الفهرس 
ScanxietyOnly 14 pages are availabe for public view
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Abstract
For cancer patients who have survived after treatment, the persistent expectation that cancer may relapse is a primary cause of anxiety and can have an impact on their physical, social and spiritual well-being.
Distress is described as ”an uncomfortable emotional experience of a psychological, spiritual or social nature. Distress exists along a continuum, ranging from common feelings of insecurity, distress, and fear to problems that can become debilitating, like depression, anxiety, panic, social withdrawal, and moral crisis
Routine surveillance imaging studies may create ”scanxiety” and may worsen cancer-related distress. ’Scanxiety ”refers to the clinically debilitating distress, patients with cancer feel in the period surrounding imaging scans.
These surveillance studies should be ordered at a frequency and duration compatible with the existence of risk of recurrence and to include only testing with strong positive and negative predictive values, and only when early detection of recurrence will improve survival or quality of life.
There are little studies that specifically measured scan-associated distress, and its consequences on quality of life. However, numerous studies have concluded that imaging can cause serious distress when healthy individuals perform a cancer screening scans.
The current study aimed to asses scanxiety and psychological distress associated with routine surveillance imaging at routine follow up visits among cancer patients, and different factors affecting its severity.
We conducted a cross sectional study survey on consecutive sample of 179 of cancer patients attending outpatient clinic at oncology department at Ain Shams University Hospital in Cairo, Egypt, from the period between October 2019 to February 2020. All the patients had a recent surveillance scan in the last 4 weeks from the interview. (with no recurrence or metastasis).
The Arabic translated version of General health questionnaire (GHQ) was used as screening tool for psychological distress. Patients with score ≥ 7, were subjected to the Arabic version of Hamilton Anxiety Rating Scale (HAM-A), to assess the severity of anxiety symptoms at the time around imaging scan. Sociodemographic and clinical data were obtained from patients and from the medical records. Patient are approached by the investigator in the waiting room, and were asked to participate in the survey, and given a consent form.
The study included 179 patients, 69.8% (n= 125) were females and 30.2% were males (n= 54), with mean age of 52.64 (SD= 11.20). Most the patients were married (92.7%) (n=166). and most of them were having children (92.2%), with 7.8% (n= 14) had no children, 48.6% were illiterate, while 45.3% were having primary or secondary school and 6.1 were having university education. (73.2%) (n= 131) were not working and 26.8% (n= 48) were working.
As regard to the diagnosis of patients: breast cancer was the most common one, found in 28.5% of patients. GIT cancer in 18 %, Gynecological cancers in 13.4%. genitourinary, head and neck and thyroid each in 7.3% of the patients. Lung cancer in 6.7%, sarcoma and lymphoma each in 2.2 %, thymic tumors in 1.1 %, skin cancer in 0.6 %.
The range of number of years since diagnosis in our study was (1-21) with median of (2) years.
We found that most of the patients had some degree of psychological distress at the time of follow up scans, as 60.9% of patients (n=109) had a score ≥ 7 in General Health Questionnaire.
Using Hamilton anxiety scale, Mild degree of anxiety (HAM-A score ≤ 17) was found in 16.2% of patients, mild to moderate (score 18-24) in 14.0 %, moderate to severe (score 25-30) in 17.3%, and very severe anxiety (score 31-56 ) in 13.4%. Moderate to severe anxiety was the most common degree of anxiety in our patients (28.4 % of patients with anxiety).
Significant relationship was found between high GHQ (score ≥ 7) and age of patients. (p value= 0.004). Mean age of patients with GHQ score ≥ 7 was: 50.7 and SD 11.16.
Also, there was a highly significant relationship between HAM score and age of patients (p value = 0.002) .
No significant relationship was found between GHQ and gender of patients.
As regard to the marital state, having children, educational level and working status: there was only a significant relationship between if the patient have children and GHQ score (p value = 0.047). Most of patients with no children had GHQ score ≥ 7, probably due to loss of social support.
And as regard to HAM-A, there was only a highly significant relationship between HAM-A score and working state of patients. working group tend to had more anxiety, probably due to more financial - responsibilities.
A significant relationship also was found with the type of cancer and duration since diagnosis.
Some degree of anxiety was found in: almost all patients with CNS tumors, skin cancer, and sarcoma. In 84.6 % of head and neck cancer patients, 80% of patients with lymphoma, 75 % of lung cancer patients, 69.8 % of thyroid cancer patients, 54.2 % of gynecological cancer patients ,53.8% of genitourinary cancer ,53.1 % of GIT cancer, 50 % of thymic tumors, 49% of breast cancer patients.
The mean of HAM-A score was highest in skin cancer patients (36), head and neck cancer (35) , CNS tumors (25) , lung cancer (25).
Highly significant relationship was found between (GHQ) score and number of years since diagnosis. With median of 2 years since diagnosis in patients with GHQ score ≥ 7, and median of 5 years in patients with GHQ score < 7.
Also, a highly significant relationship between HAM score and years since diagnosis with very severe anxiety for median of 1 year, moderate to severe at median of 2 years, mild to moderate anxiety at 3 years and no anxiety at median of 5 years.