For PA Hospital Cancer Services patients like Debra McKenzie, wearing a thermoplastic face mask during radiation therapy is often a stressful part of the cancer treatment journey.
“The mask itself is so firm you can’t take deep breaths…it feels like you can’t breathe,” says Debra.
“There is constriction. Until you get used to how it feels, it is hard to cope with. The actual physical feeling I experienced at first was akin to an anxiety attack. I’m not claustrophobic, but when I started treatment and put it on my face, my heart was going a million miles an hour.”
According to PA Hospital Occupational Therapist and mask anxiety researcher Dr Jodie Nixon (pictured), patients with head and neck cancer wear the thermoplastic mask to immobilise them so that the high dose radiation used to kill cancer cells and shrink tumours during therapy can be directed at the problem tissue only, a requirement that often leads to anxiety.
“Early studies on mask anxiety showed between 14 and 58 percent of patients experienced distress and claustrophobia related to mask use during radiotherapy which is something we also identified anecdotally at PA Hospital, so we took the time to research the issue further,” she said, explaining it had become the focus of her PhD.
"We have been working closely with patients over the last four years to determine strategies to help them manage anxiety during treatment."
Dr Nixon said as part of her research she interviewed 20 patients who were distressed about mask use to explore what their experiences were, what they were worried about, and techniques they were using to get through their treatment in an effort to identify common themes. From these 20 interviews and a further study that followed 35 patients and their experience, she found that patients were benefiting most from having the nurse, radiation and occupational therapists talk them through what was happening during treatment. They also benefited from relaxation strategies and acknowledgement that it was an unusual procedure.
As a result of the research, Dr Nixon said changes have been made to the way people with head and neck cancer having radiation therapy are supported during their treatment.
“All patients are now routinely screened for mask distress and given support from our Occupational Therapy, Nursing and Radiography staff to help get them through it. We also attempt to create a calming environment by playing relaxing music in treatment rooms, teaching patients visualisation and relaxation techniques, and giving patients the option to take anti-anxiety medication.”
From Ms McKenzie’s perspective, she said the support PA Hospital staff have provided since her treatment commenced last month has allowed her to stay the course of repeat radiation therapy sessions.
“All the staff have been wonderful. When they talk to me, they are very calm, and they ask me what will make it easier for me. They signpost what they are doing during treatment, so I’m not left wondering what is going on, and give lots of reassuring feedback. It may sound trivial but hearing positive affirmations like you’re doing really great actually helps a lot when you’re feeling vulnerable in the mask.”