Anxiety and depression in patients with intracranial meningioma:
Mixed methods analysis
Graham Kasper, Shannon Hart, Nardin Samuel, Colleen Fox and Sunit Das
Canadian study
Abbreviations
ESCC-SM: The health survey in Canadian communities on mental health (ESCC-SM)
HADS: Hospital Anxiety and Depression Scale (Hospital anxiety and depression scale)
WHO: World Health Organization
Ww: surveillance
Summary
Contexte : Alors que le diagnostic d’une tumeur intracrânienne de haut grade est connu pour être associé à un fardeau psychosocial plus important, le fardeau associé aux méningiomes est moins bien décrit. Cette étude visait à examiner le fardeau de la santé mentale chez les patients atteints de méningiomes qui ont subi une résection chirurgicale ou une observation en série, afin d’identifier et de mieux faire connaître les lacunes dans les soins.
Méthodes : L’échelle d’anxiété et de dépression de l’hôpital (HADS) a été soumise aux participants. Des tests exacts de Fisher ont été réalisés pour évaluer les distributions de fréquences et des tests ont été appliqués pour comparer les scores HADS des patients postopératoires et non chirurgicaux. Des entretiens semi-structurés ont été réalisés avec un sous-ensemble de participants. L’analyse thématique des entretiens a permis d’identifier les thèmes émergents.
Résultats : Trente patients atteints de méningiomes intracrâniens répondaient aux critères d’inclusion. L’âge moyen de la cohorte était de 56,01 ans et 66,67% étaient des femmes (n = 20). Quatorze ont subi une intervention chirurgicale ; seize ont été traités de manière conservatrice avec observation. Le délai moyen depuis le diagnostic de l’échantillon était de 37,6 mois. La prévalence des symptômes légers à sévères d’anxiété était de 28,6 % chez les patients traités par chirurgie et de 50 % chez les patients sous surveillance active (p = 0,325). La prévalence des symptômes légers à sévères de dépression était de 7,14% chez les patients traités par chirurgie et de 6,25% chez les patients en surveillance active (p = 0,533). Les thèmes émergents de huit entretiens révèlent l’influence de la résilience, de l’incertitude et du temps, du soutien social, des interactions avec les experts médicaux et des difficultés pendant le rétablissement sur la santé mentale.
Conclusion : Les résultats de la présente étude révèlent que les patients atteints de méningiomes subissent un lourd fardeau en matière de santé mentale, ce qui illustre la nécessité d’améliorer les soins centrés sur le patient et axés sur la santé mentale.
Mots-clés : Anxiété, Dépression, Analyse de méthodes mixtes, Méningiome, Surveillance.
Context
Meningiomas are the most frequent primary intracranial tumors in North America, representing about a quarter of all non -metastatic lesions.
Par rapport aux autres tumeurs intracrâniennes, les méningiomes évoluent souvent lentement et ont généralement un bon pronostic : le taux de survie à 5 ans et le taux de survie à 15 ans atteignent respectivement 85-90 % et 75-80 %. La lenteur de leur croissance, associée à l’utilisation de plus en plus répandue de l’imagerie crânienne, fait que de nombreux patients sont diagnostiqués de manière fortuite et souvent sans aucun symptôme associé.
La chirurgie reste le pilier du traitement des méningiomes et est souvent curative si une résection totale est obtenue. Cependant, de nombreux méningiomes asymptomatiques ne sont pas traités et font l’objet d’une surveillance régulière par imagerie en série. Malgré leur pronostic favorable, il existe un risque de récidive après résection, en particulier pour les tumeurs de haut grade.
Les méningiomes sont relativement peu étudiés par rapport à leurs homologues malins. Cette affirmation est vraie lorsque l’on examine le bien-être mental et émotionnel des patients atteints de méningiomes par rapport aux patients atteints de tumeurs cérébrales de grade supérieur. Par exemple, la dépression et l’anxiété sont courantes chez les patients atteints de tumeurs cérébrales, avec une prévalence de la dépression allant de 10 à 40 % et une prévalence de l’anxiété allant de 5 à 50 % ; cependant, la majorité des études portant sur cette relation se sont concentrées sur des populations de tumeurs de haut grade, sans prendre en compte de manière significative les méningiomes.
