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    Psychological disorders, cognitive dysfunction and quality of life in nasopharyngeal carcinoma patients with radiation-induced brain injury. Tang Yamei,Luo Donghua,Rong Xiaoming,Shi Xiaolei,Peng Ying PloS one PURPOSE:To evaluate factors affecting psychology, cognitive function and quality of life (QOL) of nasopharyngeal carcinoma (NPC) patients with radiation-induced brain injury (RI). METHODS AND MATERIALS:46 recurrence-free NPC patients with RI and 46 matched control patients without RI were recruited in our study. Subjective and objective symptoms of RI were evaluated with the LENT/SOMA systems. Psychological assessment was measured with Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Montreal Cognitive Assessment (MoCA) was carried out in these patients for assessing their cognitive function. QOL was evaluated by means of WHOQOL BREF. RESULTS:Of the patients with RI, 39(84.8%) had depression and 40(87.0%) had anxiety. The patients with RI got higher scores both in SDS and SAS than those without RI (SDS, 63.48±8.11 vs. 58.67±7.52, p = 0.008; SAS, 67.36±10.41 vs. 60.34±9.76, p = 0.005). Score in MoCA of patients with RI was significantly lower than that of patients without RI (21.32±2.45 vs. 25.98±1.73, p<0.001). SAS was positive correlated with post-radiotherapy interval. Both SAS and SDS had a significantly positive correlation with the rank of SOMA, while MoCA had a significantly negative correlation with SOMA. Chemotherapy was a risk factor for cognitive dysfunction. In addition, patients with RI got significantly lower scores in physical health (16.50±11.05 vs. 35.02±10.43, p<0.001), psychological health (17.70±10.33 vs. 39.48±12.00, p<0.001) and social relationship (48.00±18.65 vs. 67.15±19.70, p<0.001) compared with those in patients without RI. Multiple linear regression analysis revealed that anxiety and cognitive impairment were significant predictors of global QOL. CONCLUSIONS:NPC patients with RI exhibit negative emotions, impaired cognitive function and QOL. The severity of clinical symptoms of RI plays an important role in both emotions and cognitive function. Anxiety and cognitive impairment are associated with decreased QOL. 10.1371/journal.pone.0036529
    Predicting social withdrawal, anxiety and depression symptoms in pediatric brain tumor survivors. Desjardins Leandra,Barrera Maru,Schulte Fiona,Chung Joanna,Cataudella Danielle,Janzen Laura,Bartels Ute,Downie Andrea Journal of psychosocial oncology OBJECTIVE:Pediatric brain tumor survivors (PBTSs) are at risk for impairments in social adjustment and psychological distress. This study investigated longitudinal associations between symptoms of social withdrawal and anxiety/depression in PBTS, as well as medical, demographic, and personal characteristics that may also influence reports of social withdrawal and anxiety/depression. METHOD:About 91 PBTS (51% male, mean age 11.21 years, off-treatment) participated. At baseline and 8 months follow-up, primary caregivers of PBTS completed measures of social withdrawal, anxiety, and depression symptoms. Medical information (e.g. tumor type and location, cranial irradiation therapy) and child personal characteristics (e.g. child's age and gender, executive function, social skills) were obtained at baseline. RESULTS:Baseline reports of depression symptoms and social skills predicted social withdrawal 8 months later. Social withdrawal at baseline predicted greater combined anxiety and depression symptoms 8 months later. Depression alone predicted greater anxiety symptoms at follow-up. Anxiety symptoms and poor global executive functioning predicted greater depression symptoms at follow-up. CONCLUSIONS:The social adjustment and psychological distress of PBTSs are interrelated and can influence each other across time. These findings support the importance of multifaceted interventions targeting both psychological distress and social adjustment, in order to support the optimal psychosocial adjustment of PBTSs. 10.1080/07347332.2018.1535531
    Effectiveness of an Interventional Package on the Level of Anxiety, Depression, and Fatigue among Patients with Cervical Cancer. Kaur Mandeep,Agnihotri Meenakshi,Das Karobi,Rai Bhavana,Ghai Sandhya Asia-Pacific journal of oncology nursing Objective:To evaluate the effectiveness of interventional package on the level of anxiety, depression, and fatigue. Methods:The study was conducted in room no. 5, first floor, B Block, Department of Radiotherapy, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh Quasi experimental pretest-posttest design was used in the study. A total of 60 patients receiving radiotherapy/chemotherapy were assigned in two groups of 30 each, through total enumeration sampling technique. The tools used for the study were Zung Anxiety Scale, Beck Depression inventory, and Fatigue Scale. The protocol used for the study includes the Jacobson's Progressive muscle relaxtion technique, counsling and home care techniques. Results:Sociodemographic variables and clinical profile of participants in both groups were comparable. Interventional package significantly reduces the anxiety, depression, and fatigue ( < 0.001 in 3 variables) in experimental group. Conclusions:Interventional package for patients with cervical cancer proved to be an effective modality in reducing the anxiety, depression, and fatigue. 10.4103/apjon.apjon_56_17
    Smoking, drinking, and depression: comorbidity in head and neck cancer patients undergoing radiotherapy. McCarter Kristen,Baker Amanda L,Britton Benjamin,Wolfenden Luke,Wratten Chris,Bauer Judith,Halpin Sean A,Carter Gregory,Beck Alison K,Leigh Lucy,Oldmeadow Christopher Cancer medicine We aimed to determine the prevalence and co-occurrence of tobacco smoking, alcohol consumption, and depressive symptoms among a sample of head and neck cancer (HNC) patients undergoing radiotherapy. A total of 307 HNC patients participated in a multi-site stepped-wedge randomized controlled trial (RCT) evaluating the effectiveness of a dietitian-delivered health behavior intervention in patients with HNC undergoing radiotherapy. During week one of radiotherapy patients completed measures of smoking, alcohol consumption, and level of depression. Approximately one-fifth (21%) of patients had two or more co-occurring problems: current smoking, hazardous alcohol use, and/or likely presence of a major depressive episode (MDE). Approximately one-third (34%) of the sample were current smokers, one-third (31%) were drinking hazardously and almost one-fifth (19%) had likely cases of depression. Comorbidity of smoking, hazardous alcohol use, and MDE is high in HNC patients, and interventions need to address this cluster of cancer risk factors. 10.1002/cam4.1497
    Explorative study on quality of life in relation to salivary secretion rate in patients with head and neck cancer treated with radiotherapy. Almståhl Annica,Alstad Torgny,Fagerberg-Mohlin Bodil,Carlén Anette,Finizia Caterina Head & neck BACKGROUND:Radiotherapy (RT) to the head and neck region often results in oral complications. In this explorative study, the pretreatment and posttreatment (6 months and 12 months) quality of life (QOL) was analyzed for patients with head and neck cancer. The associations between QOL and salivary secretion rates were analyzed. METHODS:In 29 patients (19 men and 10 women; mean age, 59 ± 8 years), the stimulated whole salivary secretion and buccal minor gland secretion were measured. The patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC-QLQ-C30) and Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-C30-H&N35) and the Hospital Anxiety and Depression Scale (HADS). RESULTS:One year after the completion of RT, patients with hyposalivation (≤0.7 mL/min) reported clinically meaningful, but not statistically significant differences, in cognitive functioning, insomnia, swallowing, social eating, dry mouth, sticky saliva, and use of painkillers. Statistically significant differences were found for emotional functioning, sticky saliva, and dyspnea (p < .05). Thirty-three percent of them had a HADS score suggesting anxiety problems, compared with 8% for those with whole stimulated salivary secretion rates >0.7 mL/min. CONCLUSION:RT in the head and neck region, also using intensity-modulated RT, is associated with many aspects of life, such as cognitive functioning, insomnia, dry mouth, and sticky saliva, especially for those with hyposalivation. 10.1002/hed.23964
    An investigation of anxiety about radiotherapy deploying the Radiotherapy Categorical Anxiety Scale. Shimotsu Sakie,Karasawa Kumiko,Kawase Eri,Ito Kana,Saito Anneyuko I,Izawa Hiromi,Horikawa Naoshi International journal of clinical oncology BACKGROUND:Radiotherapy is one of the major methods for treating cancer, but many patients undergoing radiotherapy have deep concerns about receiving radiation treatment. This problem is not generally appreciated and has not been adequately studied. METHODS:The objective of this investigation was to empirically investigate the anxieties that cancer patients feel towards radiotherapy by using questionnaires to classify and quantitatively measure their concerns. A preliminary interview to develop a questionnaire was carried out with 48 patients receiving radiotherapy to discover their anxieties about on-going treatments. Subsequently, a main study was performed using a questionnaire with 185 patients to classify their types of anxiety and to ascertain the reliability and validity of the responses. Confirmatory factor analysis was then carried out with a 17-item Radiotherapy Categorical Anxiety Scale. RESULTS:Three anxiety factors were abstracted by factor analysis: (1) adverse effects of radiotherapy, (2) environment of radiotherapy, and (3) treatment effects of radiotherapy. Reliability, content validity, and concurrent validity were obtained. The adequacy of the three-factor model of anxiety concerning radiotherapy was confirmed. CONCLUSION:A 17-item Radiotherapy Categorical Anxiety Scale was formulated to quantitatively measure the specific types of anxiety among cancer patients receiving radiotherapy. 10.1007/s10147-010-0088-z
