title: The experience of pain and anxiety in rectal cancer patients during high-dose-rate brachytherapy.
abstract: BACKGROUND
  Pain and anxiety have been reported as primary concerns for patients with head-and-neck, gynecologic, and prostate cancers undergoing high dose rate (hdr) brachytherapy. However, almost no research has been published on the degree to which these symptoms are experienced by rectal cancer patients undergoing hdr brachytherapy. We conducted a pilot study examining the experiences of rectal cancer patients during hdr brachytherapy, specifically the intensity and trajectory of their anxiety and pain.
  
  
  METHODS
  Rectal cancer patients (n = 25) who received hdr brachytherapy treatment at a hospital in Montreal, Quebec, completed verbal analog scales for pain and anxiety at 4 time points over 4 treatment days.
  
  
  RESULTS
  On all 4 days, a subset of patients reported moderate-to-severe anxiety before applicator insertion. Pain increased significantly from the time patients were lying on the table to immediately after insertion of the applicator (p < 0.001). Insertion of the applicator appears to be the most painful part of the procedure, and although anxiety declined to below baseline after applicator removal, pain remained somewhat elevated. Some patients required conscious sedation; however, reports of moderate-to-severe pain were more frequent from patients who received pain medications than from patients who did not receive such medication (p < 0.05).
  
  
  CONCLUSIONS
  Most patients with rectal cancer tolerated hdr rectal brachytherapy well, although the procedure is stressful and painful for some. Insertion of the applicator was found to be the point of maximal pain, and medication was not always completely successful at alleviating the pain, suggesting that additional psychosocial interventions might be needed, with particular emphasis on the time of applicator insertion.
authors: Louise-Granofsky Psychosocial Oncology Program, Segal Cancer Centre, and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC.
authors: S
authors: S
authors: Néron
authors: Psychology Department, McGill University, and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC.
authors: S
authors: S
authors: Perez
authors: Segal Cancer Centre, Jewish General Hospital, Montreal, QC.
authors: R
authors: R
authors: Benc
authors: Segal Cancer Centre, Jewish General Hospital, Montreal, QC.
authors: A
authors: A
authors: Bellman
authors: Louise-Granofsky Psychosocial Oncology Program, Segal Cancer Centre, and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC.
authors: Z
authors: Z
authors: Rosberger
authors: Segal Cancer Centre and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC.
authors: T
authors: T
authors: Vuong
keywords: Brachytherapy; anxiety; cancer treatment; patient experience; procedural pain; psycho-oncology; rectal cancer