The Cancer Bell: Too Much of a Good Thing?

Patrick A Williams; Jinxiang Hu; Dongyun Yang; Shu Cao; Richard L Jennelle

doi:10.1016/j.ijrobp.2019.06.012

The Cancer Bell: Too Much of a Good Thing?

Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):247-253. doi: 10.1016/j.ijrobp.2019.06.012. Epub 2019 Jun 13.

Authors

Patrick A Williams¹, Jinxiang Hu², Dongyun Yang³, Shu Cao³, Richard L Jennelle⁴

Affiliations

¹ Department of Radiation Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California. Electronic address: patalbwil@gmail.com.
² Department of Biostatistics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas.
³ Biostatistics Core, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
⁴ Department of Radiation Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.

PMID: 31300336
DOI: 10.1016/j.ijrobp.2019.06.012

Abstract

Purpose: Patients around the world often ring a bell on the final day of radiation therapy (RT) to celebrate treatment completion. Patients appear to enjoy ringing the bell, but its psychological impact is unexamined. Applying a psychological principle named the "peak-end rule," we hypothesized that ringing the bell would improve patients' perceptions of the overall distress from cancer treatment.

Methods and materials: We enrolled 2 cohorts of patients completing definitive RT in a single-center outpatient radiation oncology clinic. Patients in the control arm completed treatment and filled out the survey mentioned below. A bell was then installed in the clinic, and patients in the intervention arm rang the bell on the final day of RT and filled out the same survey. Patients evaluated their overall distress from cancer treatment using a survey composed of an 11-point numerical rating scale in combination with the Verbal Rating Scale. At follow-up, a shorter survey was completed that asked the same questions about distress from cancer treatment.

Results: Two hundred ten patients were enrolled, 107 in the bell group and 103 in the control group. One hundred sixty-three patients completed follow-up surveys, n = 86 (80%) and n = 77 (75%) in the bell and control groups, respectively. Demographics and treatment characteristics were well balanced. The bell group reported worse overall distress scores than those not ringing the bell (mean [standard deviation] 5.6 [2.8] vs 4.7 [2.7], P = .045). This difference worsened further at follow-up (6.4 [2.9] vs 5.1 [3.0], P = .009; mean 103 vs 130 days, P = .056).

Conclusions: Counter to our hypothesis, ringing the bell on the final day of RT worsens patients' evaluation of overall distress from cancer treatment, and this distress persists and even worsens in the months after treatment. Emotional arousal created by ringing the bell may magnify the distress from cancer treatment and subsequently worsen the perception of distress from treatment.

Publication types

Controlled Clinical Trial

MeSH terms

Anniversaries and Special Events*
Cancer Care Facilities
Cohort Studies
Diagnostic Self Evaluation
Duration of Therapy
Female
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasms / psychology*
Neoplasms / radiotherapy*
Patient Reported Outcome Measures*
Prospective Studies
Stress, Psychological / diagnosis*
Stress, Psychological / etiology
Time Factors