Psycho-Oncology in Brain Tumour Patients

  • Alice Malabaila
  • Riccardo Torta


Psycho-oncology is a multidisciplinary matter that studies the psychological, social and behavioural aspects of cancer. It can be absolutely applicable to neuro-oncology because a brain cancer is a complex health condition that can have destructive physical, cognitive and psycho-social consequences. High levels of psychological distress were found among patients and caregivers, with high scores on anxiety and depression scales. It is necessary to identify and treat mood disorders in an appropriate and effective manner using, if required, an integrated approach that includes psychotherapy and pharmacotherapy, to build customized interventions according to the needs of the patient and his family.


  1. 1.
    Torta R, Mussa A. PsicOncologia. Il modello biopsicosociale. 2nd ed. Torino: Centro Scientifico Editore; 2007.Google Scholar
  2. 2.
    Selye H. A syndrome produced by diverse nocuous agents. J Neuropsychiatry Clin Neurosci. 1998;10(2):230–1.PubMedGoogle Scholar
  3. 3.
    Neylan TC. Hans Selye and the field of stress research. J Neuropsychiatry Clin Neurosci. 1998;10(2):230.Google Scholar
  4. 4.
    Lazarus RS. From psychological stress to the emotions: a history of changing outlooks. Annu Rev Psychol. 1993;44:1–21.PubMedGoogle Scholar
  5. 5.
    Fredrickson BL, Joiner T. Positive emotions trigger upward spirals toward emotional Well-being. Psychol Sci. 2002;13(2):172–5.PubMedGoogle Scholar
  6. 6.
    Board F, Persky H, Hamburg DA. Psychological stress and endocrine functions. Psychosom Med. 1956;18:324–33.PubMedGoogle Scholar
  7. 7.
    Sachar EJ, Hellman L, Roffwarg HP, Halpern FS, Fukushima DK, Gallagher TF. Disrupted 24-hour patterns of cortisol secretion in psychotic depression. Arch Gen Psychiatry. 1973;28(1):19–24.Google Scholar
  8. 8.
    Moreno-Villanueva M, Bürkle A. Stress hormone-mediated DNA damage response. Implications for cellular senescence and tumour progression. Curr Drug Targets. 2016;17(4):398–404.PubMedGoogle Scholar
  9. 9.
    Greer S. Healing the mind/body split: bringing the patient back into oncology. Integr Cancer Ther. 2003;2(1):5–12.PubMedGoogle Scholar
  10. 10.
    Descartes R. Meditations VI. In: Martin P, editor. The sickening mind. London: Flamingo; 1998.Google Scholar
  11. 11.
    Oken D. What to tell cancer patients: a study of medical attitudes. JAMA. 1961;175:1120–8.PubMedGoogle Scholar
  12. 12.
    Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–36.PubMedGoogle Scholar
  13. 13.
    Engel GL, Romano J. Delirium: II. Reversibility of the electroencephalogram with experimental procedures. Arch Neurol Psychiatr. 1944;51:378–92.Google Scholar
  14. 14.
    Engel GL. From biomedical to biopsychosocial: I. Being scientific in the human domain. Fam Syst Health. 1996;14:425–33.Google Scholar
  15. 15.
    Kangas M, Tate RL, Williams JR, Smee RI. The effects of radiotherapy on psychosocial and cognitive functioning in adults with a primary brain tumour: a prospective evaluation. Neuro-Oncology. 2012;14(12):1485–502.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Ownsworth T, Hawkes A, Steginga S, Walker D, Shum D. A biopsychosocial perspective on adjustment and quality of life following brain tumour: a systematic evaluation of the literature. Disabil Rehabil. 2009;31(13):1038–55.PubMedGoogle Scholar
  17. 17.
    van Kessel E, Baumfalk AE, van Zandvoort MJE, Robe PA, Snijders TJ. Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumour treatment. J Neuro-Oncol. 2017;134(1):9–18.Google Scholar
  18. 18.
