Background: Use of immobilisation masks during radiation therapy for head and neck cancer (HNC) is recognised to induce high levels of situational anxiety in many HNC patients. Radiation therapists (RTs) interact with patients daily and this places them in a unique position to recognise anxiety and provide appropriate support. However, concordance between RTs’ estimate of patient mask anxiety and patient’s actual experience is unknown.
Aims: We aimed to explore RTs’ ability to identify mask anxiety in participant’s undergoing radiation therapy to the head and neck region.
Methods: Adult participants with HNC commencing radiation therapy at Westmead and Blacktown hospitals provided consent and completed the State Trait Anxiety Inventory (STAI) tool before their mask making and CT planning session, and once a week before treatment. Their treating RTs independently rated their perception of the patient’s anxiety at each of these time points. Paired samples t-tests were conducted to examine concordance between patient and RT responses.
Results: 65 patients (83% male; Mean age= 62.02, SD= 12.10, range= 29-89 years) and 16 RTs participated (56% male, Mean age= 29.44, SD= 5.24, range= 21-40 years). Most patients received definitive treatment over 7 weeks; 24 received adjuvant treatment over 6 weeks and 10 received high dose palliative treatment over 4-5 weeks. Nearly half (43%) of patients reported clinical levels of anxiety (STAI>40) before their planning CT session, and ranged between 29% and 42% immediately before their weekly treatments. RTs significantly underestimated patients’ anxiety at 5 of the 7 weekly sessions (range CI 95% [1.33, 15.39], range p value= .000 and .008), by 4.94 to 10 points on average.
Conclusions: RTs consistently underestimated HNC patients’ state anxiety during radiation treatment. Interventions to improve RTs’ skills and resources to detect and support HNC patients are required in addition to improving other supports and skill development for patients.