Emotional Experiences of Skin Markings Among Patients Undergoing Radiotherapy and Related Factors: A Questionnaire-Based Cross-Sectional Study

Abstract

Purpose Patients undergoing radiotherapy often have their skin marked. Previous studies on skin markings examined the durability and physical effects of the markings, but no study has focused on patients’ emotional experiences toward the markings. This study aimed to clarify how patients undergoing radiotherapy feel about skin markings, as well as factors that affect patients’ emotional experiences. Patients and Methods We conducted a cross-sectional study using a self-administered questionnaire and medical records. Participants were patients aged ≥20 years undergoing cancer radiotherapy at a designated cancer care hospital. The primary outcome was the level of uncomfortable emotions toward skin markings, and the secondary outcome was the level of favorable ratings on skin markings. To examine factors related to uncomfortable emotions, ordinal logistic regression analysis was performed. Results Questionnaire forms were distributed to 153 patients, and responses were collected from 132 (86%). Among 108 patients included in the analysis, 56% (59/105, excluding 3 who did not answer this question) responded that they were uncomfortable with skin markings. The proportion of patients who favorably rated skin markings was 63% (59/93, excluding 15 who did not answer this question). No factors were significantly associated with the primary outcome. Conclusion Many patients accepted skin markings with resignation, as they understood the necessity of the markings in their treatment. Medical staff should understand the emotional experiences of patients toward skin markings and take sufficient care to ensure that they are provided with explanations, including the impact of skin markings on their daily lives, as well as a sense of security that treatment is being performed in a precise manner.

Clinical experience of a tattoo application device

“…It has been widely reported in literature that RT tattoos can be a cause of distress and anxiety to patients, particularly women receiving treatment for breast cancer [18] , [19] . Tattoos for breast cancer patients are generally located centrally on the mid-chest and on each side of the chest.…”

The association of adverse reactions and depression in cervical cancer patients treated with radiotherapy and/or chemotherapy: moderated mediation models

“…More specifically, among patients with low marital relations/high quality of life and high marital relations/high quality of life, the skin dryness and itching could directly and positively affect depression. Skin dryness and itching in patients with cervical cancer is mainly caused by inflammatory skin reactions caused by radiation exposure, which not only leads to changes in physical appearance and lowers patients’ self-esteem levels, but also significantly reduces patients’ quality of life and causes significant psychological burden ( Chu et al, 2021 ; Asada et al, 2022 ), with studies reporting insomnia in over 88% of patients with pruritic skin. Pruritic skin can significantly reduce patients’ quality of life, and with pruritic skin disease, patients are 1.4 times more likely to suffer from depressive mood or anxiety than those who do not ( Kopyciok et al, 2016 ; Huet et al, 2022 ).…”

Development of a phantom for assessing the precision of setup in skin mark‐less surface‐guided radiotherapy

“…It has been reported that more than half of patients show an uncomfortable with skin marks during radiotherapy. 6 Particularly for the treatment of breast cancer, it has been observed that many patients are averse to conventional skin marks and tattoos. 7 Consequently, several studies on the use of skin mark-less treatment using SGRT have been conducted, [8][9][10] taking into account the emotional discomfort experienced by the patients.…”