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The Assessment of Anxiety About Radiotherapy in Patient With Early Breast Cancer Receiving Breast Irradiation

2007; Elsevier BV; Volume: 69; Issue: 3 Linguagem: Inglês

10.1016/j.ijrobp.2007.07.1884

1879-355X

Hiromi Izawa, Kumiko Karasawa, Eri Kawase, Kana Ito, T. Takada, Hisako Hirowatari, T. Furuya, Chie Kurokawa, Naoki Horikawa,

Cancer survivorship and care

Purpose/Objective(s)Radiotherapy is considered to be associated with psychological distress. The purpose of this study was to obtain data on psychological distress, the types and grade of anxiety in early breast cancer patients receiving breast irradiation and to find the optimal patient supports.Materials/MethodsFrom April 2006 to February 2007, 89 patients (average age 51.1 ± 12.1 years old) receiving breast irradiation to the conserving breast in our department and who agreed on the study were requested to fill in the questionnaire about radiotherapy and of Hospital Anxiety and Depression Scale (HADS) before radiotherapy and after completion of radiotherapy. The questionnaire which had been developed from our studies about anxiety of radiotherapy consisted of 17 items, three subscales with high internal consistency and validity. All patients had received breast-conserving surgery for stage 0–II breast cancer, positive lymph nodes less than 3, no concurrent chemotherapy and planned to receive whole breast irradiation. We have two treatment schedules and the division of irradiated schedule was decided by the patient's free selection. The short course irradiation is consists of 43.2 Gy/16 f to the whole breast and additional tumor bed boost of 8.1 Gy/3 f in positive or less than 5 mm surgical margin cases. The conventional course irradiation is consists of 50 Gy/25 f to the whole breast and additional tumor bed boost of 10 Gy/5 f in positive or less than 5 mm surgical margin cases or 6 Gy/3 f in negative surgical margin cases which has been our standard care. All breast are irradiated with 4 MV photon, tangential fields using electric compensator.ResultsTo evaluate the differences between the scores before and after radiotherapy, we performed paired t-test with HADS total score, HADS-A (anxiety), HADS-D (depression), total score of the questionnaire about radiotherapy and average scores of the three subscales of the questionnaire. T values of HADS total score was 4.9, HADS-A was 5.9, HADS-D was 3.1, total score of the questionnaire about radiotherapy was 6.0, anxiety about adverse effect of radiotherapy was 6.3, anxiety about environment of radiotherapy was 4.2 and anxiety about treatment effect of radiotherapy was 4.8, and these were all statistically significant (p < 0.01). The scores of anxiety and depression were significantly lower after radiotherapy. To evaluate the affecting factors about anxiety before radiotherapy, student t-test, chi square test and Fisher's exact test were performed. The significant factors affecting the anxiety were total anxiety score and radiotherapy schedule (conventional vs short course) (X2(1) = 9.3, p < 0.05), anxiety about environment of radiotherapy and radiotherapy schedule (X2(1) = 4.8, p < 0.05). The patients who selected short course radiotherapy have significantly low score in anxiety about environment of radiotherapy.ConclusionsFrom the result of this study, we had better explain details about environment of radiotherapy using brochure and/or audio-visual materials especially to the conventional radiotherapy cases. Purpose/Objective(s)Radiotherapy is considered to be associated with psychological distress. The purpose of this study was to obtain data on psychological distress, the types and grade of anxiety in early breast cancer patients receiving breast irradiation and to find the optimal patient supports. Radiotherapy is considered to be associated with psychological distress. The purpose of this study was to obtain data on psychological distress, the types and grade of anxiety in early breast cancer patients receiving breast irradiation and to find the optimal patient supports. Materials/MethodsFrom April 2006 to February 2007, 89 patients (average age 51.1 ± 12.1 years old) receiving breast irradiation to the conserving breast in our department and who agreed on the study were requested to fill in the questionnaire about radiotherapy and of Hospital Anxiety and Depression Scale (HADS) before radiotherapy and after completion of radiotherapy. The questionnaire which had been developed from our studies about anxiety of radiotherapy consisted of 17 items, three subscales with high internal consistency and validity. All patients had received breast-conserving surgery for stage 0–II breast cancer, positive lymph nodes less than 3, no concurrent chemotherapy and planned to receive whole breast irradiation. We