Understanding the Trajectory of Depressive Symptoms in Newly Diagnosed High-Grade Glioma Patients-A Meta-Analysis.

Abstract

Introduction: High-grade gliomas, the most common and aggressive brain cancer, are associated with significant neurological disability and are almost uniformly fatal. Though the diagnosis of brain cancer is represented as one of the most stressful life events for patients as well as for their caregivers, the prevalence of depression as a longitudinal event during and after the initial diagnosis and sequential lines of treatment is under-researched.

Objectives: To inform clinical practice, we assembled published, time-specific estimates of the prevalence of depression in adult high-grade glioma patients to test the idea that depression prevalence varies across therapeutic trajectory milestones.

Methods: We a priori defined five time points in the clinical course of first-line therapy. After an exhaustive search of the current literature, we extracted time point-specific estimates of depression prevalence, pooled the data by time point across studies, and constructed 95% confidence intervals on depression prevalence at each time point. A total of 822 patients were identified and entered into our analyses.

Results: The prevalence of depression in adult high-grade glioma is about 16%-27% between surgery and the end of temozolomide maintenance therapy, which is higher than the 9% estimated for the general population. However, when assessed in the time interval between the initial diagnostic tumor imaging and the confirmatory surgery, at least 30% of these patients are depressed.

Conclusions: Because depression worsens the patient's quality of life and is treatable, the multidisciplinary treatment teams involved in the care of high-grade glioma patients should assess depression throughout the disease trajectory, and especially immediately after the first imaging study showing a suspicious intracranial mass.