Utilization of Psychiatric Evaluation and Psychotherapy in Patients with a Primary Malignant Brain Tumor

Introduction: There are high rates of depression in cancer patients, but more specifically in those with a primary brain tumor, especially if malignant. Harsh prognoses, difficult treatment in additional to anatomical perturbations of the brain increase the risk in this population. Despite established rates of depression, the utilization of psychological interventions in practice is understudied. This study aims to analyze the rate of psychiatric evaluation and subsequent psychotherapy utilization of those with a primary malignant brain tumor to better characterize this gap in care.

Methods: A retrospective review of the PearlDiver database identified patients with a primary malignant brain tumor from 2013 to 2023. A secondary cohort was identified that included any patients of those with a primary malignant brain tumor who received psychiatric evaluation and subsequent psychotherapy after the initial evaluation. Patients were broken down further by age range, region, payer status and year of psychotherapy.

Results: Among 456,320 patients with a primary malignant brain tumor, only 15,333 (3.36%) underwent psychiatric evaluation with subsequent psychotherapy utilization. The most represented age group of this cohort were those aged 55 to 64 years old (20.4% of the total patients). Only 10.9% of patients receiving psychotherapy were categorized in the West region, as compared to an equal distribution among the Northeast, Midwest and South. Psychotherapy utilization increased across the years included in the database, with a minor drop from 2019 to 2020 (2,312 to 2,089 patients).

Conclusion : This study observes that a small proportion of patients with a primary malignant brain tumor are evaluated by a psychiatrist and subsequently receive psychotherapy. This is more alarming in consideration of elevated depression rates in this population, as well as improved detection of depressive symptoms by screening tools. Although increasing in utilization over time, this rate may represent a targetable area in the improvement of patient care. The decreased utilization by the West is consistent with the larger mental health literature and highlights an increased need for access to care in this region, in particular.