TITLE:
The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study
AUTHORS:
Kenza Benali, Mohammed Adnane Tazi, Gael Kietga, Tayeb Kebdani, Khalid Hassouni, Sanaa El Majjaoui, Hanan El Kacemi, Noureddine Benjaafar
KEYWORDS:
Cervical Cancer, Brachytherapy, High-Dose Rate, Pain, Anxiety
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.13 No.7,
July
12,
2022
ABSTRACT: Purpose: To evaluate the anxiety and pain levels of cervical cancer patients
undergoing intracavitary multifraction high-dose rate
(HDR) brachytherapy, as part of a process to develop guidelines for quality
patient-centered care. Methods: Cervical cancer patients (n = 31)
undergoingmultiple fraction HDR brachytherapy treatment at the National
Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety
intensity using 11-point verbal analog scales, at 6 key time points over 2
brachytherapy insertion procedures and 4 brachytherapy fractions. Women were
evaluated for psychological status at baseline before starting the
brachytherapy process using the Hospital Anxiety and Depression Scale (HADS).
Scores were grouped as follows: 0 - 7 =
normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship
status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were
evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in
12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported,
with a maximum intensity in the operating room during spinal anesthesia (3.23 ±
1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety
scores were reported in 25.8% and 22.6% of patients respectively.
Level of education showed a significant correlation with anxiety scores (p =
0.027). Pain increased significantly during
the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful
parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary
multifraction high-dose rate brachytherapy is associated with mild to moderate
levels of pain and anxiety, although a subset of patients reported more severe
symptoms and may require additional medical and psychological support, with particular
emphasis on bed-rest duration and applicator removal. The development of
effective interventions (both
pharmacological and non-pharmacological) is needed to improve women’s
experiences of brachytherapy for locally advanced cervical cancer.