DETERMINANT FACTORS OF MOOD DISORDERS IN BRAIN CANCER PATIENTS:DEVELOPMENT OF NOVEL INTRAOPERATIVE TOOLS IMPACT ON PROGNOSIS AND QUALITY OF LIFE

Brain tumour is an infiltrating disease harbouring within the central nervous system (CNS) causing Cognitive and Mood Disorders. The prognosis is very poor. The optimization of the surgical procedure with the aid of Brain Mapping Technique (BMt) allows to extending the resection of the tumour beyond its boundaries (supramarginal resection), increasing the patients’ survival while preserving the patients’ functional integrity, assuring them the best possible Health Related Quality of Life (HRQoL). However, despite the advanced surgical procedure, patients face many stressors in the course of the disease, among which the Cognitive deficits leading in Mood Disorders. Notably, Mood disorders, in turn, dramatically affect the HRQoL, the survival and other crucial aspect of care including the compliance to treatment (Litofsky et al. 2004, Maino et al. 2006). The negative influence of Cognitive and Mood Disorders on HRQoL is still a matter of debate. At present is indeed still unsolved the critical issue of whether are the clinical features related to the tumour, or rather the psychological response to the stressors secondary to the care, to be considered the main predicting factors for emergence of Mood Disorders in brain tumour patients (Madhusoodanan 2015). Based on these premises the present PhD study investigated the association between Mood Disorders, the specific clinical and anatomical features related to the tumour itself, and the patients’ cognitive outcome with the aim of disclosing the influence of Cognitive and Mood Disorders on HRQoL before and after treatments in patients with brain tumour and, accordingly, of developing specific “interventions” aimed at improving the patient’s HRQoL. The results of the study, conducted on 116 patients who underwent awake procedure for tumour resection, showed that Mood Disorders were not associated with the clinical features of brain tumour per se, as might be expected, but rather they were associated with the lack of recovery from Cognitive post-surgical deficits and, among the possible Cognitive deficits, specifically language, attentive/executive and visual deficits. Moreover the HRQoL turned out to be negatively affected by both the lack of cognitive recovery and by the occurrence of Mood Disorders, especially in the long run (3, 6 months after treatments). Based on these results, in order to reduce the incidence of Mood Disorders and to improve the HRQoL of the patients affected by brain tumour, two new intraoperative tools designed to map and preserve the networks involved in the attentive/executive and visual functions were designed and tested in the intraoperative setting. The feasibility of the new “intraoperative Stroop tools - iST” and its accuracy in preserving attentive/executive functions (EF) was assessed in 45 patients affected by glioma and candidate for tumour resection during the awake-asleep-awake surgery. The results showed that iST was successfully administered intraoperatively in all patients with high feasibility and reduced dramatically the prevalence of acute and long-term post-operative EFs deficits. The feasibility a new intraoperative Visual tool (iVT) designed to preserve visual abilities patients affected by glioma involving visual pathways was assessed in 25 patients candidate for surgical resection in awake surgery. The results showed that the iVT was successfully administered intraoperatively in all patients with high feasibility. The analysis of peripheral visual assessment showed that 17 of 25 (68%) patients did not show any post-operative visual deficits. Conclusively the novel evidence provided by this PhD Study was that is not the Cognitive deficit induced by the treatment per se, but rather the patients’ expectation about their recovery after treatment and their disappointment, that play a crucial role in determine the emergence of Mood Disorders, consequently negatively affecting their HRQoL. These results first highlight the importance of a proper communication of predicted deficits by the medical team. Moreover, the feasibility of a more accurate BMt implemented with new intraoperative tools (iST and iVT) and allowed to optimize the resection without affecting patient’s functional integrity. Overall this research suggests that the efficacy of a neurooncological treatment should account for both the neuropsychological outcome of treatments and also patients’ expectation, delivering them realistic information and thus expectations, about their post-treatment outcome and implementing new techniques to reduce the occurrence of deficits significantly affecting the QoL of patients.