En outre, par rapport aux patients atteints de tumeurs plus agressives, les patients atteints de méningiomes présentent des taux de récidive plus faibles, évitent souvent les traitements adjuvants et bénéficient d’une période de suivi à long terme plus longue. Chacun de ces éléments contribue à une expérience unique pour le patient. Compte tenu de leur prépondérance relative par rapport aux autres tumeurs cérébrales (aggravée par leur pronostic favorable et les taux de survie plus élevés des patients), les conséquences des problèmes de santé mentale, comme l’anxiété et la dépression, sur les patients vivant avec des méningiomes sont probablement beaucoup plus importantes qu’on ne le pense actuellement. De plus, comme le système de santé canadien continue de mettre l’accent sur la prestation de soins holistiques et centrés sur le patient, la reconnaissance du bien-être ou de la détresse mentale et émotionnelle des patients atteints de méningiomes doit faire partie de la nouvelle norme de soins. Il est donc nécessaire d’évaluer et de comprendre le fardeau des symptômes d’anxiété et de dépression dans cette population de patients afin d’améliorer la qualité des soins qu’ils reçoivent.
In addition, the research that has explored the weight of depression and anxiety in patients with meningiomas were mainly based on quantitative data. The absence of qualitative analysis, exploring the perspectives of patients concerning the effect of their diagnosis, their treatment and follow -up care, has probably contributed to the lack of conclusive results in this field of study. Qualitative methods add depth and context to the extent of the information provided by quantitative data and it is widely used in mental health research. The use of such an approach for this population of patients has the advantage of improving the understanding by the scientific community of unique experiences experienced by patients with benign brain tumors, to obtain the personal point of view of patients directly and to allow the formulation of new hypotheses for future research.
The combination of quantitative and qualitative methods allows a better understanding of the data collected than one or the other approach alone. This is an excellent tool for studying the symptoms of anxiety and depression in patients with low -grade meningioma, because it is necessary to explore the depth and context of these symptoms (which qualitative analysis makes it possible to better grasp), while obtaining complementary and convergent data describing the prevalence and intensity of these symptoms (what quantitative analysis to input).
To this end, we carried out a mixed method study using a quantitative and qualitative analysis to identify the load and prevalence of depression and anxiety symptoms in patients with meningioma. We have sought to compare these symptoms and the experiences of patients between those who have been treated by surgery and those who have undergone a series observation.
Material and methods
Study design
A mixed sequential explanatory method has been used. Patients identified during recruitment were informed of the study during a visit to the neurosurgery clinic, or by phone. After obtaining their informed consent, the participants fulfilled the HADS questionnaire immediately or planned a later evaluation by phone. The results were depersonalized.
A subset of twelve participants, five who underwent surgery and seven who continued the wait under surveillance, was random identified to participate in the maintenance phase. The interviews, in which only the investigator and the questioned person participated, were carried out and recorded by phone. The recordings were then transcribed, depersonalized and analyzed. Four people identified to participate in the study's maintenance phase did not finish the interviews (three for logistical reasons and one which withdrew its consent for this study phase). The maintenance process continued until a satisfactory level of thematic saturation was reached, which occurred after eight interviews (surgery = 5, ww = 3). All assessments and interviews were administered and documented by the first author.
Participants were divided into a "surgery" or "vigilant expectation" subgroup for comparison purposes.
Selection of participants
The study was approved by the Unity Health Toronto Research Ethics Committee, and all research was carried out in accordance with the relevant directives, including the Helsinki Declaration. Adult patients with intracranial meningiomas of Grade I or II according to the World Health Organization (WHO) and taken care of by the Senior Researcher (SD) were considered as possible participants. This decision was made secondarily to logistical constraints. From July 2018 to February 2019, 56 people were contacted and 32 agreed to participate. For the participants who were recruited during remote/telephone appointments, verbal consent was obtained, otherwise written consent was obtained from all the other participants. This procedure was approved by the Ethics Committee. The exclusion criteria were as follows: diagnosis of anxiety and/or depression preexisting to a diagnosis of meningioma, absence of mastery of English and cognitive disorders preventing the understanding and communication of the study and its objectives. Two patients were removed due to a prior diagnosis of anxiety and/or depression.
