S1491
Interdisciplinary - Patient involvement
ESTRO 2026
Digital Poster 5172 Psychological Distress and Adaptation to Immobilization Masks in Radiotherapy Patients Nesrine Sellami, Asma Ghorbel, Sarra Saidi, Farah Liouane, Alia Mousli, Semia Zarraa, Chiraz Nasr Radiation oncology, Salah Azaiez Institute, Tunis, Tunisia Purpose/Objective: Immobilization masks are essential for ensuring treatment accuracy in radiotherapy, but can provoke significant psychological distress, including fear, loss of control, and anxiety. Despite their routine use, patient experiences of mask-related distress remain underexplored, particularly in low- and middle-income settings where psychological support may be limited. This study, conducted in the Radiation Oncology Department of the Salah Azaiez Institute in Tunis, Tunisia, aimed to assess distress, anxiety, and depression related to mask immobilization and to identify factors influencing patient adaptation and trust in the care team. Material/Methods: A cross-sectional descriptive study was conducted between October and November 2025, including 50 adult patients undergoing curative radiotherapy with thermoplastic mask immobilization. After informed consent, participants completed a validated structured questionnaire evaluating socio-demographic and clinical characteristics, emotional and physical reactions to the mask, coping strategies, social support, and trust in the care team. Psychological distress was measured using the Distress Thermometer (DT) referring specifically to the moment of mask fixation, while anxiety and depression were assessed using the HADS-7. Data were analyzed using SPSS version 25. Results: The fifty patients (mean age 56 [26-80]; with 72.5% being male), were mostly treated for head and neck cancer (90%) over 30–35 fractions (67.5%). Psychological history was reported in 27.5% of patients, including claustrophobia (20%) and anxiety disorders (10%). Physical discomfort during immobilization was common: 61.8% reported pressure, 38.2% difficulty breathing, 29.4% heat, 11.8% pain, and 14.7% other discomforts. Fear of suffocation occurred in 57.5% and loss of control in 37.5%; Twenty-five percent considered interrupting at least one session. Sleep disturbances and post-session nervousness persisted in 20%. The mean DT score was 3.9 ± 2.8, with 25% scoring ≥7; prior anxiety was associated with higher DT scores.Adaptation improved over time, with 77.5% reporting habituation to the mask. Coping strategies included controlled breathing (62.5%), prayer or faith (35%), positive thinking (20%),
mental distraction (17.5%), and other methods (7.5%). Key facilitators of adaptation were repetition of sessions (57.5%), explanations from the care team (37.5%), prayer or faith (32.5%), family support (27.5%), breathing exercises (20%), and mental distraction (2.5%). Trust in the care team remained high, with 97.5% feeling reassured by staff and 47.5% rating confidence at the maximum level (10/10). Conclusion: Immobilization masks can cause significant distress, especially in patients with prior anxiety, but most adapt over time with coping strategies and strong trust in the care team. Early psychological support is
key to improving comfort and adherence. Keywords: Radiotherapy_Immobilization mask_Coping strategies
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