    Depression in Choroidal Melanoma Patients Treated with Proton Beam Radiotherapy. Moschos Marilita M,Moustafa Giannis A,Lavaris Anastasios,Damaskos Christos,Laios Konstantinos,Karathanou Ekaterini,Ladas Dimitrios S,Asproudis Ioannis,Garmpis Nikolaos,Kalogeropoulos Christos Anticancer research AIM:To determine depression in patients with choroidal melanoma (CM) treated with proton beam radiotherapy. PATIENTS AND METHODS:This was a cross-sectional study including 50 patients with CM (50% males, mean age=49.88±6.34 years) and 46 age- and sex-matched healthy controls (52% males, mean age=48.60±8.05 years). Participants completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Self-Rating Depression Scale (SDS) questionnaires. RESULTS:There was a considerable difference in visual acuity as logarithm of the minimum angle of resolution (logMAR) between the patient and control groups (1.16±0.97 and 0.04±0.05 logMAR, respectively, p<0.0001). Both PHQ-9 and SDS scores differed significantly between the two groups (10.18±4.68 and 8.07±4.90, p=0.04; and 47.94±12.56 and 39.91±8.80, p=0.004, respectively). Scores appeared to be positively correlated with logMAR visual acuity (Spearman rho=0.700, p<0.0001 for PHQ-9; and 0.767, p<0.0001 for SDS), and they were also correlated to each other (Spearman rho=0.759, p<0.0001). CONCLUSION:Patients with CM having undergone proton beam therapy seem to be more depressed compared to a sample of healthy individuals, and the level of depression is correlated with their visual acuity. 10.21873/anticanres.12562
    Psychological distress (depression and anxiety) in people with head and neck cancers. Neilson Kate A,Pollard Annabel C,Boonzaier Ann M,Corry June,Castle David J,Mead Karen R,Gray Marcelle C L,Smith David I,Trauer Tom,Couper Jeremy W The Medical journal of Australia OBJECTIVE:To assess symptoms of depression and anxiety in patients with head and neck cancers (HNCs) before and after radiotherapy. DESIGN, PARTICIPANTS AND SETTING:Prospective observational study of 102 outpatients with HNCs at a tertiary cancer centre in Melbourne between 1 May 2008 and 30 May 2009. Eligibility criteria were a first-time diagnosis of HNC, age over 17 years, and agreement to undergo cancer treatment involving radiotherapy with curative intent. Data were collected before commencement of radiotherapy and again 3 weeks after completing treatment. MAIN OUTCOME MEASURES:Symptoms of depression and anxiety as assessed by the Hospital Anxiety and Depression Scale (HADS); physical and psychosocial aspects of quality of life as assessed by the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). RESULTS:Seventy-five participants completed pretreatment and posttreatment questionnaires. Mean depression scores increased significantly from before to after treatment, while anxiety scores decreased significantly over the same period. The prevalence of mild to severe depression was 15% before treatment and 31% after treatment. The prevalence of mild to severe symptoms of anxiety was 30% before treatment, reducing to 17% after treatment. Posttreatment depression was predicted by pretreatment depression and receiving chemotherapy. Posttreatment anxiety was predicted by pretreatment anxiety and male sex. CONCLUSIONS:These findings suggest that rates of depression in patients with HNCs increase after cancer treatment, with a third of patients experiencing clinically significant symptoms of depression after radiotherapy.
    Pilot randomised controlled trial of a radiation therapist-led educational intervention for breast cancer patients prior to commencing radiotherapy. Halkett G K B,O'Connor M,Aranda S,Jefford M,Shaw T,York D,Spry N,Taylor M,Schofield P Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:Although patients receive information prior to commencing radiotherapy, they often experience anxiety and distress. We conducted a pilot randomised controlled trial to determine whether a radiation therapist led psycho-educational intervention for breast cancer patients prior to radiotherapy is likely to be effective in reducing radiotherapy-related concerns, patient anxiety and depression. METHODS:The intervention comprised two face-to-face consultations with a radiation therapist (one prior to radiation planning and the other prior to treatment). Patients completed surveys at baseline, prior to treatment planning and on the first day of treatment. Outcome measures included the Hospital Anxiety and Depression Scale, Radiation Therapy Related Patient Concerns and Radiation Therapy Knowledge Scales. RESULTS:One hundred and twenty two patients completed baseline measures. Fifty-eight patients received usual care, and 64 received the intervention. After the first consultation, patient anxiety was significantly lower in the intervention group (p = 0.048), as were concerns about radiotherapy (p = 0.001). There were no differences between groups for depression. Patient knowledge for the intervention group was higher after the first consultation (p < 0.001). CONCLUSION:This intervention is likely to be effective in reducing patient anxiety and concerns and increasing knowledge. Future research is required to test this intervention with a larger population. 10.1007/s00520-013-1719-5
    Levels of Anxiety and Depression Before Palliative Reirradiation Are Comparable to Those Before First Palliative Radiotherapy. Nieder Carsten,Kämpe Thomas A Cureus INTRODUCTION:The purpose of this study was to evaluate whether or not patients scheduled for the reirradiation of a previously treated target volume report reduced levels of anxiety and depression, compared to patients receiving their first course of palliative radiotherapy, e.g., because they are familiar with the process of treatment planning and delivery. METHODS:A retrospective comparison of two groups of patients (37% reirradiated, overall 102 patients), which scored their symptoms before palliative radiotherapy with the Edmonton symptom assessment system (ESAS). RESULTS:The two groups differed significantly with regard to the incidence of bone metastases, which was higher in the reirradiation group. Mean anxiety and depression scores were not significantly different between the two groups. The same was true for the proportion of patients with symptom scores ≥4. Analyses limited to patients treated for bone metastases revealed no significant differences either. Survival was similar, too. CONCLUSION:The facts that similar ESAS scores of anxiety and depression were observed and that prognosis was comparable suggest that the magnitude of these symptoms might be associated with the presence of incurable cancer itself (or the related somatic symptom burden) rather than the setting in which palliative radiotherapy is performed. 10.7759/cureus.2519
    Frequency, clinical associations, and longitudinal course of major depressive disorder in adults with cerebral glioma. Rooney Alasdair G,McNamara Shanne,Mackinnon Mairi,Fraser Mary,Rampling Roy,Carson Alan,Grant Robin Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:There is a need for high-quality evidence regarding the frequency, independent clinical associations, and longitudinal course of depression in patients with cerebral glioma. PATIENTS AND METHODS:This was a twin-center, prospective, observational cohort study with 6-month follow-up. Consenting adults with a new diagnosis of cerebral glioma received the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to diagnose major depressive disorder (MDD). Interviews occurred shortly after the start of radiotherapy (T1), with follow-up interviews 3 months later (T2) and 6 months later (T3). Independent associations between MDD and clinical variables were analyzed using logistic regression. RESULTS:One hundred fifty-five patients participated. The frequency of MDD was 13.5% ± 5.4% at T1 (n = 155); 14.8% ± 6.7% at T2 (n = 108); and 6.8% ± 5.3% at T3 (n = 88). Overall, 32 individuals were diagnosed with MDD during the study period (20.6% ± 6.4%). Inter-rater diagnostic agreement for MDD was good (κ = 0.81; 95% CI, 0.60 to 1.00). Independent predictors of MDD were functional impairment (odds ratio, 3.9; 95% CI, 1.5 to 10.8) and a previous history of depression (odds ratio, 2.7; 95% CI, 0.99 to 7.3). MDD persisted for at least 3 months in half of the patients with adequate follow-up, but many depressed patients also dropped out of the study as a result of clinical deterioration. CONCLUSION:In this longitudinal study, one in five patients with glioma developed clinical depression in the 6 months after starting radiotherapy. Patients with functional impairment or previous depression were at higher risk. MDD often persisted for at least 3 months. Clinicians should seek and treat depression in adults with glioma. 10.1200/JCO.2011.34.8466
    Predictors of anxiety and depression in people with colorectal cancer. Gray Nicola M,Hall Susan J,Browne Susan,Johnston Marie,Lee Amanda J,Macleod Una,Mitchell Elizabeth D,Samuel Leslie,Campbell Neil C Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer BACKGROUND:People living with colorectal cancer are at risk of anxiety and depression. We investigated what factors were most highly associated with these. METHODS:Four hundred and ninety-six people with colorectal cancer completed the Hospital Anxiety and Depression Scale (HADS). Data on functioning, symptoms, illness perceptions and social difficulties were collected by questionnaire. Case-note-identified disease, treatment and co-morbidity data were recorded. Multiple logistic regression identified factors independently predictive of anxiety and depression caseness. RESULTS:Self-reported history of anxiety/depression predicted anxiety but not depression caseness. Depression caseness predicted anxiety caseness (p = 0.043), as did poorer self-reported cognitive functioning (p = 0.001), dyspnoea (p = 0.015) or diarrhoea (p = 0.021), reporting a high negative life and emotional impact (p < 0.001) and having difficulties with finance (p = 0.007). Having neo-adjuvant radiotherapy increased the odds of depression caseness (p = 0.007), as did poorer physical (p = 0.007), cognitive (p < 0.001) and social (p < 0.001) functioning, having constipation (p = 0.011), reporting a high negative life and emotional impact (p < 0.001), having difficulties with personal care (p = 0.022) and communicating with others (p = 0.014). CONCLUSION:Levels of anxiety caseness were similar to those of non-clinical samples, but depression caseness was higher, particularly in those who had received neo-adjuvant radiotherapy. Most factors associated with possible or probable depression may be modified with appropriate intervention. 10.1007/s00520-013-1963-8
