Oral Papers: Neuropsychiatry
Background: Adult survivors of brain tumors are living longer following diagnosis and treatment, due to improvements in detection, treatment. With the reduction in mortality, questions arise around morbidity, especially those related to treatments. In this scoping review, we present an overview of the literature on neuropsychiatric sequelae after surgical resection of brain tumors in adults. Methods: Using scoping review methodology by Arksey & O’Malley (2005), we broadly included any articles that discussed or included adult brain tumor patients who underwent a partial or total brain resection, and examined major neuropsychiatric domains. We also hand-searched articles to include cited works, as well as consulted experts for inclusion of seminal works. Results: We scoped 81 articles: 63 empirical and 18 non-empirical. The majority of the work focused on survivors within 1 month to 1 year of diagnosis and treatment, with significant gaps in the impact of surgical intervention in the earlier or later phases of survivorship. Discussion: Cognition was most widely studied, yet still suffered from a lack of systematic studies to derive clear associations. General trends suggest a transient worsening in cognition, globally, during the first month, with return to pre-operative baseline or improvement thereafter. Working memory and language were most vulnerable to deterioration post-resection, with some association to side of resection. Depression appears to increase in frequency in survivorship, and associated with frontotemporal location, survival, quality of life, cognitive and physical parameters, and functional status. Anxiety, independent of depression, appears related to tumor histology, grading, has also been found to have a weaker, albeit, significant association with cognition and quality of life. While the HADS aligns with clinical interview in depression; it is not as reliable in anxiety. Obsessive-compulsive symptoms were sparsely studied, though some possible association with female sex, and left anterior location. Other neuropsychiatric symptom clusters have received even less attention, including psychosis, mania, and delirium – despite our understanding that these states are often found in early phases of treatment, and with steroid use. No substantive evidence was found that discusses benefits and risks of treating psychiatric conditions comorbid in brain tumors. Conclusion: Our scoping review highlights what is known in neuropsychiatric outcomes post-resection of brain tumours. It subsequently maps the evolution and time course of these disorders, and can influence our approaches to treating our neuro-oncological patients.
References: Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International journal of social research methodology, 8(1), 19-32.