December 3, 2010 / 10:17 PM / 9 years ago

Uncertainty a huge source of anxiety in patients

CHICAGO, ILLINOIS (Reuters Health) - Uncertainty about a diagnosis causes more anxiety and can be more stressful than actually knowing that you have a serious illness, researchers reported here at the 2010 annual meeting of the Radiological Society of North America.

“Once people have the diagnosis, they gain some understanding and control, but without it, all they have is anxiety, and they do not know how to handle it,” Dr. Elvira V. Lang, from Harvard Medical School, Boston, told Reuters Health. “It is important for physicians and others who work in the health care field to realize this and find ways to alleviate this anxiety and stress. Not only will they help patients, they will also be helping their institutions to provide more cost effective care.”

Dr. Elvira Lange and her colleague Nicole Flory studied the stress levels of 214 women waiting to undergo either a breast biopsy to investigate a suspicious lump; hepatic chemoembolization, a treatment for liver cancer; or uterine fibroid embolization, a treatment for benign fibroids.

Immediately prior to the procedures the women completed questionnaires designed to measure their stress and anxiety levels. Most of the women (112) were awaiting breast biopsy, 42 were due to undergo chemoembolization for liver cancer and 60 were awaiting treatment for fibroids.

The women awaiting breast biopsy reported significantly higher levels of anxiety, with an average score of 48 out of a possible maximum of 160. In contrast, chemoembolization patients had an average anxiety score of 26 and fibroid embolization patients, an average score of 24.

Average depression levels were also highest among breast biopsy patients, who scored 15 on a separate scale of zero to 40, with chemoembolization patients averaging a score of 14, and fibroid embolization patients, 12. The biopsy patients’ stress levels were on average 18 out of 40, compared with fibroid embolization patients’ average score of 16 and 15 for chemoembolization patients.

“We were very surprised to see that the women having breast biopsy were significantly more anxious than the women who came for treatment for malignant cancer and those who came for fibroids,” Lang said in an interview.

Health care professionals tend not to be aware that diagnostic tests can be stressful, she added.

The researchers recognize that for a woman awaiting breast biopsy, the fear of being diagnosed with cancer and uncertainty about what the outcome will be can create higher anxiety levels than even those experienced by patients undergoing a “much riskier and invasive treatment of a known cancer.”

“People in health care and also family members may judge what is minor or major by how much risk is involved. But that is not what the patient is experiencing. That is why we want to alert them,” Lang said.

There are simple ways to diffuse this anxiety prior to procedures, she added. “People want to make patients feel better but they use language that is not helpful. For instance, they will say ‘oh, it’s not going to be that bad’, or ‘it’s just going to be a little sting’, but using such vocabulary only increases anxiety and pain.”

Training health care providers to use the right language with patients about to undergo diagnostic procedures will not only reduce their anxiety levels, it will also save the health care system money, Lang added.

“Sometimes patients are so anxious they can’t complete a test. For instance, about 2.3 percent of patients can’t finish an MRI scan because they’re too frightened or claustrophobic. With some 33 million MRI scans done each year in the U.S., at $526 dollars apiece, that translates into $425 million in lost revenue or overhead every year. That money will show up in our insurance premiums, so there definitely is something in this for facilities if they help their patients overcome anxieties.”

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