    The frequency and cause of anxiety and depression amongst patients with malignant brain tumours between surgery and radiotherapy. Kilbride Lynn,Smith Graeme,Grant Robin Journal of neuro-oncology INTRODUCTION:Between surgery and radiotherapy patients with a malignant glioma may encounter a number of psychosocial issues that could invoke an anxious or depressive response. This study explored the frequency, severity and cause of anxiety and depression in patients with presumed malignant brain tumours in the period between their surgery and radiotherapy. METHODS:A prospective study of 51 patients used mixed methods to measure anxiety and depression at three time points; post surgery, three weeks post surgery and pre radiotherapy. Analysis was undertaken using statistical and content analysis of the Hospital Anxiety and Depression (HAD) scores and unstructured interviews respectively. RESULTS:Analysis of HAD scores indicated a heightened level of anxiety in patients pre radiotherapy. This anxiety is more prevalent in younger patients and is not related to the patients change in functional state. Five patients had a significant depression at one or more time points between surgery and radiotherapy. Four of the five patients who reported scores consistent with depression had past histories of depression. Content analysis of unstructured interviews indicated that the HAD scores underestimated the presence of anxiety and depression amongst this group of patients. CONCLUSION:Anxiety was more common in younger patients. Anxiety was slightly more frequent pre-radiotherapy. A past medical history of depression is a predictor of significant depression in the post-operative period. The HAD scale although useful is not an adequate measurement tool for detecting anxiety and depression amongst all patients and health care professionals should adopt other means to monitor for these signs and symptoms. 10.1007/s11060-007-9374-7
    Emotional state of patients in radiotherapy and how they deal with their disorder. Voigtmann Kristina,Köllner Volker,Einsle Franziska,Alheit Horst,Joraschky Peter,Herrmann Thomas Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] PURPOSE:The aim of the study was to record patients' symptoms of anxiety, depression and post-traumatic stress, as well as their subjective experience of illness, with different forms of radiotherapy and for different indications. The question is to be answered of whether more invasive techniques such as stereotactic radiotherapy involve greater stress or whether the psychological stress instead tends to be caused by the underlying disorder itself. PATIENTS AND METHODS:Questionnaires were given to 240 patients after conventional radiotherapy for a malignant underlying disorder, to 80 with a benign disorder, and to 67 patients following stereotactic radiotherapy. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to measure anxiety and depression; the Post-Traumatic Symptom Scale (PTSS-10) was used to measure symptoms related to post-traumatic stress disorder (PTSD), and there were questions about patients' subjective experience of radiotherapy. RESULTS:28% of all patients scored in the pathologic or borderline anxiety range; 26% were in the pathologic or borderline depression range. 22% of patients were above the diagnostic cutoff for the PTSS-10. No differences were evident between the three groups in terms of anxiety and stress-related symptoms. Women were significantly (p = 0.001) more severely affected by symptoms of PTSD and anxiety than men. No gender differences could be proven in terms of depression. In the HADS-D, patients with a benign underlying disorder had significantly (p < 0.05) lower depression values than the two other groups studied. CONCLUSION:Patients who had undergone stereotactic radiotherapy did not demonstrate higher values for anxiety, depression or PTS symptoms than patients treated with conventional radiotherapy. From the results submitted here it cannot be assumed that this form of treatment leads to an increased incidence of traumatic stress or even post-traumatic stress disorder (PTSD). All in all, it is the type of underlying disorder (malignant/benign), which affects the extent of psychological stress experienced by patients following radiotherapy. 10.1007/s00066-010-2109-2
    A cross-sectional study of agreement between the Hospital Anxiety and Depression Scale and patient- and radiation oncologist-reported single-item assessment of depression and anxiety. Mackenzie Lisa,Carey Mariko,Suzuki Eiji,Yoshimura Michio,Toi Masakazu,D'Este Catherine,Sanson-Fisher Rob Psycho-oncology OBJECTIVE:To describe among radiation oncology patients: (1) the proportion likely to be experiencing symptoms of depression and anxiety as identified by (a) the Hospital Anxiety and Depression Scale (HADS; standardised tool), (b) patient-reported single items (ultrashort tool), and (c) radiation oncologist-reported single items (clinician judgement); (2) preferences for being offered psychological support; and (3) agreement between single-item measures and the HADS. METHODS:Adult cancer patients (n = 152; consent rate 58%) receiving radiotherapy completed a touchscreen tablet survey assessing symptoms of anxiety and depression (HADS and a single-item tool) and support preferences. Each participant's treating radiation oncologist completed a survey assessing his or her perception of whether the patient was anxious or depressed. RESULTS:Prevalence estimates for likely depression (6.9-18%) and anxiety (17-33%) overlapped across the 3 measures. Overall, only 9.9% of patients (95% CI, 5.6%-16%) wanted to be offered psychological support. For depression, agreement between the HADS and ultrashort tool was fair (κ = 0.37, P < 0.0001); agreement between the HADS and clinician judgement was slight (κ = 0.14, P < 0.05). For anxiety, agreement between the HADS and clinician judgement was not significantly greater than chance alone (κ = 0.04, P = 0.33), and agreement between the HADS and ultrashort tool was moderate (κ = 0.49, P < 0.0001). CONCLUSIONS:These findings highlight the important role that oncology consultations play in interpreting assessment tool results and responding to individual patient's history and preferences for psychological support. 10.1002/pon.4736
    Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial. Wagner Lynne I,Pugh Stephanie L,Small William,Kirshner Jeffrey,Sidhu Kulbir,Bury Martin J,DeNittis Albert S,Alpert Tracy E,Tran Binh,Bloom Beatrice F,Mai Julie,Yeh Alexander,Sarma Kalika,Becker Mark,James Jennifer,Bruner Deborah Watkins Cancer BACKGROUND:Brief tools are needed to screen oncology outpatients for depressive symptoms. METHODS:Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL) (25-item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM-IV (SCID) mood disorder modules via telephone. RESULTS:Four hundred sixty-three patients from 35 community-based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty-two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ-9 ( > 9; AUC = 0.85). The NCCN-DT did not detect depression (AUC = 0.59). CONCLUSIONS:The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485-493. © 2016 American Cancer Society. 10.1002/cncr.29969
    Estimation of anxiety and depression in patients with early stage breast cancer before and after radiation therapy. Kawase Eri,Karasawa Kumiko,Shimotsu Sakie,Izawa Hiromi,Hirowatari Hisako,Saito Anneyuko I,Ito Kana,Horikawa Naoshi Breast cancer (Tokyo, Japan) BACKGROUND:Most previous studies about anxiety and depression in patients undergoing radiotherapy have only measured the quantity of general depression and anxiety and have not studied specific periods of involvement. The aim of this study was to assess anxiety and depression among early breast cancer patients, and the anxiety experienced immediately before and after radiotherapy. METHODS:Women who started radiotherapy for stage I or II breast cancer (n = 172) were asked to answer two questionnaires: the Hospital Anxiety and Depression Scale (HADS) and Radiotherapy Categorical Anxiety Scale immediately before and after radiation therapy. RESULTS:The results showed that the mean scores of anxiety and depression (HADS and Radiotherapy Categorical Anxiety Scale) decreased after radiotherapy. The mean score of depression (HAD-D) in the group receiving conventional radiotherapy was higher than in those receiving hypofractionated radiotherapy before and after radiotherapy. The mean scores of anxiety and depression (HADS) in the endocrine therapy group were lower than in the group without endocrine therapy before treatment. However, the scores after treatment of both groups were not significant. CONCLUSION:Some intervention may be needed to decrease the temporary anxiety and depression raised during radiotherapy for early stage breast cancer patients. This is especially so for patients who do not receive concurrent endocrine therapy and choose the conventional radiotherapy course. 10.1007/s12282-010-0220-y
