Comparing Different Psychoeducational Interventions to Decrease Treatment Related Anxiety in Breast Cancer Patients Undergoing Radiotherapy

Abstract

To determine the effect of different psychoeducational interventions on reducing treatment related anxiety in breast cancer patients undergoing radiotherapy. Ninety-eight women were randomly assigned, in order of accrual, to one of three groups. Arm A watched an informative DVD explaining the complete treatment process prior to simulation. Arm B received a personal explanation about the treatment plan prior to the first treatment from a medical physicist, and Arm C (control) received no extra intervention. All patients filled out validated stress and anxiety questionnaires (STAI-Y, distress thermometer) at four time points: after the first physician appointment, after simulation, after first treatment, and at the end of the treatment course. Post-lumpectomy women ages 30-70 were eligible to participate in the study. Exclusion criteria were patients receiving chemotherapy and patients with known depression or anxiety disorders. Patient mean age was 56±10 (range 34-77). There were 33, 31, and 34 subjects for groups A, B, and C, respectively. The initial STAI-Y and distress thermometer results showed no significant differences between the three groups, as expected. Differences between study groups were analyzed using Analysis of Variance (ANOVA) model, and we used least square analysis for multiple comparisons. All tests were two-tailed, and a p value <0.05 was considered statistically significant. After the first treatment the thermometer distress score for Arm B (explanation from a medical physicist) was highly statistically significantly lower compared to both Arms A, (p<0.0043) (informative DVD) and C (p<0.0051). There was no difference between the control arm (C) and the DVD group (B) at this point, indicating that watching a DVD before simulation did not allay patients’ fear or distress. There were no significant differences between arms in the STAI scores. After the last treatment there was again no significant difference between study arms. However, within each group there was a significant reduction in distress thermometer scores from the first to the last treatment. A personal explanation by a medical physicist was highly effective in reducing pre-treatment anxiety, although over the course of treatment all women’s anxiety lessened significantly. This probably indicates that over time, through familiarity with both the treatment process and staff, patients’ distress gradually lessens. Our results indicate that there is an important role for medical physicists in routine patient care. After the initial explanation, patients continued to interact with the physicist as they met in the department during treatment, and we believe and that this personal connection is important in improving the overall patient treatment experience and in helping alleviate treatment related anxiety and distress.