Psychosomatic symptoms affect radiotherapy setup errors in early breast cancer patients

Objective: To examine the trajectory of psychosomatic symptoms and to explore the impact of psychosomatic symptoms on setup error in patients undergoing breast cancer radiotherapy.Methods: A total of 102 patients with early breast cancer who received initial radiotherapy were consecutively recruited. The M.D. Anderson Symptom Inventory(MDASI) and three different anxiety scales, i.e., the Self-Rating Anxiety Scale(SAS), State-Trait Anxiety Inventory(STAI), and Anxiety Sensitivity Index(ASI), were used in this study. The radiotherapy setup errors were measured in millimetres by comparing the real-time isocratic verification film during radiotherapy with the digitally reconstructed radiograph(DRR). Patients completed the assessment at three time points: before the initial radiotherapy(T1), before the middle radiotherapy(T2), and before the last radiotherapy(T3).Results: The SAS and STAI-State scores of breast cancer patients at T1 were significantly higher than those at T2 and T3(F=24.44, P<0.001;F=30.25, P<0.001). The core symptoms of MDASI were positively correlated with anxiety severity. The setup errors of patients with high SAS scores were greater than those of patients with low anxiety levels at T1(Z=-2.01, P=0.044). We also found that higher SAS scores were associated with a higher risk of radiotherapy setup errors at T1(B=0.458, P<0.05).Conclusions: This study seeks to identify treatment-related psychosomatic symptoms and mitigate their impact on patients and treatment. Patients with early breast cancer experienced the highest level of anxiety before the initial radiotherapy, and then, anxiety levels declined. Patients with high somatic symptoms of anxiety may have a higher risk of radiotherapy setup errors.