The average score on the hospital anxiety and depression scale (HADS-A) was 10.0 (and 2.0, 4-14 interval) in the waiting and surveillance group and 10.0 (and 1.8, interval 6-14, p = 0.92 in the postoperative group. The HADS depression score (HADS-D) was 11.3 (and 1.9, interval 4-14) and 10.9, respectively (and 1.5, interval 8-13), p = 0.23. No statistically significant difference between groups was noted for the HADS-A scale (p = 0.60); however, a significantly higher number of patients in the waiting group and surveillance presented pathological values ​​on the HADS-D score (p = 0.005).

The distress thermometer (DT) has shown significant psychological distress in a large proportion of the two study groups. The average DT score in waiting and intervention groups was comparable (4.9 (and 2.0) against 4.1 (and 2.9), p = 0.31). However, 43 % of pending patients and 37 % of patients in the postoperative group presented significant distress, that is to say a DT value ≥ 6. DT analysis has shown that a significantly higher proportion of patients in the waiting and surveillance group had problems of appearance (19 % against 0 %, p = 0.01), oral sores (29 % against 6.5 %, p = 0.02) pain (67.7 % against 41.9 %, p = 0.04) (figure S1). Fatigue was the most common problem identified in the list of problems in the two study groups (55 % in the postoperative group and 48 % in the waiting and surveillance group), followed by concern (45 % and 52 %) and sleep disorders (45 % and 42 %, respectively).

Analysis of the results of the abridged survey on health (SF-36) revealed that there were no statistically significant differences in the perception of health between study groups in all categories, with the exception of the general state of health, which was significantly lower in the waiting and surveillance group (p = 0.005) (Figure 2). The overall score of the physical health component was significantly lower in the waiting and surveillance group (43.7 (13.6) against 50.5 (9.5), p = 0.03); The overall mental health component score was similar in the two groups (39.9 (15.7) against 46.2 (13.3), p = 0.10).

The total average score of the brief fatigue inventory (BFI) was similar in waiting and monitoring and postoperative groups (3.3 (1.5) against 3.4 (1.8), p = 0.95). The average values ​​as well as the proportion of patients with clinically significant fatigue (≥7) were similar among the sub-bras, except for the joy of living, where the waiting and surveillance group obtained significantly worse values ​​compared to the postoperative group (Table 2, click on the link to see the table ). The “largest fatigue” was high: 45.2 % in the waiting and surveillance group and 58.1 % in the postoperative group. No correlation was found between the average and the “most important fatigue” and the DT and HADS scores.

We evaluated the correlation between the results of different measures of psychological distress: the HADS-A and HADS-D scores, the DT score, the emotional role (RE) and the aggregated mental component of the SF-36. Among all the pairs, significant correlations between the DT score and the mental component (RHO of Spearman -0.68, P <0.001) and between the DT and the RE (RHO of Spearman -0.57, p <0.001) were found. To identify the factors associated with significant distress, uni-variated logistic regression has been carried out. As there were few patients without symptoms according to HADS scores, the classification was simplified in two groups: pathological and limit / no symptoms. DT ≥ 6 has also been used to indicate significant distress. The rank of the WHO was not included, because there were too few cases with upper grades. There were no statistically significant associations for DT and HADS-A pathological scores. The waiting and monitoring strategy was associated with a risk 4.26 times higher of pathological score on the HADS-D score (p = 0.03), and the higher nano score (worse) has been associated with a lower risk of depression symptoms (p = 0.04) (Table 3, click on the link to see the table ). The average nano score was 0.2 (and 0.5) in patients with depression symptoms and 1.1 (and 1.4) in other patients. The two factors (nano scores and treatment group) remained significantly associated with depression in the HADS-D in a multivariate model (Table 4, click on the link to see the table ).

As the majority of patients (50 out of 62) were included in 2019, COVVI-19 pandemic did not influence the mental health of most patients . A direct comparison between patients recruited in 2020 and before has not shown significant differences.

The few existing studies on depression and anxiety in patients with meningioma show higher levels of distress than in the general population-the proportion of patients with HADS-A abnormal scores reached 70 %, and for HADS-D, 30 % in operated patients. In most cases, the symptoms decreased after the operation. A study examining patients suffering from meningiomas and schwannomas of the ponto-cerebellar angle in the context of a monitoring and waiting strategy reported levels of anxiety and clinically relevant depression in a third of the patients. The proportion of anxiety and depression in our cohort was higher compared to other studies. This could reflect certain regional differences. However, a larger multicenter study is necessary to deepen these observations. The average values ​​of the HADS score in our study were approximately twice as high as the value of the normal German population. These results are particularly alarming because a statistically significant difference in the overall survival of patients with meningioma, laminated according to their preoperative HADS-D score, has been reported.

