Efficacy of an eye movement desensitization and reprocessing (EMDR) intervention for a head and neck cancer patient with intolerable anxiety undergoing radiotherapy

Radiotherapy (RT) is a mainstay of treatment for Head and Neck cancers (H&N-C), offered to nearly 75 percent of all H&N-C patients with either curative or palliative intent1. For many primary sites within the H&N, RT yields better functional outcomes than surgery and, thus, is often preferred for localized disease. For locoregionally advanced lesions, RT is often used in combination with chemotherapy as a definitive organ function-preserving approach, or after surgery as an adjuvant1. Pre-existing psychological morbidity in H&N-C patients is common, and often associated with higher than average alcohol and tobacco use, and high rates of clinically significant anxiety (15%)2. H&N-C patients experience psychological distress, even due to adverse impacts of treatment affecting everyday functioning (weight loss, alterations in eating/swallowing, difficulties with speaking/breathing, and facial disfigurement)2. RT delivery can increase discomfort and anxiety to patients2. Indeed, a distinctive feature of RT for H&N-C patients is the use of a restrictive device: a “mask” that is shaped to the patient's H&N, firmly fitted over the face and secured to the treatment couch to keep still and avoid movements (see figure). In some cases, the perception of mask intolerability is too distressing for the patient, sometimes leading to session interruption or treatment early completion, events that can lead to decreased RT efficacy. A recent study showed that mask anxiety impacted a quarter of H&N-C patients undergoing RT3. For all these reasons, appropriate psychological assistance should accompany H&N-C patients during such treatment. One psychotherapeutic option is Eye Movement Desensitization Reprocessing (EMDR) therapy, an integrative psychotherapy approach that has been extensively researched and proven effective for trauma treatment4. The model on which EMDR is based, Adaptive Information Processing, posits that much of psychopathology is due to the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. This impairs the ability to integrate these experiences in an adaptive manner. EMDR, via bilateral stimulation (BLS), facilitates the effective reprocessing of traumatic events or adverse life experiences and associated beliefs, to an adaptive resolution4. EMDR have been used in H&N-C client group to help patients to cope with this overwhelming medical diagnosis5 and in glioblastoma multiforme patients, a population especially prone to co-occurring anxiety6.

Journal

English

Loredana Dinapoli
Mariangela Massaccesi
Giuseppe Colloca
Angela Tenore
Nicola Dinapoli
Vincenzo Valentini

Dinapoli, L., Massaccesi, M., Colloca, G., Tenore, A., Dinapoli, N., & Valentina, V. (2019, January). Efficacy of an eye movement desensitization and reprocessing (EMDR) intervention for a head and neck cancer patient with intolerable anxiety undergoing radiotherapy. Psycho-oncology. doi:10.1002/pon.5000