This study offers some preliminary insights into the prevalence of patient anxiety severe enough to cause session disruption and patient self-report measures which might be used to flag patients for prophylactic treatment. Further development and replication in a larger sample is warranted before introduction of these measures into routine practice.

Purpose: The purpose of this study is to identify the incidence of anxiety and distress among patients requiring immobilization during radiation therapy to the head and neck region; then to compare this with radiation therapists' ability to identify anxiety in the same group of patients.Materials and methods: Data from a sample of 70 patients requiring an immobilization mask participated in this study. Patient self-report assessments and radiation therapists' ratings were recorded at two time points, CT-Simulation and fraction 1 of treatment. Self-reported patient anxiety was assessed with the Brief Symptom Inventory-18. To determine radiation therapists' ratings of patient anxiety, two rating scales were developed.Results: Patient self-report identified anxiety in 16% and 14% of patients at CT Simulation and fraction 1 of treatment, respectively. Radiation therapists identified anxiety in 24% patients at time point one and in 44% of patients at time point two.Conclusion: There was slight agreement between patient self-reported levels of anxiety and radiation therapists' ratings of patient anxiety. This study suggests that there is scope for further investigation into the identification and management of anxiety and distress in head and neck cancer patients requiring immobilization.

IntroductionProcedural anxiety relates to an affective state of anxiety or fear in relation to a medical procedure. Various treatment-related factors may elicit anxiety among oncology patients, including fear of diagnostic imaging (such as MRI scans) and impending treatment and medical procedures (such as chemotherapy and radiotherapy). It is common in oncology settings to manage acute anxiety relating to medical procedures with anxiolytic medication. However, pharmacological approaches are not suitable for many patients. Despite this, non-pharmacological interventions are infrequently used. The aim of this systematic review is to determine whether non-pharmacological interventions delivered prior to, or during, radiotherapy are effective in reducing procedural anxiety.Methods and analysisData sources will include the bibliographic databases CINAHL, MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled trials (CENTRAL) (from inception onward). Eligible studies will include adult patients with cancer undergoing radiotherapy treatment. Included studies will be those which employ a non-pharmacological intervention, delivered within existing radiotherapy appointments, with the aim of reducing procedural anxiety related to radiotherapy. All research designs with a control or other comparison group will be included. The primary outcome will be change in levels of self-reported procedural anxiety. Secondary outcomes will be changes in scores on physiological measures of anxiety and/or changes in treatment completion and/or changes in treatment duration and/or changes in psychological distress. Two investigators will independently complete title and abstract screening, full-text screening, data extraction and assessment of methodological quality. If appropriate, a meta-analyses will be performed. Any important amendments to this protocol will be updated in the PROSPERO registration and documented in the resulting review publication.Ethics and disseminationNo ethical issues are anticipated from this review. The findings will be disseminated through peer-reviewed publication and at conferences by presentation.Systematic review registrationCRD42019112941.

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