Depressive symptoms and executive function in relation to survival in patients with glioblastoma
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Depression and neurocognitive function, particularly executive functioning (EF), have been associated with overall survival (OS) in patients with glioblastoma (GBM). However, the combined effect of depressive symptoms and impaired EF upon OS has not been reported.
Patients with GBM (N = 102) completed neuropsychological assessment postoperatively, including the Beck Depression Inventory-Second Edition (BDI-II) and the Trail Making Test Part B (TMTB). Median splits were used to determine cut-points denoting elevated depressive symptoms on the BDI-II and impaired EF on TMTB. Patients were stratified into four groups: low depressive symptoms/low EF impairment (− Dep/− Imp; N = 23), high depressive symptoms/low EF impairment (+ Dep/− Imp; N = 28), low depressive symptoms/high EF impairment (− Dep/+Imp; N = 28), and high depressive symptoms/high EF impairment (+ Dep/+Imp; N = 23). The Kaplan–Meier method, log-rank test, and Cox regression were used to examine differences in survival between groups.
Relative to − Dep/− Imp patients (median OS = 22.8 months), median OS in all other patient groups was shorter (+ Dep/− Imp OS = 16.6; − Dep/+Imp OS = 14.8; +Dep/+Imp OS = 10.8; all p < .05). With the exception of KPS and age, groups did not differ in distribution of clinical and demographic characteristics. Neither KPS nor age modified the independent effect of BDI-II and TMTB on OS in Cox regression models.
The presence of depressive symptoms and impaired EF are independently associated with shorter OS in patients with GBM. These results suggest that routine neuropsychological assessment of mood and cognition may help refine prognosis and facilitate initiation of psychological and cognitive interventions, which can improve patient quality of life, and warrants further investigation.
KeywordsBrain tumor Glioblastoma Depression Cognition Survival
This work was previously presented as a rapid report at the 19th Annual Scientific Meeting and Education Day of the Society for Neuro-Oncology, Miami Beach, Florida, November 16, 2014.
Kyle R. Noll contributed to experimental design, data analysis and interpretation, and manuscript drafting and editing. Jeffrey S. Wefel contributed to experimental design, data analysis and interpretation, and manuscript drafting and editing. Catherine M. Sullaway contributed to data interpretation and manuscript drafting and editing.
Research reported in this publication was supported by the National Institutes of Health through the National Institute of Nursing Research award number R01NR014195 (J.S.W.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Conflict of interest
The authors report no conflicts of interest.
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