have two treatment schedules and the division of irradiated schedule was decided by the patient's free selection. The short course irradiation is consists of 43.2 Gy/16 f to the whole breast and additional tumor bed boost of 8.1 Gy/3 f in positive or less than 5 mm surgical margin cases. The conventional course irradiation is consists of 50 Gy/25 f to the whole breast and additional tumor bed boost of 10 Gy/5 f in positive or less than 5 mm surgical margin cases or 6 Gy/3 f in negative surgical margin cases which has been our standard care. All breast are irradiated with 4 MV photon, tangential fields using electric compensator. From April 2006 to February 2007, 89 patients (average age 51.1 ± 12.1 years old) receiving breast irradiation to the conserving breast in our department and who agreed on the study were requested to fill in the questionnaire about radiotherapy and of Hospital Anxiety and Depression Scale (HADS) before radiotherapy and after completion of radiotherapy. The questionnaire which had been developed from our studies about anxiety of radiotherapy consisted of 17 items, three subscales with high internal consistency and validity. All patients had received breast-conserving surgery for stage 0–II breast cancer, positive lymph nodes less than 3, no concurrent chemotherapy and planned to receive whole breast irradiation. We have two treatment schedules and the division of irradiated schedule was decided by the patient's free selection. The short course irradiation is consists of 43.2 Gy/16 f to the whole breast and additional tumor bed boost of 8.1 Gy/3 f in positive or less than 5 mm surgical margin cases. The conventional course irradiation is consists of 50 Gy/25 f to the whole breast and additional tumor bed boost of 10 Gy/5 f in positive or less than 5 mm surgical margin cases or 6 Gy/3 f in negative surgical margin cases which has been our standard care. All breast are irradiated with 4 MV photon, tangential fields using electric compensator. ResultsTo evaluate the differences between the scores before and after radiotherapy, we performed paired t-test with HADS total score, HADS-A (anxiety), HADS-D (depression), total score of the questionnaire about radiotherapy and average scores of the three subscales of the questionnaire. T values of HADS total score was 4.9, HADS-A was 5.9, HADS-D was 3.1, total score of the questionnaire about radiotherapy was 6.0, anxiety about adverse effect of radiotherapy was 6.3, anxiety about environment of radiotherapy was 4.2 and anxiety about treatment effect of radiotherapy was 4.8, and these were all statistically significant (p < 0.01). The scores of anxiety and depression were significantly lower after radiotherapy. To evaluate the affecting factors about anxiety before radiotherapy, student t-test, chi square test and Fisher's exact test were performed. The significant factors affecting the anxiety were total anxiety score and radiotherapy schedule (conventional vs short course) (X2(1) = 9.3, p < 0.05), anxiety about environment of radiotherapy and radiotherapy schedule (X2(1) = 4.8, p < 0.05). The patients who selected short course radiotherapy have significantly low score in anxiety about environment of radiotherapy. To evaluate the differences between the scores before and after radiotherapy, we performed paired t-test with HADS total score, HADS-A (anxiety), HADS-D (depression), total score of the questionnaire about radiotherapy and average scores of the three subscales of the questionnaire. T values of HADS total score was 4.9, HADS-A was 5.9, HADS-D was 3.1, total score of the questionnaire about radiotherapy was 6.0, anxiety about adverse effect of radiotherapy was 6.3, anxiety about environment of radiotherapy was 4.2 and anxiety about treatment effect of radiotherapy was 4.8, and these were all statistically significant (p < 0.01). The scores of anxiety and depression were significantly lower after radiotherapy. To evaluate the affecting factors about anxiety before radiotherapy, student t-test, chi square test and Fisher's exact test were performed. The significant factors affecting the anxiety were total anxiety score and radiotherapy schedule (conventional vs short course) (X2(1) = 9.3, p < 0.05), anxiety about environment of radiotherapy and radiotherapy schedule (X2(1) = 4.8, p < 0.05). The patients who selected short course radiotherapy have significantly low score in anxiety about environment of radiotherapy. ConclusionsFrom the result of this study, we had better explain details about environment of radiotherapy using brochure and/or audio-visual materials especially to the conventional radiotherapy cases. From the result of this study, we had better explain details about environment of radiotherapy using brochure and/or audio-visual materials especially to the conventional radiotherapy cases.