Background: Head and neck cancer (HNC) patients commonly undergo radiation therapy (RT) requiring thermoplastic mask immobilisation which some find distressing.
Aims: To evaluate mask induced anxiety and distress from patient and health professional (HP) perspectives.
Methods: Semi-structured interviews were conducted with previously treated HNC patients recruited via multiple hospitals and social media. Interviews continued until data saturation with three further interviews conducted for member-checking purposes. Qualitative methodology with thematic analysis identified themes in the data. Semi-structured interviews were conducted with HPs involved in HNC care, including radiation oncologists, radiation therapists, nurses, and psychologists, from 9 hospitals in NSW, Australia. Framework analysis methods were used. A subsequent prospective study aimed to document the trajectory of situational anxiety during HNC treatment delivery and explore radiation therapists' ability to identify it. HNC patients completed the state-trait anxiety inventory at simulation and weekly during RT immediately before and after treatment delivery. Treating RTs independently rated their own perception of their patient's anxiety at the same time points.
Results: Patient experiences of the mask were diverse. They made cognitive appraisals of the mask and their coping abilities throughout treatment, resulting in varied levels of mask-related distress. HPs felt mask anxiety was a significant problem but easily missed. Prospective data revealed situational anxiety is indeed prevalent with 43% of patients recording clinically significant anxiety before their mask-making session. Between 30% and 43% (across time points) experienced same immediately before treatments. RTs did not reliably capture this.
Conclusion: Mask anxiety is a real and complex problem that requires a multidisciplinary approach to reduce patient distress and improve their treatment experience. Future research is required to evaluate interventions to prepare and support people with HNC, develop novel technologies to explore alternative and embed evidence-based approaches to screening and managing distress into health services.