Results measures
Anxiety and depression
The hospital anxiety and depression scale (HADS) has been used to detect symptoms of anxiety and depression. HADS consists of 14 questions designed to assess anxiety and depression (7 questions each). Each question is noted from 0 to 3, with 3 representing a more serious symptomatology, generating a score for anxiety and another for depression. Scores ≤ 7 indicate a normal score, scores ≥ 11 indicate clinically relevant anxiety or depression, and scores from 8 to 10 indicate anxiety or light depression. The HADS has shown reliability of high internal coherence with an alpha Cronbach coefficient of 0.816 for anxiety and 0.776 for depression.
Semi-structured interviews were conducted to study the perspectives of participants concerning their mental health (additional file 1: maintenance guide). This format allowed a certain flexibility to explore the relevant subjects that freely emerged from the discussion. The questions focused on the mental health and well-being of participants, in particular on symptoms of anxiety and depression, as well as on their general concerns, access to support networks or their absence, and satisfaction or dissatisfaction with their cumulative experience as a patient.
Additional measures
Socio -demographic and clinical data
The age, sex, grade and location of the tumor, the symptoms presented (neurological deficits), the treatments used (surgery, radiation, series monitoring) and the results of the treatment (extent of resection) were recorded from the medical file.
Statistical analysis
Statistical analyzes were carried out using SPSS Statistics version 27 (IBM Corporation, Armonk, NY). Summary statistics have been calculated for the cohort and each subgroup. An exact Fisher test for categorical variables has been carried out to assess the statistical significance of the frequency distributions of normal scores (≤ 7) compared to light/high scores (> 7). Tests of independent samples supposing unequal variances were carried out to compare the average anxiety and HADS depression scores between the subgroups. Statistical tests were considered significant if value P was less than 0.05 (bilateral).
Thematic analysis
Qualitative data has been evaluated using a data -descriptive data analysis approach. An open coding has been indeed generated, in parallel and independently by two investigators for each maintenance transcription, by labeling ideas, concepts and themes in the text. Emerging themes have been refined, using iterative comparative analyzes to identify models and develop relationships between concepts established in transcriptions. Using the axial coding, the transcription data was linked to reveal the themes and final sub-themes. We then compared their analyzes and generated themes and sub-themes general describing the sum of the data. The analyzes were then revised by our experienced co-investigator in qualitative research.
Results
Trente participants ont été inclus dans l’étude, dont 14 (46,7%) dans le sous-groupe chirurgie et 16 (53,3%) dans le sous-groupe WW. Il n’y avait pas de différences significatives dans les données démographiques entre les deux groupes. Le tableau 1 présente en détail toutes les statistiques récapitulatives.
Table 1 Demographic and medical information of participants
Variable post-surgical resection resection, n (%) surveillance, n (%)
Number 14 (46,67) 16 (53,33)
Age (years)
Fork 39-80 33-84
MX (SX) 55.71 (10.59) 56.31 (14.35)
Sex
Men 5 (35.71) 5 (31.25)
Women 9 (64.29) 11 (68.75)
Grade of the tumor
Stade I of WHO 11 (78.57) -
Grade II of WHO 3 (21.43) -
Extent of the tumor's resection
Total 12 (85.71) -
Subtotal 2 (14.29)-
Lateralization of the tumor
Right 6 (42.86) 11 (68.75)
Left 5 (35.71) 3 (18.75)
Other (bilateral, not specified) 3 (21.43) 2 (12.50)
Location of the tumor
Ponto-cerebellar angle 0 (0) 2 (12.50)
Convexity 3 (21.43) 2 (12.50)
Falcine 3 (21.43) 3 (18.75)
Foramen Magnum 1 (7.14) 0 (0)
Olfactory furrow 1 (7.14) 2 (12.50)
Parasagittal 0 (0) 1 (6.25)
Posterior pit 1 (7.14) 2 (12.50)
Sphenoidal 3 (21.43) 2 (12.50)
Tentorielle 1 (7.14) 2 (12.50)
Other (bilateral, multiple) 1 (7.14) 2 (12.50)
Radiotherapy history
Yes 3 (21.43) 2 (12.50)
No 11 (78.57) 14 (87.50)
Current symptoms
