Scanxiety: Scan-associated anxiety in patients with advanced solid cancers

Abstract

Scanxiety is the distress experienced by people leading up to, during and after a scan for cancer. People with advanced cancer are vulnerable to scanxiety as regular scans are often needed and results can have profound implications. This thesis aimed to improve the understanding of scanxiety and guide future research directions in this population.

The scoping review was a broad and inclusive search of the medical literature that identified 57 studies. Heterogeneity in scanxiety measurement and study methods limited comparison. Prevalence varied (range 0 to 83%) and severity appeared low. Data in people with advanced cancer was limited. The Twitter study provided real-time commentary on scanxiety experiences and cemented scanxiety as a patient-centred term. Clinical and institutional changes were recommended to reduce scanxiety. The survey of 37 cancer nurses sought perceptions on scanxiety and recommendations for nurse-led strategies to reduce scanxiety. Scanxiety was perceived as common (76%) and of at least moderate severity (100%).

A mixed-methods approach was used to understanding scanxiety in people with advanced cancer. A multicentre survey (n=222) identified 55% with scanxiety and a mean severity of 6 out of 10. Scanxiety was more prevalent in younger (p=0.02) and more remote (p=0.04) people and more severe those diagnosed within one year (p=0.04) and with higher state anxiety (p=0.004). Interviews (n=16) showed scanxiety had psychological and physical impacts and was affected by uncertainty. Both studies identified greater scanxiety while waiting for scan results. Interim results of the longitudinal study (n=67) identified high scanxiety prevalence (84%) and severity (59%), though mean scores were low (3 out of 10). Frequent scanxiety monitoring was feasible (rate 84%) and acceptable (rate 94%).

In summary, scanxiety was common and sometimes severe in people with advanced cancer. Final longitudinal study results will inform the optimal timing of interventions.