Calming panic states in the Mould Room and beyond: A pilot complementary therapy head and neck cancer service

Effects of trauma history on cancer-related screening, diagnosis, and treatment

Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.

Occupational therapy for people with mask anxiety undergoing radiotherapy

INTRODUCTION

Up to one third of people with head and neck cancer undergoing radiation therapy experience mask anxiety. However, there is limited literature guiding the role of health professionals, including occupational therapists, in managing mask anxiety. This study aimed to explore the content of occupational therapy interactions with people who have identified mask anxiety.

METHODS

A cohort of 20 participants with identified mask anxiety engaged in semi-structured interviews with occupational therapists. Theoretical thematic analysis and the framework provided by the Canadian Model of Occupational Performance and Engagement (CMOP-E) were employed to explore the content of occupational therapy interactions with people experiencing mask anxiety.

RESULTS

Theoretical thematic analysis identified 13 relevant themes with 49 codes relating to the interaction between participants and occupational therapists. Analysis of these interactions identified the occupational therapy role to be holistic and multifaceted. The cognitive, affective, and institutional components of the CMOP-E were dominantly explored by the occupational therapists with participants. Occupation, spirituality, and the cultural environment were either not addressed or minimally discussed with participants.

CONCLUSION

The management of mask anxiety during radiation therapy is a novel area of practice for occupational therapists. The results of this study suggest that the occupational therapy profession explores a range of factors with the person undergoing radiation therapy with mask anxiety, and that the CMOP-E model can be used to guide these interactions. Future research is required to further define this role and its efficacy in managing mask anxiety.

Exploring head and neck cancer patients' experiences with radiation therapy immobilisation masks: A qualitative study

OBJECTIVE

Head and neck cancer (HNC) patients commonly undergo radiation therapy requiring immobilisation by a mask. Some find the mask distressing, and this can disrupt treatment sessions. This study aimed to explore the patient experience of immobilisation masks in the Australian and New Zealand (ANZ) context, to guide possible intervention.

METHODS

Semi-structured interviews were conducted with HNC patients who had completed radiation therapy, recruited via hospitals and social media. Interviews continued until data saturation; then, three further interviews were conducted for member-checking purposes. Qualitative methodology with thematic analysis was used to identify themes in the data.

RESULTS

Twenty HNC survivors participated in interviews, and seven themes were identified: information received by participants, potential predictors of mask anxiety, participant reactions to the mask, trajectories of mask anxiety, supportive behaviour and communication of health professionals, coping with the mask, and thoughts and feelings about the mask.

CONCLUSIONS

Participant experiences of the immobilisation mask were diverse. The findings fit with Lazarus and Folkman's (Stress, appraisal, and coping. New York, NY: Springer Pub. Co) transactional model of stress and coping, as participants appeared to make cognitive appraisals of the mask and their coping abilities throughout treatment, resulting in varied levels of mask-related distress. Complex intervention is recommended to reduce mask anxiety in HNC patients across ANZ.

Working out of the 'tool box': an exploratory study with complementary therapists in acute cancer care

AIMS

The aim of this research was to explore and capture complementary therapists' experiences of and preparation for working with patients in an acute cancer care setting.

METHOD

Semi structured interviews with therapists (n = 18) in an acute cancer hospital in the North West of England. The interviews were transcribed and analysed using thematic coding.

RESULTS

Key themes identified included; the need for a 'tool box' of skills that develop beyond those taught in initial training, building confidence when adapting these new skills in practice, helping patients to become empowered, the need to support carers, research evidence and resources issues, and the role of supervision.

CONCLUSION

This study was limited by being set in a single acute cancer site. Therapists valued having a 'tool box' but needed confidence and support to navigate the challenges of clinical practice.

Reducing patient distress: a model for dementia care

More than 750000 people in the UK have some form of dementia; with a rise expected over the next 25 years. With early diagnosis of cancer, more patients with dementia will attend for cancer treatment. Immobilisation masks, used to ensure accurate head and neck radiotherapy, may trigger panic in patients, even without prior mental health problems. This single case study reports on the care provided to a patient with dementia and his carer, his wife Betty, during cancer treatment. Bert was diagnosed with dementia 10 years prior to his cancer diagnosis. The use of sedation appeared to trigger confusion rather than facilitate procedures. Bert's case illustrates how an individualised contract of care could be developed to help maximise interactions, ensure ongoing consent and maintain dignity during difficult and challenging medical procedures.

'Needle with ease': rapid stress management techniques

For some patients, even looking at a needle is enough to make them feel anxious. Repeated cannulation for bloods and all other intravenous therapies, such as scans and chemotherapy treatment can become so frightening that they escalate to feeling overwhelmed and panicky. If this response persists without any intervention, it may eventually become a phobia (Choy et al, 2007). Four-hundred-thousand patients are treated at The Christie NHS Foundation Trust each year, with many receiving intravenous chemotherapy treatments. The 'CALM' service was initiated over 5 years ago to enable and support patients to achieve a calm state during procedural-related anxieties and panic. Thanks to recent funding from 'Walk the Walk' Breast Cancer Charity, the service has grown, enabling more patients to access the service. Increasing skill has led to development of training courses for health professionals. The training provides easy-to-learn skills, some of which are described here, that can be used to prevent and/or interrupt panic states triggered by medical procedures.