The efficacy of an EMDR intervention for a cancer patient with intolerable anxiety undergoing radiotherapy
Description
Introduction
Treatments for Head and Neck cancer (H&N-C) are often complex and burdensome, involving a 6- to 7- week radiotherapy (RT) regimen that may be augmented by concurrent chemotherapy1. Receiving RT can cause discomfort and anxiety to patients2. A distinctive aspect of RT for H&N-C patients is the use of an immobilization device (mask). Prior to each treatment, a mask shaped to the patient's H&N is firmly fitted over the face and secured to the treatment bed to keep still and avoid movements. ‘Having to wear the shell’ has been nominated as one of the worst things about RT in H&N-C. Some patients define the mask as a “torture”, or described the feeling such as “being buried”. Sometimes the mask is so intolerable and distressing for the patient that can influence radiation therapists and oncologists’ work, leading to interruption of the RT sessions or worse, to treatment disruption3. In literature there is only one case report of a H&N-C patient with panic during RT successfully treated with a Cognitive Behavioral Intervention4. In our Department there is a Radiation Therapy Psycho-Oncology Service (RT-POSS) and a dedicated psychological ambulatory for H&N-C patients. We here describe a case of a H&N-C patient treated with EMDR for intolerable levels of anxiety during preparatory phases of RT.
The Case
A 73-years old male with laryngeal cancer referred for RT with curative intent. At the first computed tomography simulation (CTS), during the creation of the mask, the patient reported feeling intolerable anxiety which influenced at an extent that he was starting to think to refuse RT. The day of second CTS the patient contacted our RT-POSS to have psychological support. At the same time he consulted a psychiatrist and started venlafaxine and lorazepam. At first interview, distress was 9/10 (measured by Distress Thermometer) and anxiety was 20/21 and depression was 12/21 (measured by Hospital Anxiety and Depression Scale). We asked to indicate the level of intolerability when imaging wearing the mask by means of a Visual Analog Scale (VAS, from 0 to 10). The result was: 10, “extremely anxious”. The day after the patient started psycho-oncological consultations.
EMDR Protocol
We used EMDR protocol for oncology (stage 4: adjuvant therapy)5 but introducing specific elements for RT treatment, especially in the “safe place” Utilizing “safe place” to relax when mask is blocked on the face and during treatment execution and Installation of positive cognition phase: Focusing our attention on the curative characteristics and the importance of RT treatment for patient survival Activating patient’s resources in form of PC to undergo RT After only one session the patient reported VAS 2 and an improvement in distress and anxiety levels. He decided to resume the appointments scheduled, CTS were correctly performed and RT treatment was subsequently scheduled and completed for 35 consecutive days. In this case by using EMDR approach we allow patient to undergo RT quickly and serenely, avoiding delays and distress for the staff Department and, above all, for the patient.
Treatments for Head and Neck cancer (H&N-C) are often complex and burdensome, involving a 6- to 7- week radiotherapy (RT) regimen that may be augmented by concurrent chemotherapy1. Receiving RT can cause discomfort and anxiety to patients2. A distinctive aspect of RT for H&N-C patients is the use of an immobilization device (mask). Prior to each treatment, a mask shaped to the patient's H&N is firmly fitted over the face and secured to the treatment bed to keep still and avoid movements. ‘Having to wear the shell’ has been nominated as one of the worst things about RT in H&N-C. Some patients define the mask as a “torture”, or described the feeling such as “being buried”. Sometimes the mask is so intolerable and distressing for the patient that can influence radiation therapists and oncologists’ work, leading to interruption of the RT sessions or worse, to treatment disruption3. In literature there is only one case report of a H&N-C patient with panic during RT successfully treated with a Cognitive Behavioral Intervention4. In our Department there is a Radiation Therapy Psycho-Oncology Service (RT-POSS) and a dedicated psychological ambulatory for H&N-C patients. We here describe a case of a H&N-C patient treated with EMDR for intolerable levels of anxiety during preparatory phases of RT.
The Case
A 73-years old male with laryngeal cancer referred for RT with curative intent. At the first computed tomography simulation (CTS), during the creation of the mask, the patient reported feeling intolerable anxiety which influenced at an extent that he was starting to think to refuse RT. The day of second CTS the patient contacted our RT-POSS to have psychological support. At the same time he consulted a psychiatrist and started venlafaxine and lorazepam. At first interview, distress was 9/10 (measured by Distress Thermometer) and anxiety was 20/21 and depression was 12/21 (measured by Hospital Anxiety and Depression Scale). We asked to indicate the level of intolerability when imaging wearing the mask by means of a Visual Analog Scale (VAS, from 0 to 10). The result was: 10, “extremely anxious”. The day after the patient started psycho-oncological consultations.
EMDR Protocol
We used EMDR protocol for oncology (stage 4: adjuvant therapy)5 but introducing specific elements for RT treatment, especially in the “safe place” Utilizing “safe place” to relax when mask is blocked on the face and during treatment execution and Installation of positive cognition phase: Focusing our attention on the curative characteristics and the importance of RT treatment for patient survival Activating patient’s resources in form of PC to undergo RT After only one session the patient reported VAS 2 and an improvement in distress and anxiety levels. He decided to resume the appointments scheduled, CTS were correctly performed and RT treatment was subsequently scheduled and completed for 35 consecutive days. In this case by using EMDR approach we allow patient to undergo RT quickly and serenely, avoiding delays and distress for the staff Department and, above all, for the patient.
Format
Conference
Language
English
Original Work Citation
Dinapoli, L. (2018, June). The efficacy of an EMDR intervention for a cancer patient with intolerable anxiety undergoing radiotherapy. Poster presented at the 19th EMDR Europe Conference, Strasbourg, France
Citation
“The efficacy of an EMDR intervention for a cancer patient with intolerable anxiety undergoing radiotherapy,” Francine Shapiro Library, accessed May 7, 2024, https://francineshapirolibrary.omeka.net/items/show/25253.