    Impact of Health-Related Quality of Life and Prediagnosis Risk of Major Depressive Disorder on Treatment Choice for Stage I Lung Cancer. van Dams Ritchell,Grogan Tristan,Lee Percy,Punglia Rinaa,Raldow Ann JCO clinical cancer informatics PURPOSE:We hypothesized that prediagnosis depressive symptoms and patient-reported health-related quality of life (HRQOL) would be associated with treatment choice for stage I non-small-cell lung cancer (NSCLC). METHODS:Using the SEER and Medicare Health Outcomes Survey (SEER-MHOS)-linked data set, we identified patients age 65 years and older with stage I NSCLC diagnosed between 2004 and 2013 who completed the HOS 24 or fewer months before diagnosis. HRQOL was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Medical Outcomes Study Short Form-36 and the Veterans RAND 12-Item Health Survey instruments. Major depressive disorder (MDD) risk was derived from responses to HOS questions that screen for depressive symptoms. Associations with treatment choice were assessed with multivariable multinomial logistic regression while controlling for prespecified patient characteristics. RESULTS:We analyzed 515 evaluable patients, of whom 140 (27%) met criteria for risk of MDD. On univariable analysis, a higher proportion of patients who received radiotherapy (RT) versus surgery were at risk for MDD (34% 22%, respectively; = .011). On multivariable analysis, higher PCS and MCS scores were associated with a decreased likelihood of receiving RT compared with surgery (adjusted odds ratio per 10-point PCS increase, 0.60 [95% CI, 0.45 to 0.79; < .001]; adjusted odds ratio per 10-point MCS increase, 0.61 [95% CI 0.46 to 0.80; < .001]). CONCLUSION:Among older patients with stage I NSCLC, there was a significant association between those who self-reported lower HRQOL and receipt of RT. There was also a nonsignificant association in MDD risk and increased likelihood of RT receipt. Additional studies are warranted to examine the impact of pretreatment HRQOL and MDD risk on clinical decision making. 10.1200/CCI.19.00072
    Distress, anxiety and depression in patients with brain metastases before and after radiotherapy. Cordes Marie-Christine,Scherwath Angela,Ahmad Tahera,Cole Ansa Maer,Ernst Gundula,Oppitz Karina,Lanfermann Heinrich,Bremer Michael,Steinmann Diana BMC cancer BACKGROUND:Many patients with cancer suffer from distress, anxiety and depression. However, studies on patients with brain metastases are lacking. In this exploratory study we prospectively assessed distress, anxiety and depression in patients with brain metastases from different solid primary tumour treated with radiotherapy to the brain. METHODS:Patients were recruited between May 2008 and December 2010. Distress, anxiety and depression were subjectively evaluated before radiotherapy, 6 weeks, 3 months and 6 months after radiotherapy using the validated National Comprehensive Cancer Network Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). The treatment group consisted of adult patients (n = 67) with brain metastases who were treated with whole-brain radiotherapy (n = 40) or hypofractionated stereotactic radiotherapy (n = 27). The control group comprised of patients (n = 32) diagnosed with breast cancer without cranial involvement who received adjuvant whole breast radiotherapy. Forty-six patients (24 in the treatment group) completed the study after six months. RESULTS:Before radiotherapy, the treatment group experienced higher distress than the control group (p = 0.029). Using a cut-off ≥ 5, 70% of the treatment group were suffering from significant distress (66% of the control group). No significant time-by-group interaction on distress, anxiety and depression was observed. At all time points, a high proportion of patients reported psychological stress which featured more prominently than most of the somatic problems. Global distress correlated strongly with the Hospital Anxiety score before radiotherapy, but only moderately or weakly with both HADS scores after radiotherapy with the weakest association 6 months after radiotherapy. CONCLUSION:In conclusion, the course of distress, anxiety and depression does not differ significantly between patients with brain metastases and breast cancer patients without cranial involvement. This finding suggests that both groups need similar psychological support during their treatment. Both screening instruments should be used as they cover different facets of distress. 10.1186/1471-2407-14-731
    A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer. Neilson Kate,Pollard Annabel,Boonzaier Ann,Corry June,Castle David,Smith David,Trauer Tom,Couper Jeremy Psycho-oncology OBJECTIVE:The aim of the study was to assess symptoms of depression and anxiety in patients with head and neck cancer up to 18 months after radiotherapy. METHODS:Prospective observational study of consecutive head and neck outpatients was conducted at a tertiary cancer centre (n = 101). Eligibility included diagnosis of cancer in the head and neck region, where the patient agreed to radiotherapy with curative intent. Data were collected before commencement of radiotherapy and 3 weeks and 18 months after completion. Symptoms of depression and anxiety were assessed by the Hospital Anxiety and Depression Scale. Tumour/treatment-related physical symptoms were assessed using the 'Additional Concerns' subscale of the Functional Assessment of Chronic Illness Therapy for Head and Neck Cancer. RESULTS:The prevalence of identified probable cases of depression was 15% at baseline, increasing to 29% 3 weeks post-treatment, falling to 8% at 18-month follow-up. The number of probable cases of anxiety was 20% at baseline, 17% at 3 weeks post-treatment and 22% at 18-month follow-up. Depression scores significantly increased from baseline to 3 weeks post-treatment and decreased at 18-month follow-up. Variability in depression scores was accounted for by tumour/treatment-related physical symptoms. Anxiety scores significantly decreased between baseline and 3-week post-treatment and increased at 18-month follow-up. Younger age and more tumour/treatment-related physical symptoms predicted anxiety scores. CONCLUSIONS:The rates of depression in head and neck cancer patients increase following cancer treatment and are related to tumour/treatment-related physical symptoms. Anxiety levels are higher pre-treatment, lower immediately following cancer treatment but rise to near pre-treatment levels more than a year after completion of cancer treatment. 10.1002/pon.3228
    A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Kangas Maria,Milross Chris,Taylor Alan,Bryant Richard A Psycho-oncology OBJECTIVE:Head and neck cancer (HNC) patients have a high incidence of cancer-related posttraumatic stress disorder (PTSD) and other anxiety and depressive disorders. We report the results from the first pilot randomized controlled trial in which the efficacy of an early cognitive-behavioral therapy (CBT) program was compared with a non-directive supportive counseling (SC) intervention in reducing PTSD, general anxiety and depressive symptoms, and improving perceived quality of life in newly diagnosed, distressed HNC patients undergoing radiotherapy. PATIENTS AND METHODS:Thirty-five HNC patients (mean age=54.8 years; 80% males) with elevated levels of PTSD, depression or anxiety were randomized to seven individual sessions of a multi-modal CBT or non-directive SC, concurrent with patients' radiotherapy. The SC intervention provided non-directive counseling support. PTSD, anxiety and depressive symptoms (primary outcomes), and cancer-related appraisals and quality of life (secondary outcomes) were assessed pre-intervention (baseline), 1 month, 6 months and 12 months post-intervention by diagnostic clinical interviews and validated self-report questionnaires. RESULTS:The CBT and SC interventions were found to be equal in their effects in reducing PTSD and anxiety symptoms both in the short and longer term. However, up to 67% of patients in the CBT program no longer met clinical or sub-clinical PTSD, anxiety and/or depression by 12 months post-treatment compared with 25% of patients who received SC. CONCLUSION:Findings indicate that the early provision of psychotherapy has utility in reducing PTSD, anxiety and depressive symptoms, and preventing chronic psychopathology in distressed HNC patients. 10.1002/pon.3208
    Effect of one comprehensive education course to lower anxiety and depression among Chinese breast cancer patients during the postoperative radiotherapy period - one randomized clinical trial. Li Zhensheng,Geng Wenhui,Yin Junpu,Zhang Jun Radiation oncology (London, England) BACKGROUND:We investigated the effectiveness of one education course to lower the severity of anxiety and depression symptoms among breast cancer (BC) patients during radiotherapy (RT). METHODS:All 290 one-sided BC patients were evenly randomized into intervention or control arm. "Intervention" patient was additionally provided with one three-hour course on psychological stresses and management skills. Changes of anxiety and depression score and their 3-level severity category ('normal', 'borderline' and 'abnormal' scored 0-7, 8-10 and 11-21, respectively) from HADS questionnaire over RT were evaluated by multivariable linear and ordinal logistic regressions. RESULTS:Response rates were 94 and 100% by "intervention" and "control" arm, respectively. Means of score changes by "intervention" and "control" (n = 145) were + 0.59 (SD = 2.47) and + 0.11 (SD = 2.55) for anxiety and + 0.81 (SD = 2.81) and + 0.45 (SD = 2.77) for depression scores, respectively. 'Abnormal' anxiety and depression patients were 4.1 and 6.9% at baseline and 4.8 and 6.9% at end of RT at 'control' arm; those rates were 6.6 and 7.4%, and 8.8 and 10.3% at 'intervention' arm, respectively. Both changes on anxiety and depression measurements between two arms were all insignificant (p > 0.20). CONCLUSIONS:One education course did not reduce the score and severity of anxiety and depression symptoms over RT period. TRIAL REGISTRATION:Chinese Clinical Trial Registry #: ChiCTR-IIR-16008818 at www.chictr.org.cn . 10.1186/s13014-018-1054-6