Cephalae 8 (57.14) 7 (43.75)
Engine deficit 8 (57.14) 3 (18.75)
Epilepsy 3 (21.43) 1 (6.25) crisis)
Dizziness/dizziness/
Instability 4 (28.57) 3 (18.75)
Visual deficit 5 (35.71) 4 (25.00)
Antecedent of neurological risk factor (HTN, DLD, smoking)
Yes 6 (42.86) 6 (37.50)
No 8 (57.14) 10 (62.50)
Frequency and intensity of anxiety and depression
The prevalence of light to clinically relevant anxiety (HADS> 7) in the cohort studied was 40 %; In the surgery subgroup, the prevalence was 28.6 % and in the WW subgroup, it was 50 %. The prevalence of light to clinically relevant depression (HADS> 7) in the cohort was 6.67 %; In the surgery subgroup, the prevalence was 7.14 % and in the WW subgroup, it was 6.25 %. The frequency distributions of positive anxiety and depression (scores> 7) and non-positive (scores ≤ 7) do not differ significantly between the surgery and ww subgroups (anxiety: p = 0.325, depression: p = 0.533) (Table 2). There was no significant difference in the average anxiety or depression scores by comparing the two sub-groups (anxiety: p = 0.587, depression: p = 0.798) (Table 2).
Table 2 results concerning anxiety and depression
HADS Résection post-chirurgie Attente vigilante Total
n (%) gross scores, n (%) gross scores, n (%) gross scores,
M (sd) m (sd) m (sd)
HADS A - 6.21 (3.91) - 7.06 (4.54) - 7 (4.00)
Bas (≤ 7) 10 (71.43) 4.2 (2.20) 8 (50) 3.25 (2.66) 18 (60) 3.78 (2.39)
Moderate/high (> 7) 4 (28.6) 11.25 (2.06) 8 (50) 10.88 (1.96) 12 (40) 11 (1.91)
HADS D - 3.21 (2.99) - 2.94 (2.85) - 3.07 (2.88)
Bas (≤ 7) 13 (92.86) 2.77 (2.59) 15 (93.75) 2.4 (1.96) 28 (93.33) 2.57 (2.23)
Moderate/high (> 7) 1 (7.14) 9 1 (6.25) 11 2 (6.67) 10 (1.41)
Time relationship on anxiety and depression
At the time of the evaluation with the HADS questionnaire, the time elapsed since the diagnosis for the entire cohort was between 2 and 182 months, with an average of 37.6 months. A linear regression analysis has been carried out to assess the impact of time elapsed since the diagnosis on HADS scores. Although the scores have tended to decrease over time since the diagnosis, no significant relationship has been revealed (p = 0.217 for depression and p = 0.113 for anxiety).
Thematic analysis
The average duration of interviews was 41.9 minutes. The thematic analysis revealed four common themes: personal resilience, the impact of uncertainty and time, the importance of social support and mental health difficulties during recovery. The summary statistics of the interview participants are presented in Table 3.
Table 3 Selected Demographic Information of Participants in Maintenance and HADS scores
Variable post-surgical resection, resection, n (%) surveillance, expectation, n (%) total
Number 5 (62.5) 3 (37.5) 8
Age (years)
Fork 46-68 33-52 33-68
Average 52.8 43 49.1
Sex
Men 2 (40) 0 (0) 2 (25)
Women 3 (60) 3 (100) 6 (75)
Symptoms present
Headed 2 (40) 3 (100) 5 (62.5)
Engine deficit 3 (60) 2 (66.7) 6 (75)
Epilepsy 2 (40) 0 (0) 2 (25)
Dizziness/dizziness/
Instability 0 (0) 1 (33.3) 1 (12.5)
Visual deficit 2 (40) 1 (33.3) 3 (37.5)
Time has elapsed since the diagnosis (month)
Fork 15-66 6-64 6-66
Average 42.6 27.3 36.9
Time has elapsed since the operation (month)
Fork 15-65--
Average 42.4 - -
HADS A> 7 2 (40) 3 (100) 5 (62.5)
HADS D> 7 1 (20) 1 (33.3) 2 (25)
Theme 1: Personal resilience
This theme encompasses the capacity of participants to face their diagnosis and to bounce during their recovery period. Six questioned people specifically mentioned having a positive self -proclaimed vision of life: "being positive is the only thing I must say that is important" (participant B1). The A4 participant has highlighted an example of this optimism when he said: "Emotionally, even if there are a lot to manage ... We can dwell on this, or we can dwell on the fact that," hey, I'm going to dine this evening "". Optimism has been noted as a long -standing character trait among participants - "My default configuration is to be happy and positive and ... to see the good side of things" (participant A5) - and has been frequently attributed to family values and education: "We draw the best party of any situation in which we find ourselves, and this has always been the case in [our family]" (participant A4).
