The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study

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.

Clinical study of analgesia in brachytherapy for cervical cancer

“…In a systematic review, nine out of ten studies on psychological problems reported that brachytherapy caused anxiety and pain in most women, 17 pain easily induced anxiety and depression in patients, and all patients who received brachytherapy in our study had different levels of anxiety and depression. The study of pain and anxiety levels in patients during brachytherapy for cervical cancer in Morocco conducted by Kenza and Benali found that up to 25% and 64% of patients experienced moderate and severe anxiety and pain, respectively 18 . Before brachytherapy, 85% (17/20) of the patients reported anxiety and depression according to Rollison et al.…”