    Saria MG, Courchesne N, Evangelista L, Carter J, MacManus DA, Gorman MK, et al. Cognitive dysfunction in patients with brain metastases: influences on caregiver resilience and coping. Support Care Cancer. 2017;25(4):1247–56.PubMedGoogle Scholar
  19. 19.
    Stone AA, Neale JM. New measure of daily coping: development and preliminary results. J Pers Soc Psychol. 1984;46(4):892–906.Google Scholar
  20. 20.
    Folkman S, Lazarus RS. If it changes it must be a process: study of emotion and coping during three stages of a college examination. J Pers Soc Psychol. 1985;48(1):150–70.PubMedGoogle Scholar
  21. 21.
    Zani B, Cicognani E. Le vie del benessere. Eventi di vita e strategie di coping. 6th ed. Roma: Carocci Editore; 2008.Google Scholar
  22. 22.
    Grassi L, Biondi M, Costantini A. Manuale pratico di psiconcologia. Roma: Il Pensiero Scientifico Editore; 2009.Google Scholar
  23. 23.
    Heim E, Augustiny KF, Schaffner L, Valach L. Coping with breast cancer over time and situation. J Psychosom Res. 1993;37(5):523–42.PubMedGoogle Scholar
  24. 24.
    Heim E, Valach L, Schaffner L. Coping and psychosocial adaptation: longitudinal effects over time and stages in breast cancer. Psychosom Med. 1997;59(4):408–18.PubMedGoogle Scholar
  25. 25.
    Acquaye AA, Lin L, Vera-Bolanos E, Gilbert MR, Armstrong TS. Hope and mood changes throughout the primary brain tumour illness trajectory. Neuro-Oncology. 2016;18(1):119–25.PubMedGoogle Scholar
  26. 26.
    McDaniel JS, Musselman DL, Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry. 1995;52(2):89–99.PubMedGoogle Scholar
  27. 27.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedGoogle Scholar
  28. 28.
    Skarstein J, Aass N, Fossa SD, Skovlund E, Dahl AA. Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res. 2000;49(1):27–34.PubMedGoogle Scholar
  29. 29.
    Arnold SD, Forman LM, Brigidi BD, Carter KE, Schweitzer HA, Quinn HE, et al. Evaluation and characterization of generalized anxiety and depression in patients with primary brain tumours. Neuro-Oncology. 2008;10(2):171–81.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Anderson SI, Taylor R, Whittle IR. Mood disorders in patients after treatment for primary intracranial tumours. Br J Neurosurg. 1999;13(5):480–5.PubMedGoogle Scholar
  31. 31.
    Litofsky NS, Farace E, Anderson F Jr, Meyers CA, Huang W, Laws ER Jr. Depression in patients with high-grade glioma: results of the Glioma outcomes project. Neurosurgery. 2004;54(2):358–66.PubMedGoogle Scholar
  32. 32.
    Rooney AG, Carson A, Grant R. Depression in cerebral glioma patients: a systematic review of observational studies. J Natl Cancer Inst. 2011;103(1):61–76.PubMedGoogle Scholar
  33. 33.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: distress management. 2nd ed. Fort Washington: NCCN; 2009.Google Scholar
  34. 34.
    Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Rooney AG, McNamara S, Mackinnon M, Fraser M, Rampling R, Carson A, et al. Screening for major depressive disorder in adults with cerebral glioma: an initial validation of 3 self-report instruments. Neuro-Oncology. 2013;15(1):122–9.PubMedGoogle Scholar
  36. 36.
    Baider L, Cooper CL, De-Nour AK. Cancer and the family. 2nd ed. New York: Wiley; 2000.Google Scholar
  37. 37.
    McCarter H, Furlong W, Whitton AC, Feeny D, DePauw S, Willan AR, Barr RD. Health status measurements at diagnosis as predictors of survival among adults with brain tumours. J Clin Oncol. 2006;24:3636–43.PubMedGoogle Scholar
  38. 38.
