Schmerzmedizin (A) – Optimization of pain and distress management in locally advanced cervical cancer patients undergoing high-dose-rate brachytherapy

Introduction:

Image-guided high-dose-rate brachytherapy (HDR-BT) with two fractions in one application under spinal and epidural anaesthesia enables optimized and targeted radiation. HDR-BT has been successfully used for locally advanced cervical cancer (1). However, a previous study demonstrated that the brachytherapy in question was associated with a 30% incidence of acute stress disorder one week after treatment and 41% of posttraumatic stress disorder (PTSD) three months after treatment (2). This might be linked to psychological distress during the maintenance of the application. Stressful factors were pain, immobility between brachytherapy fractions and organizational problems during treatment.

Aim:

The aim of this descriptive study is to compare psychological and physical distress during maintenance of HDR-BT after treatment change to a historical data set.

Materials and methods:

For the present study, HDR-BT under spinal and epidural anaesthesia was changed to minimize stressful factors in therapy (additional i.v. analgosedation, shorter application time, intermediated care support). The data of the psychological distress questionnaires were compared to a historical data set.

Results:

57 questionnaires from 39 patients were compared with 50 questionnaires from a historical data set. The new treatment groups' median VAS (visual analogue scale) score of psychological distress was 0 (Range 0 – 6) and thus significant lower than the historical data (VAS median 8 (Range 1 – 10)) (p = 0.001). (Fig. 1) No habituation effect between the first and second application of the brachytherapy was detectable (p = 0.119).

Conclusion:

Psychological and physical distress during maintenance of HDR-BT was controlled by the new treatment procedure. There was a significant improvement in psychological distress after the introduction of new treatment guidelines. A decrease in distress can be taken as an indication of a decline in PTSD, but further research is needed.

Fig. 1

References:

[1] Pötter R et al. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 2011;100(1):116 – 23.

[2] Kirchheiner K et al. International journal of radiation oncology, biology, physics. 2014;89(2):260 – 7