Abstract
BACKGROUND
The COVID-19 pandemic and associated mitigation procedures have significantly altered daily life in ways that may disproportionately affect the mental health of patients with CNS tumors. This study aimed to explore differences in mood disturbance and associated health status in the CNS tumor patient population during the COVID-19 pandemic, compared to pre-pandemic assessments.
MATERIAL AND METHODS
This was a cross-sectional analysis using data from the Neuro-Oncology Branch (NOB) Natural History Study (NHS) at the NIH. Patients seen during the 1st year of the COVID pandemic between March ’20 and Feb ’21 made up the COVID year group. We compared PROs assessments in these individuals to their assessments collected prior to March ’20 (‘Pre-COVID’ sample) and also to a historical control group (‘NOB Normative’ sample) which included all NHS PROs assessments through Feb ’20. Comparison of PROs (PROMIS-Anxiety and Depression 8a Short Forms, EQ-5D-3L) between groups was done using one-sample proportion tests and stepwise logistic regression was used to identify risk factors for depression in those seen during the COVID year.
RESULTS
178 CNS tumor patients were seen during the COVID year, the majority of whom were male (55%) and Caucasian (82%) with a median age of 45 (range 18-79) and the most common diagnosis was glioblastoma (25%). Although the proportion of patients with moderate-severe anxiety symptoms was higher during the COVID year compared to the other 2 groups, this difference did not reach significance. A significantly greater proportion of patients seen during the COVID year reported moderate-severe depressive symptoms on PROMIS compared to pre-COVID assessments and NOB normative patients (17% vs. 8% and 12%, p = .023, Cohen’s h = 0.22) and they also were more likely to report moderate-severe impact on the depression/anxiety dimension of health on the EQ-5D-3L (53% vs. 45% and 43%, p = .009, Cohen’s h = 0.28). Logistic regression revealed that patients were more likely to experience moderate-severe depressive symptoms during COVID if they had concurrent moderate-severe distress (OR 19.3, 95% CI [5.5, 68.5]), use of psychotropic medications (OR 3.4, 95% CI [1.1, 11.3]), a low tumor grade (OR 4.6, 95% CI [1.3, 15.7]), and male gender (OR 3.9, 95% CI [1.1, 13.9]).
CONCLUSION
These findings demonstrated that patients with CNS tumors seen during the first year of the COVID pandemic experienced higher levels of depression, particularly in men who typically report lower mood disturbance than women. This suggests that male patients may have been disproportionately impacted by the stressors of the pandemic, which warrants further investigation. Future work is needed to incorporate innovative tools and interventions that can be utilized remotely to better identify and target mood disturbance in CNS tumor patients who are most at risk for experiencing these symptoms.