Predictors of Anxiolytic Requirement During Radiation Therapy With Thermoplastic Mask Immobilization.

PURPOSE/OBJECTIVE(S) Anxiety during radiation simulation and/or treatments is common in cancer patients and is frequently treated with anxiolytic medications. Specifically, mask anxiety has been documented in patients requiring a thermoplastic mask for immobilization and has the potential to disrupt the safety and efficacy of treatments. We sought to identify factors that predict for anxiolytic requirement (AR) during mask immobilization. MATERIALS/METHODS Patients who received radiation therapy with a thermoplastic mask covering their entire face (including eyes, nose, and mouth) at a single institution from 2019-2020 were identified and charts were retrospectively reviewed. The use of anxiolytic medications during simulation/treatments, possible predictive factors, and absolute number and percentage of missed treatment days were recorded. If patients underwent multiple radiation treatments, only the first was evaluated. Factors analyzed include gender, spoken language, ECOG performance status, smoking history, past psychiatric history (anxiety, depression, panic attacks, dementia, alcohol abuse, claustrophobia, or post-traumatic stress disorder), previous use of anxiety-related medications, treatment site, mask type, treatment modality, and dexamethasone use. Regression analysis using a generalized linear model was used to create predictive models for AR and for missed radiation treatments. RESULTS A total of 250 patients were evaluated, of whom 124 were female and 126 were male. Median age was 63 years and median ECOG performance status was 1. Thirty-nine percent of patients had a history of anxiety, 4% of claustrophobia, 30% of depression, and 41% were previously prescribed at least one outpatient anxiety-related medication. Thirty patients (12%) required an anxiolytic medication during radiation simulation and/or treatments and 67 patients (27%) missed at least one planned treatment fraction. On multivariate analysis, history of anxiety (P = 0.0002, OR = 5.6) and claustrophobia (P = 0.003, OR = 7.7) were independently predictive of AR. Additionally, AR and head and neck treatment site were independently predictive of percentage of missed radiation fractions (P < 0.01) and AR and IMRT were independently predictive of absolute missed radiation fractions (P < 0.01). CONCLUSION History of anxiety and claustrophobia were independently predictive of AR during radiation simulation/treatments with a thermoplastic mask. These factors can be detected in patient charts prior to consultation and therefore have the potential to allow for early identification of individuals who may be at higher risk for anxiety during their radiation experience. Furthermore, patients who required anxiolytics during radiation therapy tended to miss more treatment days, possibly indicating that optimal anxiety management has not yet been achieved.