Improving the Pediatric Patient Experience During Radiation Therapy – A Children’s Oncology Group Study

Abstract

Treatment with radiation therapy (RT) can cause anxiety for pediatric patients and their families. Radiation oncology (RO) teams have developed strategies to reduce the negative psychological impact. This survey study aimed to characterize these methods. A survey was sent to all RO discipline members of the Children’s Oncology Group (COG), representing 210 institutions. The survey included 37 questions exploring strategies to improve the pediatric patient experience. Wilcoxon rank-sum test was used to assess for associations. Surveys were completed by 104 individuals from 82/210 institutions (39%; 66 academic & 16 private). Respondents included 87 radiation oncologists and 17 supportive staff. The median number of pediatric patients treated with RT per year per at these institutions is between 26-50 children. Preparatory strategies include early consultations before initiation of RT (83%), tours of the RO department (72%), child life specialist support (67%), information packet (57%), practice simulation (46%), RT videos/photographs (43%), model simulators/linear accelerators (23%), RT activity/coloring books (23%), practice laying still at home (23%), web-based tools or iPhone/iPad apps (10%) and virtual reality (VR; 6%). Methods for improving mask tolerance include modification (ex. cutting eye holes; 80%), decoration (71%), and making masks on objects (40%) or family members (24%). During the simulation/RT, strategies include comfort objects (77%), music/audiobooks (63%), anticipatory guidance (55%), audio between child/family (57%), tattoo avoidance (36%), caregiver presence during the simulation scan with a lead apron (16%), video-based distraction (VBD; 16%), and aromatherapy (11%). Additional methods include end-of-treatment gifts/celebrations (63%), treasure chests (48%), countdown treatment charts (37%), bravery beads (21%), and mini cars/airplanes to ride to treatment (15%). The greatest obstacles to implementation include insufficient lead time (40%), inadequate funding/support staff (36%), and lack of awareness of these strategies (26%). The median age at which most children no longer require anesthesia for RT was reported as 6-years-old (range 3-8); anesthesia use at an older age was associated with physician’s lack of awareness of these strategies (p = .041) and <5 years of pediatric experience (p = .049). Anesthesia use adds a median time between 46-60 minutes daily for patients in the department. Of responding physicians, 26% plan to implement new strategies within the next 2 years to improve the pediatric patient experience, primarily (65%) focusing on VBD and/or VR. Many strategies are used to improve children’s experience during RT. Lack of awareness of these interventions is a common barrier. We plan to disseminate these methods with the goal of raising awareness, facilitating implementation, and, ultimately, improving the experience of pediatric cancer patients and their caregivers.