Association of pre-operative depressive and anxiety symptoms with five-year survival of glioma and meningioma patients: a prospective cohort study

Background. Mental symptoms are common and associated with worse health status of brain tumor patients. We evaluated the association of pre-operative depressive and anxiety symptoms with 5-year mortality of glioma and meningioma patients. Methods. One-hundred and fifty-two patients (mean age 56.9 +/- 14.7 years, 69% women) were evaluated for functional status (Barthel index), and depressive and anxiety symptom severity (Hospital Anxiety and Depression scale or HADS). Patients were categorized as having mild, moderate or severe depressive/anxiety symptoms if they scored <= 7, 8-10 or >= 11 on the HADS, respectively. Information pertaining to histological diagnosis, extent of resection and adjuvant therapies were obtained from medical records. Follow-up continued through November, 2015. Results. Forty-three patients were diagnosed with high-grade glioma, 20 with low-grade glioma and 89 with meningioma. Moderate to severe depressive and anxiety symptoms were diagnosed in 28% and 36% of patients, respectively. In meningioma patients, survival was the shortest in patients with severe depressive symptoms (40.32 +/- 7.92 months) followed by patients with moderate (46.66 +/- 6.05 months) and mild (55.68 +/- 1.77 months) depressive symptoms (Log-Rank = 6.211, p = 0.045). After adjusting for patients' age, gender, functional status, extent of resection, history of depression, and tumor location, laterality and grade, severe depressive symptoms were associated with increased 5-year mortality risk of meningioma patients (HR = 7.083 [95% CI: 1.755-28.588], p = 0.006). Depressive and anxiety symptoms were not associated with mortality of glioma patients Conclusions. Depressive and anxiety symptoms are common in glioma and meningioma patients. Pre-operative depressive symptoms are associated with shorter survival of meningioma patients independently from clinical prognostic indicators.