New study shows patients with low-grade gliomas are more likely to experience mental health disorders

A recent retrospective cohort study from Penn State Health Milton S. Hershey Medical Center indicates patients with low-grade glioma (LGG) tumors are more likely to experience mental health distress and/or be treated for a mental health disorder (MHD).

Dr. Alireza Mansouri, surgical neuro-oncologist at Penn State Health Neurosurgery, and his colleagues, including Debarati Bhanja, a medical student at Penn State College of Medicine and key researcher of the study, knew patients with LGGs were living longer with advanced treatment, but their mental health status was largely undetermined.

“Though causation remains unknown, we’ve been able to delay the progression of gliomas and therefore extend life expectancy,” Mansouri said. “As we attempt to transition LGG diagnosis into a chronic disease rather than an acutely deteriorating one, it’s important to look at the impact of diagnosis and medical interventions on a patient’s quality of life.”

The prevalence of LGGs in patient populations

The World Health Organization classification of central nervous system tumors categorizes LGGs as grade 1 and 2.²

Generally, grade 1 gliomas are more contained and may be treated with curative surgery. Grade 2 gliomas are often more infiltrative and typically grow beyond what the human eye or microscope can see. Surgery is not considered a curative treatment for grade 2 gliomas which have a higher likelihood of becoming malignant. Grade II gliomas make up 13% to 16% of all glial tumors.¹ Grade 2 gliomas were the focus of this study.

Previous research indicates a strong correlation between a cancer diagnosis and MHDs. Patients with cancerous brain tumors, however, report emotional distress significantly greater than patients with a systemic cancer diagnosis and almost double that of the general population. However, research on the connection between MHDs and gliomas has been limited to high-grade gliomas, with only depression and anxiety measured.

Tracking MHDs in LGG patients

Using the IBM MarketScan Commercial Claims and Encounters, Mansouri and his team examined the data of more than 20,000 patients with LGGs to determine the incidence of MHDs before and after diagnosis. Patient data came from private, employer-funded health insurance plans that assign diagnostic codes to tumor diagnoses and MHDs, along with codes associated with any interventions and medications provided.

Information on patients diagnosed between Jan. 1, 2005, and Dec. 31, 2014, was reviewed, and only those over the age of 18 with data covering 12 months pre-LGG diagnosis and 12 months post-diagnosis were measured.

“This 12-month period was important to make sure there was a long enough duration for the diagnosis to be understood and a treatment plan underway,” Mansouri said. “Yet it was not so long that other factors might confound the mental health diagnosis with the presence of an LGG.”

The MHDs analyzed in this study included episodic mood disorders such as depression, anxiety, non-alcohol drug dependence, adjustment reaction and depressive disorder not otherwise specified.

To account for patients who may not have received a formal mental health diagnosis, researchers tracked medication dispensing records for patients using psychotropic medications, including antidepressants, antipsychotics and monoamine oxidase inhibitors.

“As researchers, we recognize the possibility that a doctor might not have entered a specific mental health diagnosis in the database, yet the patient still struggled with mental health symptoms,” Mansouri said. “We tried to capture relevant information based on the medications those patients were prescribed.”

The prevalence of MHDs among patients with LGGs was measured by quantifying the number of patients with concurrent LGG codes and MHD/psychotropic drug fill codes. The new onset of MHDs in LGG patients was determined by measuring the number of patients with their first recorded MHD or psychotropic drug fill after the diagnosis of an LGG.

Substantial findings suggest need for improved care

What this study revealed is significant: 60.9% of patients with LGG developed an MHD, which is well above the national average of 21%.

Of the 11,458 patients identified as never having a MHD prior to their LGG diagnosis, 16.7% developed one within 12 months of being diagnosed. Rates of MHDs were even higher among women, patients in the Western part of the U.S. and patients between the ages of 35 and 44.

Also notable was the diagnosis of MHDs among LGG patients who experienced seizures. Patients with glioma-related seizures were 2.1 times more likely to develop a MHD in the 12 months post-diagnosis than patients without them.

Patients whose first line of treatment included surgery or biopsies were also at a higher risk of developing MHDs, which may point to the impact surgery has on the brain networks that affect mood.

“We were able to show that patients who received these treatments had higher rates of MHDs than systemic cancer populations,” Mansouri said. “These results suggest the idea that both diagnosis and surgical treatments do indeed worsen anxiety and depression.”

Based on these initial findings, Mansouri and his colleagues recommend providers integrate mental health screenings throughout the course of LGG treatment to improve patient’s quality of life and overall treatment efficacy.

“For providers, it’s important to consider these results proactively,” Mansouri said. “At the onset of diagnosis, LGG patients should be screened for mental health symptoms at every stage of treatment, and programs need to effectively incorporate those strategies into patient management.”

A prospective study that looks at patients with LGG who are directly screened for MHDs is the next step.

“We’re undertaking that right now, a prospective assessment of mental health disorders incidence and prevalence in patients with LGG,” Mansouri said.

Until then, the association between LGG diagnosis and the presence of MHDs seems clear.

“Now that we have effective tools to better manage LGGs, providers should focus on quality of life,” Mansouri said. “We should not lose track of how these diagnoses impact our patients’ quality of life and ultimately, the effectiveness of the care we provide.”

References:

1. Bhanja D, Ba D, Tuohy K, Wilding H, Trifoi M, Padmanaban V, Liu G, Sughrue M, Zacharia B, Leslie D, et al. Association of low-grade glioma diagnosis and management approach with mental health disorders: A MarketScan analysis 2005–2014. Cancers. 2022;14(1376). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946211/
2. Aiman W, Rayi A. Low Grade Gliomas. [Updated 2022 May 15]. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK560668/?report=reader.