    A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy. Hernández Blázquez Manuel,Cruzado Juan Antonio Journal of psychosomatic research BACKGROUND:The aim of this study is to evaluate the presence of anxiety, depressive and adjustment disorders, suicide ideation, and symptoms of anxiety and depression in patients with cancer before (T1), and after radiotherapy (T2) and at the 1-month follow-up (T3). METHODS:A longitudinal study on 103 patients with cancer treated as outpatients undergoing radiotherapy was carried out, evaluating them three times (T1-T2-T3) according to DSM-IV criteria with the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale. RESULTS:Prevalence of the depressive disorders was: T1=6.8%, T2=3.9% and T3=3.9%; for anxiety disorders: T1=16.5%, T2=18.4% and T3=16.5%; for adjustment disorder: 10.7%, 5.8% and 7.8%; and for suicide ideation: T1=11.7%, T2=7.8% and T3=7.8%. In all, the presence of disorders was: T1=35%, T2=26.2%0.4% and T3=29.1%. At least one mental disorder was diagnosed in 46.6% of patients in one of the three times of the study. In relation to the symptoms, the prevalence of the possible cases of clinical anxiety was: T1=35.9%, T2=18.4% and T3=22.3%; the prevalence of possible cases of clinical depression was 19.4%, 16.5% and 10.7%, respectively; and the prevalence of emotional distress was 27.2%, 17.5% and 18.4%, respectively. All symptoms decreased significantly from T1 to T2 and from T1 to T3, with moderate effect sizes. No changes were observed between the end of the radiotherapy and the follow-up period. CONCLUSIONS:High prevalence of mental disorders and symptoms of anxiety, depression and distress were observed in the patients with cancer before finishing radiotherapy treatment and during the follow-up. FUNDING:Basurto University Hospital and Basque Foundation for Innovation and Research in Health-BIOEF. 10.1016/j.jpsychores.2016.05.010
    Do patients with brain metastases selected for whole brain radiotherapy have worse baseline quality of life as compared to those for radiosurgery or neurosurgery (with or without whole brain radiotherapy)? Chow Ronald,Tsao May,Pulenzas Natalie,Zhang Liying,Sahgal Arjun,Cella David,Soliman Hany,Danjoux Cyril,DeAngelis Carlo,Vuong Sherlyn,Chow Edward Annals of palliative medicine BACKGROUND:The purpose was to examine the baseline characteristics, symptoms and quality of life (QOL) in patients who receive different treatments for brain metastases. METHODS:Eligible patients were divided and analysed based on their treatment: whole brain radiotherapy (WBRT) alone versus stereotactic radiosurgery (SRS) or neurosurgery with or without WBRT. The Functional Assessment of Cancer Therapy-Brain (FACT-Br) items were grouped according to different domains for summary scores. The domains used for summary scores were physical, social/family, emotional, functional well-being (FWB) and additional concerns. RESULTS:A total of 120 patients were enrolled, with 37 treated with WBRT alone and 83 with SRS or neurosurgery with or without WBRT. Of the 50 baseline FACT-Br items, only five items (I feel ill; I get support from my friends; I worry about dying; I have difficulty expressing my thoughts, I am able to put my thoughts into action) were statistically worse in patients treated with WBRT alone (P<0.05). Patients who received SRS or surgery with or without WBRT had statistically (P<0.05) higher scores for the FWB domain, additional concerns domain, and FACT-G total scores, indicating better QOL. CONCLUSIONS:Patients selected for WBRT alone reported statistically different baseline QOL as compared to patients who were treated with SRS or neurosurgery (with or without WBRT). 10.3978/j.issn.2224-5820.2015.11.01
    The Effects of Attention Problems on Psychosocial Functioning in Childhood Brain Tumor Survivors: A 2-Year Postcraniospinal Irradiation Follow-up. Oh Yunhye,Seo Hyunjung,Sung Ki Woong,Joung Yoo Sook Journal of pediatric hematology/oncology OBJECTIVE:To examine the psychosocial outcomes and impact of attention problems in survivors of pediatric brain tumor. STUDY DESIGN:The survivors' cognitive functioning was measured using the Wechsler Intelligence Scale for Children. The Child Behavior Checklist-Attention Problems scale was used to screen for attention problems, and participants were classified as having attention problems (n=15) or normal attention (n=36). Psychosocial functioning was examined with the Korean Personality Rating scale for Children (K-PRC) at precraniospinal radiation and at 2-year follow-up. RESULTS:The attention problem group showed significantly higher depression and externalizing symptoms (delinquency, hyperactivity) and more significant impairment in family relationships than did the normal attention group at baseline. At follow-up, the attention problem group demonstrated significantly more delinquency and impaired family and social relationships. With the K-PRC scores, except for the somatization, social relationship subscale, there were significant differences between groups, but not in terms of treatment by time interaction or within time. At follow-up, multiple linear regressions showed that age at diagnosis significantly predicted K-PRC somatization (B=-1.7, P=0.004) and social relationships (B=-1.7, P=0.004), baseline full-scale intelligence quotient predicted K-PRC depression (B=-0.4, P=0.032) and somatization (B=-0.3, P=0.015), and attention problems at baseline predicted K-PRC depression (B=-15.2, P=0.036) and social relationships (B=-11.6, P=0.016). CONCLUSION:Pediatric brain tumor survivors, in particular, patients with attention problems, had worse psychosocial functioning at baseline and follow-up. Attention problems at baseline need to be carefully evaluated in assessing psychosocial functioning of pediatric brain tumor survivors. 10.1097/MPH.0000000000000766
    Lithium protects hippocampal progenitors, cognitive performance and hypothalamus-pituitary function after irradiation to the juvenile rat brain. Zhou Kai,Xie Cuicui,Wickström Malin,Dolga Amalia M,Zhang Yaodong,Li Tao,Xu Yiran,Culmsee Carsten,Kogner Per,Zhu Changlian,Blomgren Klas Oncotarget Cranial radiotherapy in children typically causes delayed and progressive cognitive dysfunction and there is no effective preventive strategy for radiation-induced cognitive impairments. Here we show that lithium treatment reduced irradiation-induced progenitor cell death in the subgranular zone of the hippocampus, and subsequently ameliorated irradiation-reduced neurogenesis and astrogenesis in the juvenile rat brain. Irradiation-induced memory impairment, motor hyperactivity and anxiety-like behaviour were normalized by lithium treatment. Late-onset irradiation-induced hypopituitarism was prevented by lithium treatment. Additionally, lithium appeared relatively toxic to multiple cultured tumour cell lines, and did not improve viability of radiated DAOY cells in vitro. In summary, our findings demonstrate that lithium can be safely administered to prevent both short- and long-term injury to the juvenile brain caused by ionizing radiation. 10.18632/oncotarget.16292
    Hippocampal dysfunction during the chronic phase following a single exposure to cranial irradiation. Son Yeonghoon,Yang Miyoung,Kim Joong-Sun,Kim Juhwan,Kim Sung-Ho,Kim Jong-Choon,Shin Taekyun,Wang Hongbing,Jo Sung-Kee,Jung Uhee,Moon Changjong Experimental neurology Ionizing radiation can significantly affect brain functioning in adults. The present study assessed depression-like behaviors in adult C57BL/6 mice using the tail suspension test (TST) at 30 and 90days following a single cranial exposure to γ-rays (0, 1, or 10Gy) to evaluate hippocampus-related behavioral dysfunction during the chronic phase following cranial irradiation. Additionally, hippocampal neurogenesis, inflammatory cytokines, inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), brain-derived neurotrophic factor (BDNF), and glial cell line-derived neurotrophic factor (GDNF) were analyzed. At 30 and 90days following irradiation with 10Gy, mice displayed significant depression-like behaviors. We observed a persistent decrease in the number of cells positive for doublecortin, an immunohistochemical marker for neurogenesis, in the hippocampus from 1 to 90days after irradiation with 10Gy. Changes in the mRNA expression of inflammatory cytokines, including interleukin (IL)-1β, tumor necrosis factor-α, IL-6, and interferon-γ, were not correlated with the decrease in hippocampal neurogenesis or the appearance of depression-like behavior during the chronic phase following irradiation. However, at 30 and 90days after irradiation with 10Gy, the number of microglia was significantly decreased compared with age-matched sham-irradiated controls. The reduction in the chronic phase was consistent with the significant down-regulation in the mRNA expression of iNOS, COX-2, BDNF, and GDNF in the hippocampus. Therefore, hippocampal dysfunction during the chronic phase following cranial irradiation may be associated with decreases in the neurogenesis- and synaptic plasticity-related signals, concomitant with microglial reduction in the hippocampus. 10.1016/j.expneurol.2014.01.018