    Brown PD, Decker PA, Rummans TA, Clark MM, Frost MH, Ballman KV, Arusell RM, Buckner JC. A prospective study of quality of life in adults with newly diagnosed high-grade gliomas: comparison of patient and caregiver ratings of quality of life. Am J Clin Oncol. 2008;31(2):163–8.PubMedGoogle Scholar
  39. 39.
    Ergh TC, Hanks RA, Rapport LJ, Coleman RD. Social support moderates caregiver life satisfaction following traumatic brain injury. J Clin Exp Neuropsychol. 2003;25(8):1090–101.PubMedGoogle Scholar
  40. 40.
    Sherwood PR, Given BA, Doorenbos AZ, Given CW. Forgotten voices: lessons from bereaved caregivers of persons with a brain tumour. Int J Palliat Nurs. 2004;10:67–75.PubMedGoogle Scholar
  41. 41.
    Horowitz S, Passik SD, Malkin MG. In sickness and in health: a group intervention for spouses caring for patients with brain tumours. J Psychosoc Oncol. 1996;14:43–56.Google Scholar
  42. 42.
    Litofsky NS, Resnick AG. The relationship between depression and brain tumours. J Neuro-Oncol. 2009;94:153–61.Google Scholar
  43. 43.
    Northouse LL, Katapodi MC, Song L, Zhang L, Mood D. Interventions with family caregivers of cancer patients. CA Cancer J Clin. 2010;60:317–39.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Invernizzi G, Bressi C, Comazzi AM. La famiglia del malato neoplastico. Padova: Piccin; 1992.Google Scholar
  45. 45.
    Bloch S, Kissane D. Psychotherapies in psycho-oncology. An exciting new challenge. Br J Psychiatry. 2000;177:112–6.PubMedGoogle Scholar
  46. 46.
    Cunningham AJ. Adjuvant psychological therapy for cancer patients: putting it on the same footing as adjunctive medical therapies. Psycho-Oncology. 2000;9:367–71.PubMedGoogle Scholar
  47. 47.
    Straker N. Psychodynamic psychotherapy for cancer patients. J Psychother Pract Res. 1998;7:1–9.PubMedCentralGoogle Scholar
  48. 48.
    LeShan L. Cancers a turning point. New York: Penguin Books; 1990.Google Scholar
  49. 49.
    Moorey S, Greer S. Psychological therapy for patients with cancer. A new approach. Oxford: Heinemann Medical Books; 1989.Google Scholar
  50. 50.
    Rooney AG, Brown PD, Reijneveld JC, Grant R. Depression in glioma: a primer for clinicians and researchers. J Neurol Neurosurg Psychiatry. 2014;85(2):230–5.PubMedGoogle Scholar
  51. 51.
    Bielecka-Wajdman AM, Lesiak M, Ludyga T, Sieroń A, Obuchowicz E. Reversing glioma malignancy: a new look at the role of antidepressant drugs as adjuvant therapy for glioblastoma multiforme. Cancer Chemother Pharmacol. 2017;79(6):1249–56.PubMedGoogle Scholar
  52. 52.
    Ma J, Yang YR, Chen W, Chen MH, Wang H, Wang XD, Sun LL, Wang FZ, Wang DC. Fluoxetine synergizes with temozolomide to induce the CHOP-dependent endoplasmic reticulum stress-related apoptosis pathway in glioma cells. Oncol Rep. 2016;36(2):676–84.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Liu KH, Yang ST, Lin YK, Lin JW, Lee YH, Wang JY, Hu CJ, Lin EY, Chen SM, Then CK, Shen SC. Fluoxetine, an antidepressant, suppresses glioblastoma by evoking AMPAR-mediated calcium-dependent apoptosis. Oncotarget. 2015;6(7):5088–101.PubMedGoogle Scholar
  54. 54.
