Mood Disorders in Patients with CNS Metastases

Abstract

Mood disorders and cancer are linked through shared pathology that involves inflammation, oxidative stress, decreased immune surveillance, and dysfunction of the HPA axis. Cancer treatment often involves interventions that can, directly or indirectly, contribute to mood symptoms. Patients with cancer are at up to three times greater risk for depression compared to the general population, and advanced disease and central nervous system (CNS) involvement are additional risk factors. The presence of a mood disturbance impacts patient decision-making related to cancer treatment and is associated with poorer cancer-related outcomes, including medication nonadherence, comorbid substance misuse and relapse, higher healthcare utilization and costs, and mortality. Depressive and bipolar disorders are reviewed, particularly as they relate to patients with metastatic involvement of the CNS. Strategies for the screening and treatment of mood disorders in the medical setting are discussed.