Depression, Impaired Executive Function Shortens Survival in Glioblastoma

Depressive symptoms and impaired executive functioning, both common in patients with glioblastoma (GBM), are independently associated with shorter overall survival. Patients with both symptoms have even shorter survival, according to a new study presented at the Society for Neuro-Oncology (SNO) Annual Scientific Meeting in Miami.

“Over 70% of glioma patients report significant depressive symptoms,” said Kyle R. Noll, PhD, of the department of neuro-oncology at the University of Texas MD Anderson Cancer Center in Houston. “Up to 90% of glioma patients have cognitive impairments. We aimed to investigate this a bit further.” Other earlier research showed a median overall survival of 13.3 months in GBM patients considered to have impaired executive function; those without impairment had a median survival of 47.7 months.

The new study was a retrospective analysis of patient records from 1991 to 2013 who were diagnosed with GBM and who had a neuropsych evaluation within 60 days following tumor resection. Executive function was measured using the Trail Making Test (TMT) part B, while depression was measured using the Beck Depression Inventory (BDI) second edition; a score of at least 13 was considered clinically significant. The overall sample included 102 patients, divided into four groups based on TMT and BDI median splits. Survival was measured from the date of surgery to date of death or last follow-up.

Overall, 27% of the cohort had significant depression, while more than half (55%) were considered significantly impaired. The no depression/no impairment group had a median overall survival of 22.8 months; this compared to 16.6 months in the depression/no impairment group; 14.8 months in the no depression/impairment group; and 10.8 months in the depression/impairment group. The latter group had a hazard ratio (HR) for death of 4.15 (95% CI, 2.12-8.10). The no depression/impairment group also had a significant HR, while the depression/no impairment group did not reach significance.

“Executive impairment and depression are quite common,” Noll said. “They are independently associated with reduced survival, with those exhibiting both depression and impairment showing the worst prognosis … It seems more of a synergistic effect rather than one vs the other.” He noted that molecular markers including MGMT methylation status and IDH mutation status could not be included in this study.

Noll also pointed out that this highlights big opportunities to improve care. In this cohort, in spite of the presence of depression in 27% of patients, he said only half of those patients were prescribed any anti-depressant medication. “There is definitely a need to intervene,” he said.