‘Having the mask on didn't worry me until … they clamped my head down so I wouldn't move’: A qualitative study exploring anxiety in patients with head and neck cancer during radiation therapy

Abstract

IntroductionMore than 20% of patients undergoing radiation therapy for head and neck cancer report anxiety specifically related to the immobilisation mask, a tight‐fighting mask patients are required to wear for the duration of each treatment session. However, limited research has investigated this from the patient perspective. The aim of this study was to better understand patient experiences of mask anxiety during head and neck cancer radiation therapy and to explore patient attitudes toward potential strategies that may reduce mask anxiety during this treatment.MethodsFive patients with head and neck cancer, who had self‐reported mask anxiety during radiation therapy, participated in semi‐structured, qualitative interviews exploring their experiences of anxiety and suggestions for reducing anxiety. A codebook thematic analysis was conducted.ResultsSix main themes were identified: (1) triggers of anxiety; (2) adjusting to radiation therapy; (3) education about the mask; (4) coping; (5) motivation and (6) improving the patient experience.ConclusionFindings from these interviews provide valuable insight into how and when healthcare providers may be able to assist patients to manage mask anxiety. Recommendations include increased communication from health care providers; delivery of visual information to improve patient preparedness; exposure/opportunities to interact with the masks prior to treatment commencing and increased control of music/soundtrack selection. However, a limitation of this study is the small sample size and further research is warranted.

Mask‐related anxiety and distress during radiation therapy for head and neck cancer

“…A key finding of Forbes et al 5 . is lack of information about and preparation for use of the mask, consistent with other qualitative studies in this population 2,4 .…”

“…Recognising the, sometimes, high levels of anxiety and the variable trajectory of anxiety experienced by people with HNC during their RT there has been a growing body of evidence describing the patient experience using a range of research methodologies. [1][2][3][4] Forbes et al 5 report on a small qualitative exploration of patient experience of the immobilisation mask and strategies to address anxiety. Five patients who self-reported mask anxiety during treatment participated in semi-structured interviews.…”

“…The six main themes discussed included: triggers of anxiety; adjusting to radiation therapy; education about the mask; coping; motivation and improving the patient experience. Recommendations made by Forbes et al 5 include increased communication from health professionals, delivery of visual information opportunity to interact with masks prior to treatment, and providing patients with the opportunity to control music played in the room. In this editorial, we further consider how we can support patients to reduce their mask-related anxiety and distress.…”

Situational anxiety in head and neck cancer: Rates, patterns and clinical management interventions in a regional cancer setting

“…While patients do receive education about the procedure, many patients report not feeling adequately prepared for what it entails. 26 Additionally, as the presession surveys were completed in the waiting room prior to the SIM appointment, participants were yet to receive the standard RT education (explanation of the procedure and images of the mask or other equipment) that is provided immediately before the SIM session. Thus, their anxiety rating may have been lower prior to the appointment.…”

“…It is possible that some (possibly many) participants were unaware of the nature of the mask‐making procedure at the time of data collection prior to SIM. While patients do receive education about the procedure, many patients report not feeling adequately prepared for what it entails 26 . Additionally, as the pre‐session surveys were completed in the waiting room prior to the SIM appointment, participants were yet to receive the standard RT education (explanation of the procedure and images of the mask or other equipment) that is provided immediately before the SIM session.…”