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Determinants and Timeline of Perioperative Anxiety in Mohs Surgery
Irèn Kossintseva1, David Zloty
1*Both authors are affiliated with the Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
Background:
Patients undergoing Mohs micrographic surgery (MMS) exhibit anxiety relating to cancer cure or the expected cosmetic outcome.
Objective:
To obtain quantitative measurements of perioperative cancer and cosmetic anxiety levels in first-time MMS patients. Parameters influencing anxiety and its natural course were assessed.
Methods:
Prospective, single-blinded, questionnaire study of 173 patients undergoing MMS of the face. Anxiety levels were assessed using a visual analog scale preoperatively and postoperatively over 6 months.
Results:
Mohs patients demonstrate a trend to greater or equal anxiety about cancer over cosmesis at all measured time points, but differences only reached statistical significance beginning 1 week postoperatively. Clinically relevant lowering of cancer anxiety levels is delayed until 3 months postoperatively. Cosmetic anxiety reaches a clinically relevant improvement by 1 week. The intuitive predictors of cosmetic anxiety, namely female gender and younger age, were quantitatively reinforced in this study. The predictor of cancer anxiety was the use of preoperative lorazepam.
Conclusion:
To maximize patient care, Mohs surgeons must be aware of covert patient anxieties and the parameters, which influence these anxieties. Identifying and anticipating the course of cancer- and cosmetic-related anxieties will reduce patient fears, improving their satisfaction with the MMS experience.
Insights
Patients undergoing Mohs surgery experience significant anxiety about cancer cure and cosmetic outcomes. Cancer anxiety takes longer to resolve than cosmetic anxiety, impacting patient satisfaction.
Area of Science:
- Dermatology
- Surgical Oncology
- Psychology
Background:
- Patients undergoing Mohs micrographic surgery (MMS) experience anxiety related to cancer cure and cosmetic outcomes.
- Understanding patient anxiety is crucial for optimizing care during MMS procedures.
Purpose of the Study:
- Quantify perioperative cancer and cosmetic anxiety in first-time MMS patients.
- Assess factors influencing anxiety and its progression over time.
Main Methods:
- Prospective, single-blinded questionnaire study involving 173 patients undergoing facial MMS.
- Anxiety levels measured using a visual analog scale preoperatively and up to 6 months postoperatively.
Main Results:
- Cancer anxiety was generally higher than cosmetic anxiety, reaching statistical significance 1 week postoperatively.
- Cancer anxiety reduction was clinically relevant at 3 months, while cosmetic anxiety improved by 1 week.
- Female gender and younger age predicted higher cosmetic anxiety; preoperative lorazepam use predicted higher cancer anxiety.
Conclusions:
- Mohs surgeons should recognize and address patient anxieties regarding cancer cure and cosmetic results.
- Anticipating and managing these anxieties can improve patient satisfaction with the MMS experience.
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