Strategies for Patients with Mask Anxiety in Radiation Oncology


Each year, an estimated 650,0000 cases of head and neck cancers are diagnosed worldwide. Many of those diagnosed will receive radiation oncology as either their primary treatment or as an adjunct to surgical treatment of the cancer. 

While eliminating the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. To prevent accidental movement and prevent irradiation to healthy tissue, some patients may be fitted with a thermoplastic mask to wear during the course of their treatment - up to 5 times a week for up to 40 minutes over a course as long as 8 weeks.

For many patients, the mask can be a difficult experience.

I think Dr. Matthew Katz summed it up best in his article, Masks of Faith: Immobilization for Radiation

As he put it, the treatment mask requires additional courage and trust on the part of the patient: "Once your head is supported but bolted to the treatment table, the chance to escape is gone. The therapists may be wonderful, but you’re pinned down and alone in that room. Beam on, the linear accelerator chirping like a Geiger counter." 

Sounds scary even without the mask on. Dr. Katz goes on to surmise that while claustrophobia may be an issue, some of the anxiety experienced by patients is the fear involved in taking such a leap of faith. He concludes that doing a better job of preparing patients can help make that leap of faith less daunting. 

And, he may be right.

Studies explore severity of mask anxiety and how patients cope  

Two Australian research teams published studies about mask anxiety, the effectiveness of various coping strategies, and how much impact discussions with health professionals had on reducing patient anxiety ("Unmasking Anxiety: A Qualitative Investigation of Health Professionals; Perspectives of Mask Anxiety in Head and Neck Cancer," Klug, Natalie et al, Journal of Medical Imaging and Radiation Sciences, Volume 0, Issue 0;  “Exploring the prevalence and experience of mask anxiety for the person with head and neck cancer undergoing radiotherapy,” Nixon, Jodie L et al.. Journal of Medical Radiation Sciences Vol. 65,4 (2018): 282-290).

Nixon, et. al. describe mask anxiety as feelings of distress, anxiety, and claustrophobia associated with fitting and wearing of the thermoplastic mask.

They determined that mask anxiety is a combination of psychological (feelings of vulnerability, uncertainty, fear) and physiological (rapid heartbeat, rapid breathing, breaking out in sweats) responses to the mask. They state that mask anxiety can disrupt the first day of radiation treatment for approximately 24% of patients. 

The good news is that over the course of treatment, 63% of patients became accustomed to wearing the masks through a combination of interventions and strategies - from cutting off parts of the masks to aid with vision and breathing to anti-anxiety medicines and breathing/meditation training. 

Discussions with providers found most helpful

The majority of study participants (86%) found that discussions with medical staff were most helpful in coping with the mask throughout treatment. And while pharmacological intervention provided a quick fix, only 25% of the cohort who were prescribed medication found it helpful, with benefits over-ridden by side effects and restrictions to activities, such as being unable to drive.

The use of music therapy, on the other hand, was found to be helpful in minimizing mask anxiety by 72% of the patients in the study.  

Patients may be hesitant to share fears

Klug, et. al, state that mask anxiety is a significant problem that can easily be missed by providers.

Patients are already on edge dealing with their cancer and treatment but may be hesitant to share their fears with treatment personnel as the vast majority (97%) understand the importance of wearing the mask during treatment. This is why both studies stress the value of communication regarding psychological concerns throughout the entire length of treatment.

Training staff in assessing mask anxiety, having support strategies in place prior to treatment, and allowing patients choice and control over their treatment wherever permissible are also very important. 

Support strategies recommended by these Australian studies are as follows: 

  • Prescreen patients for mask anxiety by familiarizing them with the mask prior to first fitting 
  • Provide education on relaxation strategies such as controlled breathing, mindfulness, meditation 
  • Provide a wide selection of music or ambient sounds for patients to choose from and listen to during treatment
  • Cut masks to alleviate feeling of claustrophobia and discomfort for patients with more severe mask anxiety.  Beekley Medical® suggests using TenderTouch™  cushioned tape for thermoplastic masks to provide additional comfort and protect skin from rough edges of cut masks. 
  • Provide anti-anxiety meds if necessary. Alternately, many
  • facilities are choosing to provide holistic alternatives that promote relaxation without side effects or restrictions to activities such as aromatherapy. Many radiation oncology treatment centers have found success using Beekley Medical's Lavender or Lavender-Sandalwood Elequil aromatabs®, aromatherapy designed for the clinical setting to help calm and relax patients undergoing treatment. Inhalation aromatherapy can be great adjunct to controlled breathing as well. 

Proactive planning can help reduce disruptions to treatment 

Proactively planning for the psycho-social needs of head and neck cancer patients, in addition to their clinical treatment needs, not only provides a better patient experience, but can also help reduce disruptions in treatment and other complications due to patient distress. 

Visit to learn more about our solutions for everyday challenges in radiation oncology such as TenderTouch and Elequil aromatabs or call 1-800-233-5539 to speak to your Radiation Oncology Account Manager. 

Mary Lang

Mary Lang

Director of Marketing Communications

Subscribe to BeekSpeak