Protocol Title: Protocol Title: The Effect of using Weighted Blanket on anxiety, stress, depression and comfort level among Patients with cancer undergoing intravenous (IV) anticancer therapy and its feasibility of use by nurses compared to routine care; a Randomized controlled study.

Study Tools: VAS-A, ESAS-R, DASS-21 and comfort level scale will be used to study the patients' population. A survey will be used to assess the feasibility of using the weighted blankets on patients receiving IV anticancer therapy.

Methodology: Consented patients will be stratified per gender then randomized to either ARM1: The interventional arm, Weighted blanket, or ARM2: The control arm, Standard of care. (Regular blanket). The weighted blanket will be administered in the two cycles of IV anticancer therapy for the interventional arm, exploring the temporal trajectory of anxiety, depression, and psychological distress, and investigating the potential of a weighted blanket intervention to mitigate these symptoms. The tools will be administered according to the study protocol. Day Care Unit nurses will be assessed on how feasible they think the blankets are for patients. Expected Outcome: WB is expected to reduce the anxiety in patients undergoing IV anticancer therapy and reduce the nurses' burden when caring for those patients.

Cancer represents a significant public health concern in the Sultanate of Oman and continues to contribute substantially to morbidity and mortality within the population. According to the Ministry of Health (2020), cancer is the fourth leading cause of death in the country, highlighting its considerable and growing burden. The crude incidence rate among Omanis is estimated at 68.3 per 100,000 among males and 79.4 per 100,000 among females, indicating a slightly higher incidence among women.

Among the different types of cancer, breast cancer is the most common, with approximately 35% of cases diagnosed at advanced stages (stage III or IV), which is associated with poorer prognostic outcomes and increased physical and psychological burden. Thyroid cancer and colorectal cancer also contribute significantly to the overall cancer burden in the country.

The management of cancer involves a range of treatment modalities aimed at curing the disease, prolonging survival, or improving quality of life. These include surgery, radiotherapy, and systemic therapies such as chemotherapy, immunotherapy, and hormonal treatments. Among these, chemotherapy remains one of the most widely used approaches due to its effectiveness in targeting malignant cells.

However, despite its benefits, chemotherapy is associated with various adverse effects that can negatively impact both the physical and psychological well-being of patients.

Patients undergoing chemotherapy frequently experience distressing physical symptoms, including nausea, fatigue, pain, and general discomfort. In addition to these physical effects, chemotherapy also has a significant psychological impact.

Anxiety is consistently reported as the most common psychological symptom among cancer patients receiving chemotherapy. This anxiety is multifactorial in nature and may arise from concerns about treatment side effects, fear of disease progression, changes in body image such as hair loss, and disruptions to daily activities and social roles.

Anxiety levels are not constant across the cancer trajectory but tend to fluctuate depending on different stages of the disease and treatment process. At the time of diagnosis and treatment planning, patients often experience heightened emotional distress due to uncertainty and fear of the unknown. During the treatment phase, persistent physical symptoms and repeated chemotherapy cycles may sustain or even intensify anxiety levels. Additional triggers such as scan results, treatment modifications, and worsening symptoms can further exacerbate anxiety. Individual factors, including age, coping strategies, and prior mental health status, also play an important role in influencing the severity of anxiety experienced.

Unmanaged anxiety can have serious consequences on patient outcomes. It may lead to reduced adherence to treatment, lower satisfaction with care, and diminished quality of life. Furthermore, psychological distress, which encompasses emotional, cognitive, and social dimensions, is common among cancer patients and may manifest as fear, hopelessness, or social withdrawal. Evidence suggests that approximately one-quarter of patients undergoing chemotherapy experience anxiety and depression, which have been linked to poorer clinical outcomes and reduced survival rates.

In response to this burden, increasing attention has been given to non-pharmacological interventions aimed at improving patients' psychological well-being. These interventions include relaxation techniques, music therapy, psychoeducation, and cognitive behavioral therapy. Such approaches are particularly valuable as they provide supportive care without adding to the pharmacological burden or introducing additional side effects.

Deep touch pressure (DTP) has recently emerged as a promising intervention for reducing anxiety and promoting relaxation. It involves the application of gentle, sustained tactile pressure, which has been shown to enhance parasympathetic activity and reduce sympathetic nervous system arousal, thereby supporting emotional regulation and a sense of calm. A practical application of DTP is the use of weighted blankets, which provide evenly distributed pressure to create a soothing "cocooning" effect and promote relaxation and improved sleep.

Growing evidence supports the effectiveness of weighted blankets in reducing anxiety across various populations, including individuals in clinical settings. In oncology, emerging studies suggest that weighted blankets can reduce anxiety during chemotherapy sessions and are generally well accepted by both patients and healthcare providers due to their ease of use and feasibility.

Despite this growing evidence, research on the use of weighted blankets among cancer patients in Middle Eastern populations remains limited. Therefore, this study aims to evaluate the effectiveness of weighted blankets as a non-pharmacological intervention to reduce anxiety in cancer patients undergoing chemotherapy.

The study adopts a randomized controlled trial design. Participation is voluntary, and written informed consent will be obtained from all participants. Patients will be stratified by gender due to its recognized influence on anxiety reporting. Following stratification, participants will be randomly assigned to either the intervention group, which will receive the weighted blanket, or the control group. Randomization will be conducted using a computer-generated system to ensure methodological rigor.

Statistical analysis will include comparisons between the intervention and control groups using appropriate tests, with a significance level set at p ≤ 0.05. The study is powered to detect a meaningful effect, with a total sample size of 152 patients equally distributed across study groups and gender strata.

This study offers a practical and innovative approach to addressing anxiety among patients undergoing chemotherapy. By evaluating a simple, cost-effective, and non-pharmacological intervention such as weighted blankets, the study has the potential to enhance patient well-being and support the integration of holistic care in oncology settings.

Inclusion Criteria: for patients

• Newly diagnosed cancer patients aged 18 years and older.
• Receiving first-line intravenous anticancer therapy (chemotherapy or immunotherapy or a combination of both) in the daycare unit (adjuvant, neoadjuvant, or palliative).
• Weighting at least 55 kg during obtaining the informed consent. (At least 54 kg before the intervention).
• Able to complete study assessments.
• Speaks Arabic or English.
• Signs Informed consent.

Exclusion Criteria for patients:

• Prior psychological treatment or psychotherapy (confirmed psychological diagnosis, history of psychotropic medications and previous psychotherapy).

• Currently hospitalized in inpatient units.

• Patients on daily anticancer infusions.

• Positive fall risk assessment.

• Open wounds and recent surgeries/ stoma.

• Enrolled in any other device study or clinical trial during data collection.

• History of:

  • Diabetes mellitus
  • Respiratory disorders,
  • Claustrophobia (Miller et al 2003) Because of the possibility for altered sensory perception,
  • Patients who had a diagnosis of peripheral neuropathy or fibromyalgia (Vinson et al. 2020)
  • Cognitive impairment

Eligibility criteria for the nurse's population:

Day Care Unit nurses will be recruited by convenient sampling and feedback will be sought per patient per visit. The reason to this is because the same nurses maybe caring for multiple patients using the WBs and each patient will provide a different experience for the nurses caring for those patients. Only nurses who agree to complete the study questionnaire will be included.