The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study
- 1 Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco
- 2 Epidemiology Division, Ministry of Health, Rabat, Morocco
- 3 Faculty of Medicine, Mohammed V University, Rabat, Morocco
- 4 Faculty of Medicine, Mohammed V University, Rabat, Morocco
- 5 Faculty of Medicine, Mohammed V University, Rabat, Morocco
- 6 Faculty of Medicine, Mohammed V University, Rabat, Morocco
- 7 Faculty of Medicine, Mohammed V University, Rabat, Morocco
- 8 Faculty of Medicine, Mohammed V University, Rabat, Morocco
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 < 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.
- Sung, H., Ferlay, J., Siegel, R.L., et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249. https://doi.org/10.3322/caac.21660
- Cibula, D., Pötter, R., Planchamp, F., et al. (2018) The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer. International Journal of Gynecological Cancer, 28, 641-655.
- So, W.K.W. and Chui, Y.Y. (2007) Women’s Experience of Internal Radiation Treatment for Uterine Cervical Cancer. Journal of Advanced Nursing, 60, 154-161. https://doi.org/10.1111/j.1365-2648.2007.04387.x
- Humphrey, P., Bennett, C. and Cramp, F. (2018) The Experiences of Women Receiving Brachytherapy for Cervical Cancer: A Systematic Literature Review. Radiography, 24, 396-403. https://doi.org/10.1016/j.radi.2018.06.002
- Viswanathan, A.N., Thomadsen, B. and American Brachytherapy Society Cervical Cancer Recommendations Committee (2012) American Brachytherapy Society Consensus Guidelines for Locally Advanced Carcinoma of the Cervix. Part 1: General Principles. Brachytherapy, 11, 33-46. https://doi.org/10.1016/j.brachy.2011.07.003
- Pötter, R., Haie-Meder, C., Van Limbergen, E., Briot, E., De Brabandere, M., Dimopoulos, J., et al. (2006) Recommendations from Gynaecological (GYN) GEC ESTRO Working Group (II): Concepts and Terms in 3D Image-Based Treatment Planning in Cervix Cancer Brachytherapyd-3D Dose Volume Parameters and Aspects of 3D Image-Based Anatomy, Radiation Physics, Radiobiology. Radiotherapy and Oncology, 78, 67-77. https://doi.org/10.1016/j.radonc.2004.12.015
- The Royal College of Radiologists (2009) Implementing Image-Guided Brachytherapy for Cervix Cancer in the UK. The Royal College of Radiologists, London.
- Rollison, B. and Strang, P. (1995) Pain, Nausea and Anxiety during Intra-Uterine Brachytherapy of Cervical Carcinomas. Support Care in Cancer, 3, 205-207. https://doi.org/10.1007/BF00368893
- Wiebe, E., Surry, K., Derrah, L., Murray, T., Hammond, A., Yaremko, B. and D’Souza, D. (2011) Pain and Symptom Assessment during Multiple Fractions of Gynecologic High-Dose-Rate Brachytherapy. Brachytherapy, 10, 352-356. https://doi.org/10.1016/j.brachy.2011.04.001
- Kwekkeboom, K.L., Dendaas, N.R., Straub, M. and Bradley, K.A. (2009) Patterns of Pain and Distress during High-Dose-Rate Intracavity Brachytherapy for Cervical Cancer. The Journal of Supportive Oncology, 7, 108-114.