Author(s)

Kenza Benali^1,2*, Mohammed Adnane Tazi³, Gael Kietga^1,2, Tayeb Kebdani^1,2, Khalid Hassouni^1,2, Sanaa El Majjaoui^1,2, Hanan El Kacemi^1,2, Noureddine Benjaafar^1,2

¹Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.
²Faculty of Medicine, Mohammed V University, Rabat, Morocco.
³Epidemiology Division, Ministry of Health, Rabat, Morocco.

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 < 0.001). Bed-rest restriction applicator in situ (4.42 ± 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.

Cervical Cancer, Brachytherapy, High-Dose Rate, Pain, Anxiety

Benali, K. , Tazi, M. , Kietga, G. , Kebdani, T. , Hassouni, K. , Majjaoui, S. , Kacemi, H. and Benjaafar, N. (2022) The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study. Journal of Cancer Therapy, 13, 405-416. doi: 10.4236/jct.2022.137035.