Theme 2: The impact of uncertainty and time
Une part importante des périodes de diagnostic et de suivi impliquait de faire face à un certain degré d’incertitude, ce qui a été un catalyseur d’anxiété chez les participants. Les participants ont fait état d’un sentiment accru d’inquiétude et de peur associé à l’inconnu et au manque d’information. Les retards dans l’évaluation après le diagnostic initial ont été une cause notoire de détresse : « C’était probablement plus stressant pour cette [raison], à cause de la période d’attente pour connaître le résultat… C’est stressant de se demander : « Oh mon Dieu, qu’est-ce qui m’arrive ? (Participant B1). La participante B14 a décrit la peur associée à l’inconnu : « [J’ai] commencé à m’inquiéter… parce que je ne sais pas pourquoi c’est là, ou comment c’est arrivé, ou quoi que ce soit de ce genre, donc c’était très effrayant ».
A similar scenario occurs during the monitoring of patients supported in a surgical or conservative manner: a similar scenario occurs during follow-up, both for patients who have undergone surgery and for those who have benefited from conservative management: "[the lack of information] definitively modifies ... my mood and my way of working before [the meeting]" (participating B14). The impact of uncertainty or lack of knowledge is underlined by the attenuation of stress once the information is available: "the more I knew, the better I felt" (participant B14).
Theme 3: Importance of social support
Ce thème rend compte des avantages considérables que les patients retirent d’un soutien social significatif, des effets néfastes de l’isolement et de la solitude sur le bien-être mental et du désir d’être soutenu par des pairs qui ont vécu des expériences similaires. Il existe une forte association entre le soutien social et la résilience : « Il y a plus de gens… qui se soucient de vous… et qui passent outre… à la situation dans laquelle vous vous trouvez » (Participant A4). Avoir des amis proches prêts à écouter était une source importante de soutien émotionnel : « Parler avec des amis et… me vider le cœur de ce qui se passe… C’était souvent une libération que de le dire aux gens… et qu’ils… soient là pour moi, m’écoutent et compatissent » (participante B17).
The desire to have additional resources in the form of peer support, in order to get in touch with people who have had a similar experience, is a recurring theme. Seven of the eight people interviewed said that a peer support group would have been useful to them, especially at the start of the diagnosis.
Theme 4: Recovery difficulties
Après le diagnostic initial et la prise en charge, les personnes interrogées ont parlé de la traversée d’une période de plusieurs semaines à plusieurs mois qui a été particulièrement stressante et difficile. Ces difficultés étaient liées au manque de coordination des soins, aux déficits résiduels et au désir de retrouver les niveaux de fonctionnement prémorbides.
Les préoccupations des participants concernant le manque de coordination des soins étaient centrées sur les problèmes de communication entre les professionnels de santé et les patients. Le participant B1, par exemple, a connu des symptômes visuels persistants après la chirurgie et s’est dit inquiet de ne pas avoir eu de nouvelles de son ophtalmologiste ou de son médecin de soins primaires après les visites initiales d’évaluation. Plusieurs participants ont estimé que les liens avec les services de réadaptation ambulatoires n’avaient jamais été établis de manière adéquate et qu’ils devaient naviguer dans ces ressources de manière indépendante.
Regarding the fight against residual deficits, the participants talked about their desire to regain their basic functioning: "My objective is to return to normal" (participant A9). The fight against the inability to find the previous levels of operation was painful: "When someone removes you which is normal ... you must fight to return to normal" (participant A5). Although she accepted the idea of a new "normality", the participant A3 described the difficulty of adapting to her new state, for example by facing memory problems and acclimating to new tolerable social stimulation thresholds.
