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January 28, 1983

Balking at radiotherapy may signal underlying anxieties

JAMA. 1983;249(4):454-455. doi:10.1001/jama.1983.03330280010007

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To the radiation technologist, the reference to the treatment room as a "torture chamber" was just a joke—an off-the-cuff remark to ease the breast cancer patient's anxiety about yet another therapy session.

But for the patient, already feeling helpless and fearful, there was nothing funny about the remark. A World War II refugee, she had lost members of her family in Nazi concentration camp gas chambers.

The imagery of "torture" and absolute control by others and their machines was to her very real, intensifying a psychic distress that already threatened her continuation in therapy. Despite the gravity of her disease, she feared therapy almost as much.

To many patients refusing to comply with prescribed therapy, such fear is a major impediment to management of their disease. According to Joseph M. Hyland, MD, staff psychiatrist at the Menninger Foundation, Topeka, Kan, this difficulty remains poorly understood by professionals who plan and