Underutilization of Depressive Symptomatology Tools in the Oncologic Spine Population

Introduction: Cancer patients experience a significant emotional burden from their diagnosis and treatment, leading to high rates of depression. Surgical intervention, itself, is a risk factor as well as severe physical symptoms like back pain in oncologic spine patients. Despite the availability of easy-to-use screening tools, depression remains undetected and underdiagnosed. The purpose of this study was to systematically review perioperative depression rates of oncology patients, as measured by self-reported tools.

Methods: A systematic review was conducted using PubMed, EMBASE, Scopus, and APA PsycINFO (searched until December 15th, 2023). Included were clinical studies of cancer patients undergoing surgery that measured depression by a self-reported instrument. Data on study and patient characteristics, and preoperative and postoperative depression rates were extracted. Results were pooled, and overall depression rates were calculated as weighted means and percentages of patients with clinically significant depression.

Results: Data was extracted from 796 studies. 214 studies recorded the percentage of patients with clinically significant depression. Of these studies, the most common primary cancers were breast (64), head and neck (23), brain (17) and colorectal (17). There were no studies displaying depression in the oncologic spine population. Overall, the average percentage of patients with clinically significant depression was 26.0% with 27.0% in the preoperative period and 25.4% in the postoperative period. 230 studies recorded preoperative depression means. Of these, the most used tools were HADS-D (131), CES-D (37) and BDI (26). Preoperative depression means for these tools were 6.21, 13.0 and 11.2, respectively, across all cancer types. Calculation of postoperative means by time point peaked at 0-30days after surgery across the top tools.

Conclusion : This systematic review highlights a need for psychological support that accounts for a preoperative peak of clinically significant depression that extends into the immediate postoperative period. Notably, there is a lack of measurement of depressive symptoms in the oncologic spine population. Given the vulnerability of this population to depression due to physical challenges of back pain in conjunction with oncologic prognoses, there is a need for more formalized tools and increased utilization to detect depression rates of this specific population.