Prevalence of Depression and Utilization of Depressive Symptomatology Tools in Brain and Spine Tumor Patients

Introduction: Cancer patients face emotional burden due to their diagnosis, treatments, and symptoms. Depression, specifically, affects oncology patients at a higher rate than the general population, especially in those undergoing surgery. Back pain in oncologic spine patients or anatomical perturbation in brain tumor patients exacerbate this risk further. Despite the availability of screening tools, depression remains undetected and underdiagnosed. The purpose of this study was to systematically review perioperative depression rates of oncology patients, as measured by self-reported tools.

Methods: A systematic review was conducted using PubMed, EMBASE, Scopus, and APA PsycINFO (searched until December 15th, 2023). Included were clinical studies of cancer patients undergoing surgery that measured depression by a self-reported instrument. Data on study and patient characteristics, and preoperative and postoperative depression rates were extracted. Results were pooled, and overall depression rates were calculated as weighted means and percentages of patients with clinically significant depression.

Results: Data was extracted from 796 studies. 214 studies recorded the percentage of patients with clinically significant depression. Of these studies, the most common primary cancers were breast (64), head and neck (23), brain (17) and colorectal (17). There were no studies describing the oncologic spine population. Overall, the average percentage of patients with clinically significant depression at any time point was 26.0%. 230 studies recorded preoperative depression means. Of these, the most used tools were HADS-D (131), CES-D (37) and BDI (26). Preoperative depression means for these tools were 6.21, 13.0 and 11.2, respectively, across all cancer types. Postoperatively, across all tools, depression means peaked at 0-30days after surgery.

Conclusion : This systematic review highlights a need for psychological support that accounts for a preoperative peak of clinically significant depression that extends into the immediate postoperative period. Notably, there is a lack of measurement of depressive symptoms in the oncologic spine population, motivating a need for increased utilization of screening tools. In the brain tumor population, the established detection of depression continues to place focus on the need for subsequent psychological intervention measures.