gms | German Medical Science

Objective: Identification of brief, valid screening instruments is critical for providing neuro-oncological patients with appropriate psychosocial support. At the same time, due to patient’s neurocognitive impairment and/or restricted ability to undergo screening procedures, physicians’ estimation of need of support is inevitable. This is the first study applying the ultra-short 4-item version of the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) in neuro-oncological patients. Consistency of physicians’ perception (assessed by PO-Bado-SF) and patients’ screening results during first six months of the disease was evaluated.

Method: Patients with primary diagnosis of intracranial tumors, MMST >26 and written informed consent were assessed after surgery (T1), 3 and 6 months (T2, T3). Health-related quality of life was evaluated with EORTC-QLQ-C30+BN20, psychosocial burden with PHQ-4, Distress Thermometer (DT) and Hornheide Screening instrument (HSI). Simultaneously, attending neuro-oncologists (n=3) completed the PO-Bado-SF assessment. PHQ-4 results were compared to the validated instruments (DT, HSI) and the physicians’ perception.

Results: 140 patients were included (male: 46%; glioma: n=48, 34%; meningioma: n=43, 31%; metastases: n=30, 21%). The PO-Bado-SF questionnaire was completed in 139 participating patients at T1, 117 at T2 and 96 at T3 (patient drop outs: T2 n=23 and T3 n=20). Using the suggested cut-off score (>6) for PHQ-4, it identified n=20 (39%) of n=51 DT-positive and n=16 (39%) of n=41 HSI-positive cases at T1; n=8 (28%) of n=29 DT-positive and n=8 (20%) of n=40 HSI-positive cases at T2; n=5 (23%) of n=22 DT-positive and n=8 (26%) of n=31 HSI-positive cases at T3 (sensitivity 33%, resp. 29%; specificity 93%, resp. 91%). PO-Bado-SF agreement with screening results for patients in need of support was better with PHQ-4 and DT than with HSI without reaching significance (PHQ-4: 56% (T1), 58% (T2), 63% (T3) vs. DT: 51% (T1), 59% (T2), 64% (T3) vs. HSI: 56% (T1), 48% (T2), 42% (T3)). Neuro-oncologists observed fatigue/tiredness in n=113 patients (T1), in n=94 (T2) and in n=76 (T3). The number of patients suffering from anxiety/worries and/or tensions was analogous (T1: n=113, T2: n=89, T3: n=69). In n=246 of n=352 (70%) completed assessments (T1: n=93, T2: n=90, T3: n=63) physicians observed mood swings/uncertainty/helplessness, being unreported by the patients themselves at that time. In turn, at T1, n=34 patients longed for support, of whom only 19 (56%) were identified by physicians via PO-Bado-SF. After 3 resp. 6 months, n=12 resp. n=11 patients (10% resp. 11%) immediately asked for psychological help, the PO-Bado-SF detected n=8 (67%) resp. n=6 (54%) of these patients as in need for support.

Conclusion: Reliable identification of neuro-oncological patients suffering from psychological burden is limited using the PHQ-4 by cut-off: >6 alone. However, due to its construction patients cannot only be identified by a cut off score, but also by directly expressing a potential wish for support. Furthermore, the physicians’ perception by PO-Bado-SF provides a different facet of the psychosocial burden. However, the physicians view does not completely reflect the patients’ wishes. Thus, patient reported outcome measures are indispensable but should be accompanied by the assessment of the physicians.