Purpose/Objectives: Purpose: To investigate the psychological consequences of high dose rate brachytherapy (BT) with two fractions in one application under spinal/epidural anesthesia in the treatment of locally advanced cervical cancer. Primary objective: To evaluate patients' traumatization in association with this BT procedure, in particular the incidence of acute and posttraumatic stress disorder (ASD/PTSD) with symptoms of intrusion, avoidance and hyperarousal.
Secondary objectives: to evaluate the physical and psychological functioning before, during and after treatment; to identify pre-treatment risk factors for the development of PTSD symptoms and to assess qualitatively specific helpful experiences and stressful factors during the brachytherapy procedure.
Material/Methods: In 50 patients with locally advanced cervical cancer, validated questionnaires were used for prospective assessment of ASD/PTSD (IES-R), anxiety/depression (HADS-D), quality of life (EORTC-QLQ-C30+CX24), physical functioning (WHO performance status) and pain (VAS); prior to and during treatment, one week and three months after treatment. Qualitative patients' interviews were recorded in open format for content analysis.
Results: ASD occurred in 30% of patients one week, PTSD in 41% three months after treatment in association with this specific BT procedure.
The time being bedbound between fractions was reported in 61% of patients to be stressful. Several impairments in physical and psychological functioning were found prior to, during and after treatment with different pattern of progress over time. Patients at risk for PTSD can be predicted pre-treatment with 82% accuracy. Helpful experiences were the support of the treatment team, psychological support and a positive attitude. Stressful factors were pain, organizational problems during treatment and immobility between brachytherapy fractions.
Conclusions: The specific BT procedure, as performed in the investigated mono-institutional setting with 2 fractions in one application under spinal/epidural anesthesia, bears a considerable risk of traumatization.
The source of stress seems to be not the BT application itself, but the maintenance of the applicator under epidural anesthesia in the time between fractions. The results of physical and psychological functioning over time support a comprehensive counseling of patients in order to organize their professional and social life. Patients at risk for the development of PTSD may be identified prior to treatment in order to offer targeted psycho-social support. The patients' open reports regarding helpful experiences are an encouraging feedback for the treatment team; the reported stressful factors serve as basis for improvement of patient management, especially regarding pain control.