan Metabolism in the Nontumoral Hemisphere in Patients with Malignant Glioma

Current Standards of Care in Glioblastoma Therapy

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