    Hayashi K, Michiue H, Yamada H, Takata K, Nakayama H, Wei FY, Fujimura A, Tazawa H, Asai A, Ogo N, Miyachi H, Nishiki T, Tomizawa K, Takei K, Matsui H. Fluvoxamine, an anti-depressant, inhibits human glioblastoma invasion by disrupting actin polymerization. Sci Rep. 2016;6:1–12.Google Scholar
  55. 55.
    Pottegård A, García Rodríguez LA, Rasmussen L, Damkier P, Friis S, Gaist D. Use of tricyclic antidepressants and risk of glioma: a nationwide case-control study. Br J Cancer. 2016;114(11):1265–8.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Judge BS, Rentmeester LL. Antidepressant overdose-induced seizures. Neurol Clin. 2011;29:565–80.PubMedGoogle Scholar
  57. 57.
    Gross A, Devinsky O, Westbrook LE, et al. Psychotropic medication use in patients with epilepsy: effect on seizure frequency. J Neuropsychiatry Clin Neurosci. 2000;12:458–64.PubMedGoogle Scholar
  58. 58.
    Alper K, Schwartz KA, Kolts RL, Khan A. Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports. Biol Psychiatry. 2007;62:345–54.PubMedGoogle Scholar
  59. 59.
    Ribot R, Ouyang B, Kanner AM. The impact of antidepressants on seizure frequency and depressive and anxiety disorders of patients with epilepsy: is it worth investigating? Epilepsy Behav. 2017;70:5–9.PubMedGoogle Scholar
  60. 60.
    Torta R, Monaco F. Atypical antipsychotics and serotoninergic antidepressants in patients with epilepsy: pharmacodynamic considerations. Epilepsia. 2002;43:8–13.PubMedGoogle Scholar
  61. 61.
    Kanner AM. Depression in epilepsy: a complex reaction with unexpected consequences. Curr Opin Neurol. 2008;21:190–4.PubMedGoogle Scholar
  62. 62.
    Hesdorffer DC, Hauser WA, Olafsson E, Ludvigsson P, Kjartansson O. Depression and suicide attempt as risk factors for incident unprovoked seizures. Ann Neurol. 2006;59:35–41.PubMedGoogle Scholar
  63. 63.
    Rooney A, Grant R. SSRIs may (or may not) be a safe treatment for depression in GBM. Am J Clin Oncol. 2012;35:100.PubMedGoogle Scholar
  64. 64.
    Mendlewicz J, Lecrubier Y. Antidepressant selection: proceedings from a TCA/SSRI consensus conference. Acta Psychiatr Scand Suppl. 2000;403:5–8.PubMedGoogle Scholar
  65. 65.
    Klein M, Taphoorn MJ, Heimans JJ, van der Ploeg HM, Vandertop WP, Smit EF, Leenstra S, Tulleken CA, Boogerd W, Belderbos JS, Cleijne W, Aaronson NK. Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol. 2001;19(20):4037–47.PubMedGoogle Scholar
  66. 66.
    Caudill JS, Brown PD, Cerhan JH, Rummans TA. Selective serotonin reuptake inhibitors, glioblastoma multiforme, and impact on toxicities and overall survival: the mayo clinic experience. Am J Clin Oncol. 2011;34(4):385–7.PubMedGoogle Scholar
  67. 67.
    Valko PO, Siddique A, Linsenmeier C, Zaugg K, Held U, Hofer S. Prevalence and predictors of fatigue in glioblastoma: a prospective study. Neuro-Oncology. 2015;17(2):274–81.PubMedGoogle Scholar
  68. 68.
    Morrow GR, Hickok JT, Roscoe JA, Raubertas RF, Andrews PL, Flynn PJ, Hynes HE, Banerjee TK, Kirshner JJ, King DK. Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. J Clin Oncol. 2003;21(24):4635–41.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alice Malabaila
    • 1
  • Riccardo Torta
    • 1
  1. 1.Clinical and Oncological Psychology, Department of NeuroscienceUniversity of TurinTurinItaly

Personalised recommendations