Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Unmasking Anxiety: A qualitative investigation of health professionals’ perspectives of mask-anxiety in head and neck cancer. (#190)

Phyllis Butow 1 , Natalie Klug 2 , Melissa Burns 3 , Haryana Dhillon 1 , Puma Sundaresan 3
  1. CeMPED/ PoCoG, The University of Sydney, NSW, Australia
  2. School of Psychology, University of Sydney, Sydney, NSW, Australia
  3. Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia


To ensure treatment precision, patients requiring radiotherapy for head and neck cancer (HNC) are stabilised using a fitted thermoplastic immobilisation mask, however many patients find this intensely anxiety-provoking. This study elicited HPs’ perspectives of mask-anxiety to guide development of implementation-ready interventions.


Semi-structured interviews were conducted with 20 HPs involved in the care of HNC patients (radiation oncologists, radiation therapists, nurses and psychologists), at nine hospitals in NSW, Australia, guided by the PaHRiS framework. Framework analysis methods were used.


Participants were on average 40 years old (range 27-56), 75% were female, and had worked 1-22 years with HNC patients. Six themes were identified: 1. Mask-anxiety is a significant problem but is easily missed by staff. 2. Context matters. HPs stressed that mask-anxiety occurred within the context of a challenging disease and treatment regimen which could make it difficult to focus on anxiety. 3. Trust between health professionals and patients is critical.  4. Choice of coping strategies and control over the process where possible, facilitate adjustment, 5. Psychological strategies are valued with staff wishing for more training and greater access to psychological services. 6. Culture impacts. Service attitudes and resources impacted the feasibility of intervention delivery. Sub-group analysis highlighted differences in perspectives between specialties.


Participants identified key issues influencing successful intervention. Participants identified a lack of empirical evidence surrounding the prevalence and predictors of mask-anxiety, and contextual and systematic hurdles making the health-system potentially unresponsive to change. These data suggest a need for careful development of interventions which will address these hurdles.