Videos Instead of GA for Children Undergoing Radiotherapy

Roxanne Nelson, BSN, RN

May 09, 2017

VIENNA ― Watching a video could be an alternative to general anesthesia for children undergoing radiation therapy, suggest researchers from Belgium, who report preliminary results from a project involving 12 children aged 1.5 to 6 years.

The results, presented at the annual meeting of the European Society for Radiotherapy & Oncology (ESTRO 2017), suggest that video viewing may be able to keep children calm and still during radiation therapy and thus negate the need for anesthesia.

Distracting a child with a video avoids the medical risks inherent in general anesthesia and is less traumatic to both pediatric patients and their families. In addition, it reduces the treatment time and cuts costs.

"Being treated with radiotherapy means coming in for a treatment every weekday for 4 to 6 weeks," explained first author Catia Aguas, a radiation therapist and dosimetrist at the Cliniques Universitaires Saint Luc, Brussels, Belgium. The children need to remain motionless during treatment, and on the whole, that means general anesthesia to ensure adequate immobilization, she explained. "That in turn means they have to keep their stomach empty for 6 hours before the treatment."

Project Video

The VLADI (Video Launching Applied During Irradiation) project was initiated in late 2014.

"We wanted to see if installing a projector and letting children watch a video of their choice would allow them to keep still enough that we would not need to give them anesthesia," explained Aguas.

 

At the conference, Aguas reported results from the first 12 pediatric patients (aged 1.5 - 6 years) who underwent radiotherapy using a TomoTherapy System (Accuray) unit at the university hospital. The children were divided into two groups. Group 1 (n = 6) included children who received radiation therapy prior to the implementation of VLADI; group 2 (n = 6) comprised pediatric patients who began undergoing treatment after the project began.

The authors reported that after the implementation of the VLADI project, the use of general anesthesia declined from 83.3% (group 1) to 33.3% (group 2). In addition, the number of anxiolytics given to the patients was reduced.

Overall, they report, 72.2% of patients benefited from the VLADI and were able to avoid anesthesia.

As an added bonus, the treatment time with radiation therapy decreased to 15 to 20 minutes, whereas it took at least an hour if anesthesia was needed.

"These first results on our pediatric patients underline the efficiency of the system and can even be extended to claustrophobic or stressed adult patients who would – without VLADI ― require anxiolytics to undergo their treatment," the authors note.

"Radiotherapy can be very scary for children," Aguas commented in a conference press release. "It's a huge room full of machines and strange noises, and the worst part is that they're in the room alone during their treatment. Before their radiotherapy treatment, they have already been through a series of tests and treatments, some of them painful, so when they arrive for radiotherapy, they don't really feel very safe or confident.

"Since we started using videos, children are a lot less anxious," she added. "Now they know that they're going to watch a movie of their choice, they're more relaxed, and once the movie starts, it's as though they travel to another world."

Among the popular videos are SpongeBob SquarePants, Cars, and Barbie, she added.

"Now in our clinic, video has almost completely replaced anesthesia, resulting in reduced treatment times and reduction of stress for the young patients and their families," she commented.

The video projector was inexpensive and simple to install. "We bought a projector, and with the help of college students, we created a support to fix the device to the patient couch. Using video is saving money and resources by reducing the need for anaesthesia," she said.

Simple Intervention

Commenting on the study, Yolande Lievens, MD, president of ESTRO and head of the Department of Radiation Oncology at Ghent University Hospital, Belgium, pointed out that this simple intervention was able to reduce the need for anesthesia as well as anxiety in children.

"For parents, this means they no longer have to watch their child going under a general anesthetic and then into the recovery room after treatment every day for weeks on end," said Dr Lievens. "In addition, the use of videos had a positive impact on the workflow in pediatric radiotherapy, which further increased the positive effect observed by the caregivers as well."

ESTRO notes that, worldwide, 215,000 new cases of cancer occur each year in patients younger than 15 years. Around a sixth of these children require treatment with radiotherapy, including those with brain tumors and bone and soft tissue sarcomas, such as Ewing sarcoma and rhabdomyosarcoma.

The research was funded by Fondation Saint Luc.

European Society for Radiotherapy & Oncology (ESTRO 2017). Abstract OC-0546, presented May 8, 2017.

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