Panic atack in an oncology patient following exposure to adjuvant radiotherapy

Abstract

Introduction: Radiotherapy is an essential therapeutic modality in cancer management, but it can generate significant psychological burden in patients. Anxiety and distress associated with the physical environment, treatment uncertainty, and individual factors may trigger acute emotional reactions, including panic attacks, which affect adherence and oncological outcomes.

Case Presentation: A 70‑year‑old female patient, with a history of major depressive disorder in remission and family history of depression, was diagnosed with breast cancer and underwent radical mastectomy. During adjuvant radiotherapy sessions, she experienced panic attacks characterized by palpitations, sweating, intense fear, and claustrophobia. The episode was linked to witnessing another patient in crisis, the confined environment of the radiotherapy room, and brief power outages during treatment. A presumptive diagnosis of illness anxiety disorder (hypochondria) comorbid with claustrophobia was established. Cognitive‑behavioral therapy, psychoeducation, and cognitive restructuring were implemented, along with involuntary exposure to the phobic stimulus. After 38 days of intervention, the patient showed clinical improvement with reduced anxiety symptoms.

Conclusions: This case highlights the importance of early identification of psychological vulnerability factors in patients undergoing radiotherapy. Cognitive‑behavioral therapy, combined with psychoeducation and exposure strategies, is an effective tool to reduce anxiety and ensure continuity of oncological treatment. Systematic screening and comprehensive management of anxiety are recommended in oncology care.