In our study, the values ​​of the physical health component of the SF-36 were comparable to the values ​​reported in patients with meningioma before and after surgical treatment. After an operation for meningioma, patients generally declare a lower QVLS than that of healthy witnesses, although certain data on patients who have undergone an asymptomatic meningioma operation have shown no significant difference compared to the general population .

On the other hand, data on surveillance patients are lacking. In a study on healthy witnesses, waiting and under-monitoring patients and postoperative patients, a lower QVL level (using SF-36) but intact neurocognitive capacities have been reported in waiting and under surveillance patients. In accordance with our data, patients pending and under surveillance reported a less good QVLS than the group having undergone surgery. A direct comparison between operated and unpaid patients with meningioma is difficult, as the two treatment strategies cannot be offered equally to each patient. However, the results indicate that “wealthy” patients whose results are asymptomatic could suffer from a significant psychological burden .

Even if only a sub-cheer of the General Health and Physical Health component has shown statistically significant differences between study groups, the average scores of all the sub-scals were lower in the surveillance and waiting group. This observation contradicts the ECOG and Nano scales which were similar between the groups, indicating a difference between the QVLS and the physical and neurological functioning of the patient, as measured by the examiner. Psychological distress is an important determinant of QVLS. There was a significant correlation between the SF-36 role-emotional (RE), the scores of the mental health component and the DT but not with the HADS scores of our study. Like each of these scores is a validated instrument, the meaning of these differences is difficult to extrapolate and, in our opinion, underlines many facets of the psychological state of patients with meningioma.

Up to 50 % of patients with meningioma under surveillance or before the operation suffer from significant fatigue, making it one of the most common symptoms in this group of patients. About 50 % of patients said they had received a meningioma diagnosis six months after the appearance of symptoms, the most frequent being headache, fatigue and cognitive deficit .

Patients with meningioma reported significantly higher pre -post -post -post -post -post -postal levels than normative values. This complies with our conclusions because around 50 % of patients in the two study groups reported significant fatigue. The most frequent problems identified by patients in our cohort were pain, fatigue, worries and sleep disorders. In oncological patients, the presence of fatigue can be disproportionate to the activity carried out and can considerably reduce the quality of life. There is no clear explanation for the prevalence of fatigue in the group of pending patients.

Apparently asymptomatic people can undergo diagnostic imaging for various reasons, for example by participating in research, on the recommendation of a doctor, in the context of professional screening or a company. It may be part of people with non -specific symptoms, such as fatigue, anxiety and depression, which receive cranial imaging. For example, emotional stability is associated with less serious depression and anxiety in patients with a brain tumor [27]. On the other hand, the high prevalence of fatigue in postoperative patients, the outcome of which is also excellent, can become more noticeable once the other symptoms have reduced or reflect the prevalence of depressed or anxious people as such who receive brain imaging.

This study has several limits. As has been made in a single tertiary neurosurgical center, a major selection bias must be taken into account. Cohorts of patients are not important, which compromises the generalization of data. No neurocognitive test was carried out; Consequently, the association with the QVLS could not be evaluated. Patients were not asked about the current treatment for steroids, which could influence mood fluctuations. In addition, patients with postoperative morbidity were excluded from the study for methodological reasons. This can represent a selection bias. In addition, there was no specific meningiomal questionnaire dealing with relevant questions for these patients. Therefore, some of the relevant problems can remain unidentified.

After having signed a consent form, an evaluation of the patient's neurological functions was carried out using the Nano scale and the general state of the ECOG group performance, and demographic and specific data to the tumor. Demographic data included sex, age, level of education (higher in secondary or other), employment, family situation (living with a partner) and comorbidities. Patients were explicitly questioned about psychiatric comorbidities and active or completed treatment. The location, size, growth and histological grade of tumors (for operated patients) were taken into account. The location of the tumor was classified according to convexity, the false, the anterior, medium, posterior pit and the cave saddle/sinus. The time elapsed since the last significant event, that is to say the diagnosis of the tumor for patients under surveillance and the time elapsed since the operation for operated patients, has also been recorded.