Understanding anxiety in patients receiving vaginal brachytherapy for low-grade early-stage endometrial cancer

Vaginal brachytherapy (VBT) is a standard treatment after hysterectomy for early-stage endometrial cancer. Despite only requiring a few treatments with minimal toxicity, many women have significant anxiety regarding VBT. This study was to assess and quantify anxiety in early-stage endometrial cancer patients receiving VBT and to evaluate correlations with clinicopathologic and demographic variables.

A survey-based cohort study of patients ages 18-99 with stage I-II endometrioid endometrial cancer treated with adjuvant VBT after hysterectomy between 2014 and 2020 was performed to assess experience with VBT and related anxiety. Patients with recurrent disease were excluded. Assessments included: (1) qualitative questionnaire measuring anxiety and mood pre- and post-VBT, (2) clinical factors questionnaire measuring health status, (3) Hospital and Anxiety Depression Scale (HADS), and (4) demographics questionnaire. Pearson's chi-squared test was used to correlate demographics with anxiety.

About 185 patients met inclusion criteria and of those, 75 completed all 4 surveys. Forty-nine patients (65%) reported anxiety or fear prior to receiving VBT, related to concerns of pain (40%), quality of life (27%), bladder/bowel function (24%). On univariate analysis, patients with a college degree or higher, income of ≥ $80,000, and HADS-Anxiety ≥ 8 were significantly more likely to experience anxiety with X² values of 4.64 (p = 0.03), 5.79 (p = 0.02), and 6.49 (p = 0.01), respectively. Only income ≥ $80,000 approached significance on multivariable analysis (p = 0.07).

A majority of patients experience anxiety prior to treatment with adjuvant VBT. It is important to increase the general knowledge surrounding VBT and to establish educational tools to reduce VBT related anxiety and fear.