Ask about mask anxiety at every head and neck radiotherapy visit, and offer music and guided relaxation

How common. In one cohort of 100 people having head and neck radiotherapy, 26 per cent identified themselves as anxious about the mask on a modified distress thermometer. In a second study of 65 people, 43 per cent had clinically significant anxiety before the mask-making session and 30 to 43 per cent across trajectory groups before treatments; the radiographers' ratings of each patient's anxiety agreed poorly with the patient's own, so asking works better than watching. In a cohort of 35 people with mask anxiety followed through treatment, it fell over time for 72 per cent and stayed constant for 22 per cent.

What helps. In a randomised trial at a hospital in central India, 216 people were assigned to pre-recorded instrumental music with a guided relaxation and visualisation exercise during their first five sessions, or to standard care; among 208 analysed, median mask-anxiety scores after five sessions were 2 against 6 (p below 0.001), with no adverse events and four people stopping because they found it distracting. Patients followed in the 35-person cohort reported relying on staff, self-taught strategies, music, visualisation and medication.

The upgrade has two parts that cost almost nothing: a one-question screen at mask-making and at intervals, because anxiety changes over the course and staff cannot see it, and an offer of music and a recorded relaxation exercise to anyone who screens positive. Adoption of routine screening is not measured by any source OnCo found.