Discussion
À notre connaissance, cette étude est la première à examiner les symptômes d’anxiété et de dépression chez les patients atteints de méningiomes de bas grade (grade I ou II de l’OMS) en utilisant une méthode mixte.
Our study has collected quantitative data to assess the prevalence of light and clinically relevant symptoms of depression and anxiety and supplemented it with rich qualitative data from semi-structured interviews, allowing complete analysis of the mental health of patients.
Our results show that patients with low -grade meningiomas encounter many difficulties similar to those with high -grade tumors, especially in the short term; Thus, they can share similar needs and suffer from similar psychological and psychiatric morbidity.
Prevalence and intensity of anxiety and depression
La prévalence de l’anxiété au sein de la cohorte était de 40 % (n = 12). Il est difficile de comparer la prévalence ponctuelle à la prévalence sur la vie entière ou annuelle, paramètres souvent cités dans la littérature ; cependant, nos résultats suggèrent une prévalence de la dépression et/ou de l’anxiété plus élevée que celle de la population canadienne générale, dont la prévalence de l’anxiété généralisée et/ou de la dépression majeure varie entre 9,4 % et 11,3 %. Si l’on décompose les résultats en anxiété et en dépression, nous avons observé une prévalence de 40 % (n = 12) pour l’anxiété et de 6,67 % (n = 2) pour la dépression.
Anxiety analysis in the patient cohort
Nous avons constaté que 50 % (n = 8) et 28,6 % (n = 4) des participants des sous-groupes WW et Chirurgie, respectivement, présentaient des scores d’anxiété HADS modérés/élevés (> 7). Ces valeurs sont bien supérieures à la prévalence annuelle et à vie de l’anxiété généralisée au Canada, qui, selon l’Enquête sur la santé dans les collectivités canadiennes sur la santé mentale (ESCC-SM, Statistics Canada Canadian Community Health Survey on Mental Health), sont respectivement de 2,6 % et 8,7 %.
Ce résultat confirme ce que d’autres ont montré : malgré leur nature bénigne, les méningiomes sont associés à une comorbidité psychiatrique importante, en particulier à des symptômes d’anxiété. La prévalence de l’anxiété dans notre cohorte est également comparable aux niveaux décrits dans les cohortes de patients atteints de tumeurs malignes. Cependant, les études qui ont comparé la différence de prévalence de l’anxiété dans le temps entre les patients atteints de tumeurs cérébrales malignes et bénignes ont montré que, parmi les patients atteints de méningiomes, les taux d’anxiété diminuent et se normalisent dans les 5 ans. Dans l’ensemble, nos résultats sont conformes à la littérature et décrivent des taux d’anxiété similaires à ceux dont souffrent les patients atteints de tumeurs cérébrales malignes au moment du diagnostic initial.
It is interesting to note that there was no significant difference in the average anxiety scores between the surgery and WW subgroups.
This result could suggest three important points:
- (1) In patients with slow growth tumors, curative treatment may not be the determining factor in improving mental and emotional well-being;
- (2) The advantages of curative surgery on anxiety can be counterbalanced by the harmful effects of postoperative recovery, healing and residual deficits;
- and (3) The approach of vigilant waiting can be associated with significant stress and psychiatric comorbidity over time, although it is only implemented for cases with a favorable prognosis.
Depression analysis in the cohort of patients
La prévalence de la dépression dans les sous-groupes Chirurgie et WW était de 7,14 % (n = 1) et 6,25 % (n = 1), respectivement. Ces résultats indiquent un fardeau de la dépression potentiellement plus élevé chez les patients atteints de méningiomes de bas grade que dans la population canadienne générale, où la prévalence annuelle des épisodes dépressifs a été déterminée à environ 5 %. Nos résultats sont conformes aux données antérieures publiées par Goebel et Mehdorn, qui ont décrit une prévalence de la dépression de 8 % dans leur cohorte de patients atteints de méningiomes.
