Distress associated with radiotherapy for malignant disease: a quantitative analysis based on patients perceptions

Abstract

Summary Distress associated with attendance at a radiotherapy department was assessed in 80 consecutive patients. All patients were interviewed within 24h of their first fraction of radiotherapy; 31 patients were also interviewed at the end of treatment. The problem identified at first interview as causing the most distress was worry about the effects of disease and its treatment upon the patient's family. At second interview the dominant complaint was of not being allowed to wash. Psychological problems, including anxiety and sleep disturbances, caused more overall distress than did physical symptoms. The method used in this study for eliciting information on the side-effects of therapy is straightforward and has yielded data that are provocative and suggest interesting avenues for futher investigation.For nearly 100 years radiotherapy has been used in the treatment of malignant disease. Somewhat surprisingly there are very few quantitative data on the distress and toxicity experienced by patients treated with radiation therapy. The few studies so far published have used restricted lists of possible symptoms and have made little attempt to assess the relative severity of various symptoms (King et al., 1985; Court Brown, 1953).Informed choice for patients is increasingly important in oncology. In order to inform patients usefully about the relative risks and benefits of radiotherapy we need to be able to give them accurate information on the nature and types of side-effects they are likely to experience. Qualitative information is insufficient for balanced judgement; quantitative information is also necessary.We wished to devise a method for obtaining quantitative information on the distress experienced by patients attending for radiotherapy. Our aim was to use a technique that was simple, reproducible, comprehensive and which did not require specially trained staff for its administration. The technique devised by Coates et al. (1983) for the assessment of side-effects experienced by patients undergoing chemotherapy seemed to fulfil many of the above criteria. We have therefore applied an adapted form of their technique to an unselected series of patients treated with radiotherapy. Patients and methodsEighty consecutive patients being treated with radiotherapy were the subjects of this study. The only exclusions were patients being treated with single fractions of radiotherapy or patients being treated for HIV related malignant disease. A total of 85 patients were eligible during this study period, no patient declined to be interviewed but five patients were not interviewed at the appropriate time and were therefore excluded. Details on patients and treatment are summarised in Tables I and II. Only 20 patients in this study had metastatic disease. The study was carried out according to a written protocol and informed consent was obtained from all patients.The method used to obtain information from patients was adapted from that used from Coates et al. (1983) was written (for full list see Appendix). The list of...

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