    Neuroinflammatory and cognitive consequences of combined radiation and immunotherapy in a novel preclinical model. McGinnis Gwendolyn J,Friedman David,Young Kristina H,Torres Eileen Ruth S,Thomas Charles R,Gough Michael J,Raber Jacob Oncotarget BACKGROUND:Cancer patients often report behavioral and cognitive changes following cancer treatment. These effects can be seen in patients who have not yet received treatment or have received only peripheral (non-brain) irradiation. Novel treatments combining radiotherapy (RT) and immunotherapy (IT) demonstrate remarkable efficacy with respect to tumor outcomes by enhancing the proinflammatory environment in the tumor. However, a proinflammatory environment in the brain mediates cognitive impairments in other neurological disorders and may affect brain function in cancer patients receiving these novel treatments. Currently, gaps exist as to whether these treatments impact the brain in individuals with or without tumors and with regard to the underlying mechanisms. RESULTS:Combined treatment with precision RT and checkpoint inhibitor IT achieved control of tumor growth. However, BALB/c mice receiving combined treatment demonstrated changes in measures of anxiety levels, regardless of tumor status. C57BL/6J mice with tumors demonstrated increased anxiety, except following combined treatment. Object recognition memory was impaired in C57BL/6J mice without tumors following combined treatment. All mice with tumors showed impaired object recognition, except those treated with RT alone. Mice with tumors demonstrated impaired amygdala-dependent cued fear memory, while maintaining hippocampus-dependent context fear memory. These behavioral alterations and cognitive impairments were accompanied by increased microglial activation in mice receiving immunotherapy alone or combined with RT. Finally, based on tumor status, there were significant changes in proinflammatory cytokines (IFN-γ, IL-6, IL-5, IL-2, IL-10) and a growth factor (FGF-basic). MATERIALS AND METHODS:Here we test the hypothesis that IT combined with peripheral RT have detrimental behavioral and cognitive effects as a result of an enhanced proinflammatory environment in the brain. BALB/c mice with or without injected hind flank CT26 colorectal carcinoma or C57BL/6J mice with or without Lewis Lung carcinoma were used for all experiments. Checkpoint inhibitor IT, using an anti-CTLA-4 antibody, and precision CT-guided peripheral RT alone and combined were used to closely model clinical treatment. We assessed behavioral and cognitive performance and investigated the immune environment using immunohistochemistry and multiplex assays to analyze proinflammatory mediators. CONCLUSIONS:Although combined treatment achieved tumor growth control, it affected the brain and induced changes in measures of anxiety, cognitive impairments, and neuroinflammation. 10.18632/oncotarget.13551
    Hippocampal dysfunctions caused by cranial irradiation: a review of the experimental evidence. Son Yeonghoon,Yang Miyoung,Wang Hongbing,Moon Changjong Brain, behavior, and immunity Cranial irradiation (IR) is commonly used for the treatment of brain tumors but may cause disastrous brain injury, especially in the hippocampus, which has important cognition and emotional regulation functions. Several preclinical studies have investigated the mechanisms associated with cranial IR-induced hippocampal dysfunction such as memory defects and depression-like behavior. However, current research on hippocampal dysfunction and its associated mechanisms, with the ultimate goal of overcoming the side effects of cranial radiation therapy in the hippocampus, is still very much in progress. This article reviews several in vivo studies on the possible mechanisms of radiation-induced hippocampal dysfunction, which may be associated with hippocampal neurogenesis, neurotrophin and neuroinflammation. Thus, this review may be helpful to gain new mechanistic insights into hippocampal dysfunction following cranial IR and provide effective strategies for potential therapeutic approaches for cancer patients receiving radiation therapy. 10.1016/j.bbi.2015.01.007
    Fluoxetine reverses brain radiation and temozolomide-induced anxiety and spatial learning and memory defect in mice. Gan Huaiyong,Zhang Qiong,Zhu Bo,Wu Shiwu,Chai Damin Journal of neurophysiology Radiation therapy and concomitant temozolomide chemotherapy are commonly used in treatment of brain tumors, but they may also result in behavioral impairments such as anxiety and cognitive deficit. The present study sought to investigate the effect of fluoxetine on the behavioral impairments caused by radiation and temozolomide treatment. C57BL/6J mice were subjected to a single cranial radiation followed by 6-wk cyclic temozolomide administration and were then treated with chronic administration of fluoxetine. Behavioral tests were carried out to determine the anxiety-like behavior and cognition function of these animals. Long-term potentiation (LTP) in the hippocampus was measured by electrophysiology, and neurogenesis in the dentate gyrus was evaluated by immunohistochemistry. Mice treated with radiation and temozolomide showed increased anxiety-like behavior and cognitive impairment, along with LTP impairment and neurogenesis deficit. Chronic fluoxetine administration could reverse the behavioral dysfunction, enhance LTP, and increase neurogenesis in the hippocampus. NEW & NOTEWORTHY Mice treated with radiation and temozolomide showed increased anxiety-like behavior and cognitive impairment. Chronic fluoxetine administration could reverse the behavioral dysfunction. The effect of fluoxetine might be via rescuing the neurogenesis deficit caused by radiation and temozolomide treatment. 10.1152/jn.00581.2018
    COMPARATIVE CHARACTERISTIC OF «ALCOHOL DEPRESSION» IN PERSONS WHO PARTICIPATED IN COMBAT OPERATIONS (COMBATANS) AND AFFECTED BY RADIATION CATASTROP. Napryeyenko O K,Loganovsky K M,Napryeyenko N Yu,Loganovskaja T K,Gresko M V,Zdanevich N A Problemy radiatsiinoi medytsyny ta radiobiolohii The relevance of work is conditioned by the considerable prevalence of depressive disorders and alcohol abuseamong people who participated in combat operations (combatants) and affected by a radiation emergency, whichneeds to be optimized for providing them with a comprehensive social, psychological-psychiatric, medication andsomato-neurological help on the basis of a biopsychosocial paradigm.The objective of the study was to increase the level of medical care to combatants of the Antiterrorist Operation /Joint Forces Operation (ATO/JFO) and person affected by the catastrophe at the Chornobyl NPP (ChNPP) with depres-sion associated with alcohol abuse through theoretical substantiation, development and implementation in theinstitutions of public health and other agencies involved of new principles and algorithms for diagnosis, treatmentand prevention.The object and methods of the study were 160 ATO/JFO combatants from the age of 22 to 56 years old (M ± SD:(41.5 ± 16.5) years) with alcohol and depressive disorders the main group. The comparison groups included 81Chornobyl catastrophe clean-up workers (liquidators) with post-traumatic stress disorder and comorbid chroniccerebrovascular pathology, as well as other contingents affected by the Chornobyl catastrophe. Clinical-anamnestic,socio-demographic, clinical psychopathological, psychodiagnostic, neurophysiological and neuroimaging methodswere used. Somato-neurological clinical examinations and laboratory tests have been applied. The analysis of thedata was performed using MS Excel spreadsheets and statistical package Statistica 10.0 (StatSoft) with the Studentt-criterion, paired t-test, criterion χ2, and Fisher exact test.The study design of the main group consisted of 5 stages: 1) screening; 2) inclusion; 3) randomization; 4) treat-ment and 5) catamnestic (follow-up) observation.Results. In the main group the distribution of depressive syndromes was revealed as follows: depressive-hypochon-dric - in 68 (42.5 %) patients; 2) asthenic-depressive - in 33 (20,6 %); 3) anxiety-depressive - in 31 (19.4 %); 4)depressive-dysphoric - in 14 (8.8 %); 5) apathetic-depressive - in 7 (4,35 %); and 6) simple depressive - in7 (4,35%). The combatants after participation in the ATO/JFO had personality deformation and irritative changes of thebrain bioelectric activity, thickening of the intima-media complex and venous dyshaemia in the basal veins ofRosenthal. In liquidators there is an excess of depressive disorders, the frequency and severity of which increase inproportion to the radiation dose. These disorders are characterized by progressive course, personality changes withpsychosomatic pre-disposition, comorbidity with cerebrovascular pathology, neurocognitive deficits and high fre-quency (24 %) of secondary alcohol abuse. The relationship between depressive disorders and alcohol dependencein the examined patients is diverse. Their variants differ in certain clinical manifestations and to a large extentdetermine the differential diagnosis and differentiated approaches to treatment, prevention and medical and socialrehabilitationConclusions. The comorbidity of depressive disorders with the abuse of alcohol by combatants and person affectedby the catastrophe at the ChNPP is gaining an increasing significance first of all because of the increased risk of suicidal behavior. The proposed diagnostic complex and differentiated approaches to treatment, prevention and med-ical and social rehabilitation may increase the level of medical care for the ATO /JFO combatants and the Chernobylcatastrophe survivors with depression associated with alcohol abuse. 10.33145/2304-8336-2018-23-423-441
    Low-dose X-ray-induced depression of sexual behavior in mice. Miyachi Y,Yamada T Behavioural brain research In recent years concern over the biological stimulatory-effect of low-dose noxiousness has been growing. In the course of a study of low dose X-rays effects, we found that male ICR white Swiss mice showed remarkable suppression of mounting behavior after whole body irradiation by 5 to 15 cGy X-rays. Higher doses (25-35 cGy), however, did not induce such effects. Irradiation of the mice head-portion produced these effects, suggesting the important role played by the brain in this phenomenon. Furthermore, we examined the difference between the presence and absence of psychological stress when the mice were exposed to radiation. The results showed that the depression of mounting behavior could be observed in stressed mice, which were housed in prolonged social-isolation, but not in non-stressed mice, that were allowed to socialize. The central nervous system of adult animals is usually considered to be extremely radioresistant. However, the results presented here clearly demonstrate that the brain is one of the most radiosensitive organs in terms of physiological changes.
