Handholding or squeezing a stress ball did not appear to alleviate anxiety among patients with skin cancer undergoing surgery under local anesthesia, according to a study published in JAMA Dermatology.

Most dermatologic surgeries are performed while patients are awake and under local anesthesia, which often leads to anxiety. Evidence from previous studies have shown that patients undergoing other procedures — such as cataract surgery — could experience reductions in anxiety with handholding and other methods, but no studies have been conducted on dermatologic surgical settings.

For this study, researchers randomly assigned 135 patients undergoing skin cancer excision procedures on the head and neck areas to the handholding group, stress ball group, or treatment-as-usual (control) group. Anxiety was assessed before and after the procedure using a visual analog scale (VAS), the 6-item State Trait Anxiety Inventory (STAI), and physiologic measures (eg, heart rate, blood pressure).

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Results showed that patients in all 3 treatment groups experienced a reduction in anxiety over time, but there were no significant differences in VAS, STAI, and physiologic measures.

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No significant differences were observed in postprocedure pain scores between all treatment groups. Furthermore, the type of intervention had very little effect on patient satisfaction; 99.2% of patients reported being very satisfied.

Patients who did prior research to the procedure had significantly higher levels of anxiety compared with patients who did no research (P =.04), but there was no significant difference during the procedure.

The authors concluded that “this study did not find an incremental, cohort-wide reduction in patient anxiety associated with handholding or stress ball use during excisional procedures of the head or neck. It is possible that a subgroup of patients may benefit, particularly if allowed to choose their preferred method.”


Yanes AF, Weil A, Furlan KC, et al. Effect of stress ball use or hand-holding on anxiety during skin cancer excision [published online July 18, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.1783