Bien qu’il y ait un consensus sur le fait que les taux de dépression sont plus élevés chez les patients atteints de tumeurs intracrâniennes que dans la population générale – allant jusqu’à 38% – les données comparant les différences entre les grades de tumeurs sont moins uniformes. Pringle et al ont trouvé que les patients atteints de méningiomes présentaient des scores de dépression plus élevés que les patients atteints de tumeurs de haut grade ; à l’inverse, plusieurs études ont montré le contraire. Ces incohérences peuvent refléter l’effet du temps sur la santé mentale des patients tout au long de leur traitement. Il peut y avoir un pic dans le taux de symptômes dépressifs chez les patients atteints de méningiomes autour du moment du diagnostic, en préopératoire et en périopératoire, comme l’ont rapporté Bommakanti et al et Simoca et al. Ce pic de symptômes a été suivi d’une amélioration des scores de dépression après l’opération. Cela contraste avec les résultats discutés par D’Angelo et al et Litofsky et al, qui ont démontré une augmentation de la prévalence de la dépression au fil du temps chez les patients atteints de tumeurs de haut grade.
Nos résultats sont en accord avec d’autres études démontrant des niveaux de dépression stables dans le temps chez les patients atteints de méningiome. De plus, notre analyse n’a pas révélé de différence significative dans la prévalence de la dépression ou les scores moyens de dépression en comparant les sous-groupes Chirurgie et WW. Nos résultats suggèrent que chez les patients atteints de méningiome, les symptômes de dépression ne sont pas seulement causés par la simple présence de la tumeur, et que les luttes pendant la convalescence et la gestion des symptômes persistants après la chirurgie peuvent masquer tout bénéfice de la guérison sur les taux de dépression.
Themes emerging from interviews with patients
Positive impacts on the well-being of patients
In our study, the factors that tend to contribute to a positive experience for the patient and his mental well-being are personal resilience and strong social support. This is not surprising, because resilience plays an important role in restoring the physical and emotional well-being of cancer patients and is associated with the adoption of adaptation strategies that improve quality of life. Social support is an important factor of resilience, and there is substantial evidence that it is essential to maintaining physical and psychological health. The participants interviewed expressed immense gratitude for the emotional support of their friends and family. Nevertheless, they indicated that there was sometimes a lack of understanding or empathy on the part of these figures of support, which suggests a role for peer support. Participants said it would be useful to speak to other people who have had similar experiences. Previous studies have shown that the feeling of camaraderie and kinship that develops thanks to the intervention of peer support increases hope, reduces loneliness and encourages a positive change in perspective and values.
Negative impacts on the well-being of patients
The uncertainty, the lack of support for the health system and the management of difficulties during convalescence had a negative impact on the well-being of patients. Uncertainty has been demonstrated that the quality of life related to patients with high -grade brain tumors are harmed; Our study confirms the conclusion that uncertainty is also an important factor in stress and anxiety in patients with benign tumors. All patients also reported an adaptation period to physical and cognitive deficits. Acceptance of "new normality" was associated with better self-evaluated mental health. Recognition of having overcome a decisive event in life, such as the diagnosis of meningioma, significantly improves self -perception and decreases anxiety; However, prolonged deficits can hinder this perception of strength and resilience.
Impact of time on well-being
Time is a primordial factor that plays a dynamic role in patient experience. More relevantly, the time that has passed since the diagnosis has been an important factor for the well-being of patients. Although the quantitative results have not revealed a significant difference in HADS scores according to the time elapsed since the diagnosis, those questioned said they lived an initial recovery period which was both physically and emotionally difficult. Previous reports have shown that objective anxiety measures decrease over time in patients with meningioma who have undergone resection, which was reflected in our interviews.
Implications for clinical practice and health systems planning
Several suggestions for improving future clinical practice and health systems planning can be deducted from the results of this study.
Tout d’abord, le soutien par les pairs devrait être proposé aux patients dès le début du diagnostic. Lier les individus à des programmes établis s’avérerait bénéfique au niveau du patient et pourrait être institué de manière pratique au niveau des systèmes, plutôt que d’établir des soutiens à petite échelle propres à chaque hôpital. Les participants ont indiqué que ce soutien serait le plus utile au début du diagnostic, mais qu’il serait probablement aussi utile pour promouvoir l’optimisme et surmonter les difficultés pendant le rétablissement.