    Demonstration of cerebral radiation injury with metabolic positron emission tomography images. Mineura K,Sasajima T,Kowada M,Shishido F,Uemura K Pediatric neurosurgery A 2-year-old girl with medulloblastoma who had postoperative radiotherapy and intrathecal administration of methotrexate is reported. Five months after radiation and chemotherapy, she developed involuntary movement. Positron emission tomography (PET) demonstrated that the metabolic rate of glucose was depressed markedly in the temporal and occipital lobes, indicative of metabolic depression induced by radiation. Prompt initiation of steroid therapy ameliorated the patient's neurological symptoms. Follow-up PET revealed an increase in 18F-fluorodeoxyglucose uptake in the entire brain, including temporal and occipital lesions. No areas with high accumulation of (11C-methyl)-L-methionine were detectable. We concluded that PET may be useful in establishing an early diagnosis of radiation injury of the brain and in monitoring metabolic changes following radiation in brain tumor patients. 10.1159/000120597
    Early cognitive changes due to whole body γ-irradiation: a behavioral and diffusion tensor imaging study in mice. Kumar Mayank,Haridas Seenu,Trivedi Richa,Khushu Subhash,Manda Kailash Experimental neurology Radiation-induced aberration in the neuronal integrity and cognitive functions are well known. However, there is a lacuna between sparsely reported immediate effects and the well documented delayed effects of radiation on cognitive functions. The present study was aimed at investigating the radiation-dose dependent incongruities in the early cognitive changes, employing two approaches, behavioral functions and diffusion tensor imaging (DTI). Six-month old female C57BL/6 mice were exposed to whole-body doses of 2, 5 and 8 Gy of γ-radiation and 24 h after exposure, the stress and anxiety levels were examined in the open-field test (OFT). Forty-eight hours after irradiation, the hippocampal dependent recognition memory was observed by the novel object recognition task (NORT), and the cognitive functions related to memory processing and recall were tested using the elevated plus maze (EPM). Magnetic resonance imaging, including diffusion tensor imaging (DTI) was done at 48-hour post-irradiation to visualize microstructural damage in brain parenchyma. Our results indicate a complex dose independent effect on the cognitive functions immediately after exposure to gamma rays. Radiation exposure caused short-term memory dysfunctions at lower doses, which were seen to be abrogated at higher doses, but the long-term memory processing was disrupted at higher doses. The hippocampus emerged as one of the sensitive regions to be affected by whole-body exposure to gamma rays, which led to profound immediate alterations in cognitive functions. Furthermore, the results indicate a cognitive recovery process, which might be dependent on the extent of damage to the hippocampal region. The present study also emphasizes the importance of further research to unravel the complex pattern of neurobehavioral responses immediately following ionizing radiation exposure. 10.1016/j.expneurol.2013.06.005
    Psychophysiological evaluation of short-term neurotoxicity after prophylactic brain irradiation in patients with small cell lung cancer: a study of event related potentials. Parageorgiou C,Dardoufas C,Kouloulias V,Ventouras E,Uzunoglu N,Vlahos L,Rambavilas A,Christodoulou G Journal of neuro-oncology BACKGROUND:The aim of this study was to show, whether a certain prophylacting applicable radiation affects the cognition, particularly, the specific cognitive components P50, N100, P300 and N400 of auditory event related potentials (ERPs) during a short memory test. METHODS AND MATERIALS:Eleven patients with small cell lung cancer (SCLC), who had presented complete response of disease after chemotherapy and radical radiotherapy in the lung, were prescribed to receive a prophylacting cranial irradiation (PCI) with a 6 MeV linear accelerator. The dose schedule was consisting of a total dose up to 30 Gy in 10 fractions, within 12 days (5 days a week). The psychophysiological approach before and after PCI was assessed by measurements of the auditory ERPs during a short memory performance using the digit-span Wechsler test. Components of ERP were recorded from 15 scalp electrodes. Additionally, symptomatology of depression and anxiety were assessed using Zung Self-Rating Depression Scale and Spielberger Anxiety Inventory, respectively, for pre- and post-PCI. RESULTS:No significant difference was noticed pre- and post-radiotherapy of all particular level of psychophysiological analysis concerning both the latencies and the amplitudes of ERPs auditory components P50, N100, P300 and N400 (P > 0.05, Wilcoxon signed test). Additionally, no changes were found with regard to behavioral performance (memory recall), depression symptomatology and state anxiety, according to pre- and post-radiation measurements. However, the self-reported depression symptomatology showed that the patients presented moderate depression. CONCLUSION:No short-term psychophysiological neurotoxicity was detected with this PCI schedule using these instruments, lending additional support to evidence suggesting the benefit of this certain PCI schedule for patients with SCLC.
    Radiation Toxicity in the Central Nervous System: Mechanisms and Strategies for Injury Reduction. Smart DeeDee Seminars in radiation oncology The potential for radiation-induced toxicities in the brain produces significant anxiety, both among patients receiving radiation therapy and those radiation oncologists providing treatment. These concerns often play a significant role in the medical decision-making process for most patients with diseases in which radiotherapy may be a treatment consideration. Although the precise mechanisms of neurotoxicity and neurodegeneration after ionizing radiation exposure continue to be poorly understood from a biological perspective, there is an increasing body of scientific and clinical literature that is producing a better understanding of how radiation causes brain injury; factors that determine whether toxicities occur; and potential preventative, treatment, and mitigation strategies for patients at high risk or with symptoms of injury. This review will focus primarily on injuries and biological processes described in mature brain. 10.1016/j.semradonc.2017.04.006
    Short and long-term evaluation of the impact of proton minibeam radiation therapy on motor, emotional and cognitive functions. Lamirault Charlotte,Doyère Valérie,Juchaux Marjorie,Pouzoulet Frederic,Labiod Dalila,Dendale Remi,Patriarca Annalisa,Nauraye Catherine,Le Dudal Marine,Jouvion Grégory,Hardy David,Massioui Nicole El,Prezado Yolanda Scientific reports Radiotherapy (RT) is one of the most frequently used methods for cancer treatment. Despite remarkable advancements in RT techniquesthe treatment of radioresistant tumours (i.e. high-grade gliomas) is not yet satisfactory. Finding novel approaches less damaging for normal tissues is of utmost importance. This would make it possible to increase the dose applied to tumours, resulting in an improvement in the cure rate. Along this line, proton minibeam radiation therapy (pMBRT) is a novel strategy that allows the spatial modulation of the dose, leading to minimal damage to brain structures compared to a high dose (25 Gy in one fraction) of standard proton therapy (PT). The aim of the present study was to evaluate whether pMBRT also preserves important cerebral functions. Comprehensive longitudinal behavioural studies were performed in irradiated (peak dose of 57 Gy in one fraction) and control rats to evaluate the impact of pMBRT on motor function (motor coordination, muscular tonus, and locomotor activity), emotional function (anxiety, fear, motivation, and impulsivity), and cognitive function (learning, memory, temporal processing, and decision making). The evaluations, which were conducted over a period of 10 months, showed no significant motor or emotional dysfunction in pMBRT-irradiated rats compared with control animals. Concerning cognitive functions, similar performance was observed between the groups, although some slight learning delays might be present in some of the tests in the long term after irradiation. This study shows the minimal impact of pMBRT on the normal brain at the functional level. 10.1038/s41598-020-70371-w
    Early brain response to low-dose radiation exposure involves molecular networks and pathways associated with cognitive functions, advanced aging and Alzheimer's disease. Lowe Xiu R,Bhattacharya Sanchita,Marchetti Francesco,Wyrobek Andrew J Radiation research Understanding the cognitive and behavioral consequences of brain exposures to low-dose ionizing radiation has broad relevance for health risks from medical radiation diagnostic procedures, radiotherapy and environmental nuclear contamination as well as for Earth-orbit and space missions. Analyses of transcriptome profiles of mouse brain tissue after whole-body irradiation showed that low-dose exposures (10 cGy) induced genes not affected by high-dose radiation (2 Gy) and that low-dose genes were associated with unique pathways and functions. The low-dose response had two major components: pathways that are consistently seen across tissues and pathways that were specific for brain tissue. Low-dose genes clustered into a saturated network (P < 10(-53)) containing mostly down-regulated genes involving ion channels, long-term potentiation and depression, vascular damage, etc. We identified nine neural signaling pathways that showed a high degree of concordance in their transcriptional response in mouse brain tissue after low-dose irradiation, in the aging human brain (unirradiated), and in brain tissue from patients with Alzheimer's disease. Mice exposed to high-dose radiation did not show these effects and associations. Our findings indicate that the molecular response of the mouse brain within a few hours after low-dose irradiation involves the down-regulation of neural pathways associated with cognitive dysfunctions that are also down-regulated in normal human aging and Alzheimer's disease. 10.1667/RR1389.1
