Abstract
Management of gynecologic brachytherapy(BT) procedural pain or discomfort varies across institutions. Data suggest women experience symptoms of acute stress disorder and post-traumatic stress disorder (PTSD), as high as 30-41%, following BT with spinal/epidural anesthesia (AS)1. We sought to determine the prevalence of post-BT PTSD in our locally advanced cervical cancer (LACC) patients and differences based on the type of AS.
We queried an IRB-approved institutional database for eligible women who received HDR-BT for LACC (intracavitary(IC), interstitial(IS), or hybrid intracavitary/interstitial(IC/IS)) from 1/1/2015 to 9/30/2021. Eligibility also included age >= 18 years old, ability to hear and speak well enough to complete the questionnaires in English, and no prior cancer history. Contact was attempted for each eligible patient. Enrolled patients completed two validated questionnaires by phone: 1) Impact of Event Scale-Revised, and 2) EORTC QLQ-CX24. Open commentary was offered. We utilized the Impact Event Scale-Revised with the replacement of the word “event” with “brachytherapy” to assess PTSD symptoms as published by Kirchheiner et al.1 A cutoff score above 33 was chosen to represent probable PTSD.2 Scores ranging from 24-32 were considered probable partial PTSD.3
56 patients met eligibility, and 21 patients aged 30-69 years old enrolled. Reasons for non-enrollment included disinterest, no working phone number, and inability to contact despite multiple attempts. FIGO stage ranged from 1B1-IVA. Five patients identified as Black or African American, 6 Hispanic, 2 Asian, 14 unknown or unavailable race, 9 unknown or unavailable ethnicity. The mean time since treatment was 3.27 years (1.5-6). 17 women were treated for intact CC. 4 patients were treated postoperatively. 9 patients were treated with IC applicators for intact CC, and 5 were treated with IC/IS applicators. 3 patients were treated with an IS implant for intact CC. 12 women were treated for intact CC with oral narcotics and anxiolytics, while 2 women were treated with conscious sedation (SD). 3 patients treated with an IS implant received general AS for implant placement. 4 patients treated with IC BT postoperatively received no SD or AS. The mean Impact of Event Scale score was 16.62 (0-73). 3 women had scores above 33, qualifying for a probable diagnosis of PTSD. 3 women had scores ranging from 24-32, suggesting partial PTSD. 6 women in total had scores above 24, equating to a partial to full PTSD symptom rate of 28.6% (95%CI: 11.3%, 52.2%). Small sample size precluded an analysis of SD technique and its association with PTSD. Open commentary of the BT highlighted the patient experience and emotional state (Table 1).
Partial to full PTSD symptoms were present in 28.6% of women treated with HDR-BT for LACC. Challenges included loss to follow-up, successful contact, and recall bias given the retrospective approach. Further prospective study into the relationship between HDR gynecologic BT SD practices and PTSD is warranted.References: 1.doi:10.1016/j.ijrobp.2014.02.0182.doi:10.1016/j.brat.2003.07.0103.doi: 10.1007/978-0-387-70990-1_10