Understanding Anxiety in Patients Receiving Vaginal Brachytherapy for Endometrial Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Vaginal brachytherapy (VBT) is standard adjuvant treatment after hysterectomy for a majority of women diagnosed with stage I endometrial cancer. Despite requiring only a few treatments with minimal toxicity, many women express significant anxiety regarding VBT. We sought to quantify and correlate patient's anxiety regarding VBT with demographic and clinicopathologic features to develop a future model to reduce treatment related anxiety. <h3>Materials/Methods</h3> With IRB approval, women ages 18-99 with stage I-II endometrial cancer, treated with VBT alone between 2014-2020 were surveyed. 185 women were identified excluding those with recurrent disease. Participants filled out surveys including: 1) a qualitative assessment of their experience with VBT and related anxiety/mood, 2) clinical factors survey identifying past medical history, 3) Hospital and Anxiety Depression Scale, 4) and demographics questionnaire. Pearson chi squared test was used to correlate presence of anxiety with demographics. <h3>Results</h3> Of the 75 women who completed all 4 surveys, 67% (n=50) reported fear or anxiety prior to receiving VBT and 11% considered not receiving treatment due to fear/anxiety. Of those, anxiety was related to pain in 62% (31), quality of life in 40% (20), bladder/bowel function in 38% (19) and sexual functioning in 16% (8), and other in 22% (11). 88% (44/50) who exhibited anxiety pre-treatment reported a reduction in anxiety post-treatment. 92% of patients were white. 69% were married and 9% never married. 24% were employed and 71% were retired or unemployed. 63% completed college or beyond and 37% had an annual income of >$80,000. 93% identify as heterosexual. 57% had stage IA, 33% IB, and 8% stage II. 53% reported previously taking medication for depression or anxiety. 20% had a HADS-Anxiety score ≥ 8, denoting anxiety. 83% were parous. Patients who completed higher education (≥ college degree) and women with higher income (>$80,000/year) were more likely to experience anxiety compared to women with less education (74% vs 48%, p=0.02) and less income (82% vs 54%, p=0.016). Additionally, women with a HADS-A score ≥ 8 were significantly more likely to experience anxiety (93% vs 58%, p=0.01). <h3>Conclusion</h3> Nearly 70% of women receiving VBT report treatment related anxiety, primarily related to fear of pain. Women who are more educated, receive a higher income, and have a higher HADS-A score are more likely to experience anxiety. This data will be incorporated into a prospective trial using an educational tool to address and mitigate this anxiety.