    Brain irradiation leads to persistent neuroinflammation and long-term neurocognitive dysfunction in a region-specific manner. Constanzo Julie,Midavaine Élora,Fouquet Jérémie,Lepage Martin,Descoteaux Maxime,Kirby Karyn,Tremblay Luc,Masson-Côté Laurence,Geha Sameh,Longpré Jean-Michel,Paquette Benoit,Sarret Philippe Progress in neuro-psychopharmacology & biological psychiatry Long-term cognitive deficits are observed after treatment of brain tumors or metastases by radiotherapy. Treatment optimization thus requires a better understanding of the effects of radiotherapy on specific brain regions, according to their sensitivity and interconnectivity. In the present study, behavioral tests supported by immunohistology and magnetic resonance imaging provided a consistent picture of the persistent neurocognitive decline and neuroinflammation after the onset of irradiation-induced necrosis in the right primary somatosensory cortex of Fischer rats. Necrosis surrounded by neovascularization was first detected 54 days after irradiation and then spread to 110 days in the primary motor cortex, primary somatosensory region, striatum and right ventricle, resulting in fiber bundle disruption and demyelination in the corpus callosum of the right hemisphere. These structural damages translated into selective behavioral changes including spatial memory loss, disinhibition of anxiety-like behaviors, hyperactivity and pain hypersensitivity, but no significant alteration in motor coordination and grip strength abilities. Concomitantly, activated microglia and reactive astrocytes, accompanied by infiltration of leukocytes (CD45+) and T-cells (CD3+) cooperated to shape the neuroinflammation response. Overall, our study suggests that the slow and gradual onset of cellular damage would allow adaptation in brain regions that are susceptible to neuronal plasticity; while other cerebral structures that do not have this capacity would be more affected. The planning of radiotherapy, adjusted to the sensitivity and adaptability of brain structures, could therefore preserve certain neurocognitive functions; while higher doses of radiation could be delivered to brain areas that can better adapt to this treatment. In addition, strategies to block early post-radiation events need to be explored to prevent the development of long-term cognitive dysfunction. 10.1016/j.pnpbp.2020.109954
    Strategies for preservation of memory function in patients with brain metastases. Dye Nicholas B,Gondi Vinai,Mehta Minesh P Chinese clinical oncology BACKGROUND:Cognitive decline, particularly in memory, is a side effect seen in patients with brain metastases and when severe, can have a significant impact on their quality of life. It is most often the result of multiple intersecting etiologic factors, including the use of whole brain radiation therapy, effects of which, in part, are mediated by damage within the hippocampus. A variety of clinical factors and comorbidities may impact the likelihood and severity of this cognitive decline, and affected patients should be considered for evaluation in a comprehensive neuro-rehabilitation or "brain fitness" program. PREVENTION STRATEGIES OF NEUROCOGNITIVE DECLINE DUE TO WHOLE BRAIN RADIOTHERAPY (WBRT):Avoiding WBRT is warranted for some patients with brain metastases; particularly those <50 years old. However, when WBRT is clinically indicated, hippocampal avoidance WBRT (HA-WBRT) has been shown to significantly reduce memory decline compared to historical controls without compromising treatment efficacy. Additionally, the NMDA receptor antagonist memantine and renin-angiotensin-aldosterone system (RAAS) blockers have shown promise as neuroprotective agents that could be used prophylactically with radiation. TREATMENT OF PATIENTS WITH NEUROCOGNITIVE DECLINE:After the onset of neurocognitive decline the treatment is largely symptom-driven, however simply screening for and treating depression, fatigue, anxiety, cognitive slowing, and other processes may alleviate some impairment. Stimulants such as methylphenidate may be useful in treating symptoms of fatigue and cognitive slowing. Other treatments including donepezil and cognitive rehabilitation have been extensively tested in the population at risk for dementia, although they have not been adequately studied in patients following cranial radiotherapy. An innovative hypothetical approach is the use of intranasal metabolic stimulants such as low dose insulin, which could be valuable in improving cognition and memory, by reversing impaired brain metabolic activity. CONCLUSIONS:Prevention of neurocognitive decline in patients with brain metastases requires a multimodal approach tailored to each patient's need, avoiding WBRT in some, altering the WBRT plan in others, and/or using neuroprotective prophylaxis in those in whom avoidance cannot be utilized. Likewise treatment will require a personalized combination of strategies optimized to address the patient's symptoms. 10.3978/j.issn.2304-3865.2015.05.05
    Shenqi Fuzheng Injection Ameliorates Radiation-induced Brain Injury. Chen Ling-Juan,Zhang Rui-Guang,Yu Dan-Dan,Wu Gang,Dong Xiao-Rong Current medical science Shenqi Fuzheng injection (SFI) has been confirmed to be able to alleviate brain injury in mice. This study examined the brain-protective effect of SFI on patients after cranial radiation. Lung cancer patients with brain metastasis were randomly assigned to two groups. The SFI group received cranial radiation in combination with SFI. The control group received cranial radiation alone. The changes in cognitive function were evaluated pre- and post-radiation against the Mini-Mental State Exam (MMSE), Montreal Cognitive Assessement (MoCA), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). The changes in inflammatory factors, such as TGF-β1, TNF-α and IL-10, were also detected before, during and after radiation (15Gy/5F). The results showed that 6 months after cranial radiation, the total scores on the MMSE and MoCA scales of the patients decreased, especially memory ability. The control group experienced a more evident decline, the memory ability being the greatest. TGF-β1 and TNF-a increased shortly after radiation and decreased one month later, and the change was more conspicuous in SFI group than in control group. IL-10 increased after radiation and stayed at a high level one month later in both groups, the level being higher in the SFI group than in the control group. Our study indicated that cognitive functions, especially memory ability, were impaired after cranial radiation. SFI could alleviate radiation-induced brain injury by regulating inflammatory factors. 10.1007/s11596-019-2129-9
    Photobiomodulation using low-level laser therapy (LLLT) for patients with chronic traumatic brain injury: a randomized controlled trial study protocol. Poiani Guilherme da Cruz Ribeiro,Zaninotto Ana Luiza,Carneiro Ana Maria Costa,Zangaro Renato Amaro,Salgado Afonso Shiguemi Inoue,Parreira Rodolfo Borges,de Andrade Almir Ferreira,Teixeira Manoel Jacobsen,Paiva Wellingson Silva Trials BACKGROUND:Photobiomodulation using low-level laser therapy (LLLT) has been tested as a new technique to optimize recovery of patients with traumatic brain injury (TBI). The aim of this study is to evaluate inhibitory attentional control after 18 sessions of active LLLT and compare with the placebo group (sham LLLT). Our exploratory analysis will evaluate the efficacy of the active LLLT on verbal and visuospatial episodic memory, executive functions (working memory, verbal and visuospatial fluency, attentional processes), and anxiety and depressive symptoms compared to the sham group. METHODS/DESIGN:A randomized double-blinded trial will be made in 36 patients with moderate and severe TBI. The active LLLT will use an optical device composed of LEDs emitting 632 nm of radiation at the site with full potency of 830 mW. The cranial region with an area of 400 cm will be irradiated for 30 min, giving a total dose per session of 3.74 J/cm. The sham LLLT group contains only an LED device with power < 1 mW, only serving to simulate the irradiation. Each patient will be irradiated three times per week for six weeks, totaling 18 sessions. Neuropsychological assessments will be held one week before the beginning of the sessions, after one week, and three months after the end of LLLT sessions. Memory domain, attention, executive functioning, and visual construction will be evaluated, in addition to symptoms of depression, anxiety, and social demographics. DISCUSSION:LLLT has been demonstrated as a safe and effective technique in significantly improving the memory, attention, and mood performance in healthy and neurologic patients. We expect that our trial can complement previous finds, as an effective low-cost therapy to improve cognitive sequel after TBI. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02393079 . Registered on 20 February 2015. 10.1186/s13063-017-2414-5
    A prospective examination of mask anxiety during radiotherapy for head and neck cancer and patient perceptions of management strategies. Nixon Jodie L,Brown Bena,Pigott Amanda E,Turner Jane,Brown Elizabeth,Bernard Anne,Wall Laurelie R,Ward Elizabeth C,Porceddu Sandro V Journal of medical radiation sciences INTRODUCTION:Distress related to wearing an immobilisation mask for radiotherapy treatment (RT) is a common experience for the person undergoing RT for head and neck cancer (HNC). Described as 'mask anxiety', there is little known about the patterns of this distress through the course of the treatment or what strategies are being used by people to help alleviate mask anxiety. METHODS:The study used a prospective cohort design to examine the patterns of patient-reported mask anxiety during the course of RT, using a modified Distress Thermometer (DT) and a survey to explore strategies patients used to assist their mask anxiety. RESULTS:Thirty-five participants, who identified as experiencing mask anxiety, were followed throughout RT treatment. At baseline, females were more likely to experience higher mask anxiety (P = 0.03). Across the course of treatment, mask anxiety significantly (P < 0.001) reduced within the total cohort. In 72% of participants, the level of initial distress was found to reduce over time. Only 22% experienced mask anxiety that remained constant. Few (6%) experienced an increase in mask anxiety across the course of RT. Participants reported relying on intervention from health professionals, self-taught strategies, music, visualisation and medication to manage their mask anxiety. CONCLUSIONS:Due to its high prevalence and variable patterns over time, it is recommended that routine screening for mask anxiety be implemented as standard care throughout the course of RT for HNC. Multiple, diverse strategies are being used by patients and studies are needed to develop effective interventions for managing mask anxiety. 10.1002/jmrs.346