Prevalence of anxiety in people with head and neck cancer undergoing radiotherapy mask fabrication: a cross-sectional study using the STAI Y-6
Daniel Sapkaroski, Nigel Anderson, Karla Gough, Lachlan McDowAbstract
Introduction:
Radiotherapy for head and neck cancer (HNC) requires a thermoplastic immobilisation mask, which can heighten anxiety, yet this remains poorly recognised and inconsistently measured. Virtual reality (VR)-based rehearsal has been proposed as a preparatory strategy, but patient receptivity is unknown. This study examined the prevalence of state anxiety at mask fabrication, the practicality of administering the six-item State-Trait Anxiety Inventory (STAI Y-6) in a busy pre-treatment workflow and patient interest in VR-based preparation.
Methods:
In this cross-sectional study, 39 consecutively recruited adults with HNC at a tertiary cancer centre completed a 10-item questionnaire before their first CT simulation: the STAI Y-6 plus four study-specific items covering mask-specific anxiety, general treatment anxiety and interest in a guided VR rehearsal of the procedure. Associations between STAI Y-6 caseness and supplementary items were assessed using Monte Carlo-simulated chi-squared tests.
Results:
Recruitment was 93% (39/42), completion 100% and median completion time 3.6 minutes. The mean pro-rated STAI Y-6 score was 43.3 (SD 14.1, range 20–77). Seventeen participants (44%, 95% CI 29–59%) scored ≥41, the threshold for clinically meaningful state anxiety. Participants with elevated anxiety more often reported at least some mask-specific anxiety (71% vs 32%; p = 0.025) and more often expressed uncertainty about VR (p = 0.027).
Conclusions:
Nearly half of participants reported clinically meaningful anxiety at mask fabrication, and the STAI Y-6 was quick and acceptable to administer. Larger, multi-site studies with repeated assessment are needed to confirm prevalence and test targeted preparation such as VR.