En outre, les médecins devraient mettre l’accent sur les soins individualisés et l’adaptation ultérieure des ressources. La création et la diffusion de ressources dans un langage simple et adapté à la santé devraient également être un objectif. À l’avenir, des paramètres bien établis, déjà utilisés par de nombreux centres de traitement du cancer, tels que l’échelle d’anxiété et de dépression de l’hôpital, pourraient être intégrés aux plans de soins. Les services de réadaptation étant essentiels au rétablissement, l’accès à ces ressources, en particulier dans le cadre des consultations externes, devrait être garanti à tous les patients qui en ont besoin.
Finally, despite the absence of prolonged anxiety or clinical depression, we have found that patients often experience a period of emotional difficulty for several months after resection, and patients should be informed of this possibility.
Boundaries
Our study was a retrospective analysis with a small sample, which prevents the generalization of results and can influence the evaluation of the measures of the study results. In addition, the study was carried out in a single center with patients under the care of a single surgeon. Patient experience may be different in other centers and therefore have an impact on the accuracy of our results. In addition, HADS scores were collected at one point in patient follow -up, rather than several moments, which excludes the possibility of studying changes in mental health over time. In addition, only a subset of patients with brain tumors has been analyzed, without comparison with patients with higher grade tumors, or with healthy witnesses. Recruiting both high -grade groups of brain tumors and healthy witness groups would highlight specific conclusions for meningiomas. Finally, larger cohorts are essential to decipher the impact of the symptoms present, such as headaches and visual deficits, on mental health.
Conclusion
Overall, this study revealed that a significant proportion of patients with low -grade intracranial meningiomas have symptoms evocative of anxiety and/or depression.
Le fait de subir une intervention chirurgicale ou de poursuivre une surveillance en série n’a pas eu d’impact sur la prévalence ou l’intensité de l’anxiété ou de la dépression dans notre cohorte de patients.
The factors influencing mental well-being and mental distress in our cohort of patients included personal resilience, the element of uncertainty, in particular pending monitoring evaluations, the difficulty in adapting to residual symptoms or deficits, and the primordial effect of time has passed since the diagnosis or after the operation.
Les futures études portant sur des cohortes plus importantes devraient évaluer l’anxiété et la dépression de manière longitudinale à plusieurs moments, en utilisant plusieurs paramètres pour évaluer la gravité des symptômes.
This will better characterize the psychiatric burden with which this population of patients is confronted and to better understand the relationship of time on their psychiatric symptoms.
Data availability and equipment
The data sets generated and/or analyzed during this study may be made available by the corresponding author on reasonable request.
Thanks
Not applicable.
Funding
GK was supported by Ontario Medical Student Association/Associated Medical Services Compassionate Care Medical Student Education Research Grant, a summer student allowance. The funder did not play any role in the design of the study, the collection, analysis and interpretation of data, nor in the preparation of the manuscript.
Author information
Affiliation
Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Graham Kasper
Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
Shannon Hart
Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
Nardin Samuel and Sunit Das
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
Nardin Samuel and Sunit Das
Personal -oriented care, Ontario Health (Ontario Cancer Action), Toronto, ON, Canada
Colleen Fox
Contributions
GK has contributed to conceptualization, methodology, formal analysis and investigation, preparing the original version, revision and publishing, as well as obtaining funding. SH contributed to the preparation of the original version, revision and publishing. NS has contributed to revision and publishing. Cf contributed to revision and publishing. SD has contributed to conceptualization, methodology, revision and publishing, as well as the supervision of the study. All the authors have read and approved the final manuscript.
Corresponding author
Correspondence with Sunit Das.
Ethical declarations
Ethical approval and consent to participation
The study was approved by the Unity Health Toronto Research Ethics Committee (study 18-120). The informed consent was obtained from all the participants in the study before the acquisition of the data. For participants recruited during remotely meetings/telephone, verbal consent was obtained, otherwise written consent was obtained from all other participants. This procedure was approved by the Ethics Committee.
Consent for publication
The informed consent of all participants in the study concerning future publication was obtained before the acquisition of data.
Competing interests
The authors declare that they have no competing interests.
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