The frequency, longitudinal course, clinical associations, and causes of emotional distress during primary treatment of cerebral glioma

Background. Relatively little is known about the frequency, longitudinal course, independent associations, and reported causes of emotional distress in adults with primary cerebral glioma. We aimed to describe these features in an observational study. Methods. This was a twin-center prospective cohort study. Eligible adults were those with a new histological diagnosis of glioma who were receiving active management. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer and problem checklist. Subjects were sampled at 3 timepoints: T1 (shortly after starting chemo/radiotherapy), T2 (3 months later), and T3 (6 months later). Results. T1 n ¼ 154; T2 n ¼ 103; T3 n ¼ 83. Significant distress was present in 36.4+7.6% at T1, 35.9+9.3% at T2, and 33.7+10.2% at T3. Longitudinally, subjects with high distress at T1 (median Distress Thermometer score ¼ 8; interquartile range [IQR] 7‐9) remained highly distressed on follow-up (T2 median ¼ 8, IQR 6‐8; T3 median¼ 7, IQR 5‐8) (Friedman test P ¼ .304). Younger age, functional impairment, and concurrent major depressive disorder were independently associated with high distress (logistic regression x 2 for model ¼ 39.882, P , .001, R 2 ¼ 0.312). The most frequently reported causes of distress were worry, fatigue, sleep difficulties, and sadness. Emotional difficulties were among the most common causes of distress at all 3 timepoints. Conclusions. At each timepoint, one-third of patients reported significant emotional distress, which persisted during follow-up among those initially highly distressed. Young, functionally impaired, and depressed glioma patients may particularly benefit from increased support.