Play-Based Preparation Helps Children Undergoing Radiation Therapy

Support interventions by child life specialists decrease sedation use and costs associated with radiation therapy (RT) for brain cancer, according to a new study.

Researchers at St. Jude Children's Research Hospital (St. Jude; Memphis, TN, USA) conducted a retrospective chart review of 116 children aged 5–12 years in order to examine the relationship between play-based procedural preparation and support intervention, and use of sedation in children with central nervous system (CNS) tumors during RT.

Outcome measures included the total number of RT sessions, the number of treatments received with and without sedation, and the type and duration of interventions, which consisted of developmentally appropriate play, education, preparation, and distraction provided by a certified child life specialist. A secondary objective was to analyze the cost-effectiveness of the intervention, compared to costs associated with daily sedation alone.

The results showed that age and tumor location affected sedation use. Each one-year increase in patient age was associated with significantly higher odds of receiving cranial RT without any sedation. After adjusting for age, tumor location, and craniospinal radiation, each additional intervention session with the child life specialist was associated with a 23% increase in the odds of receiving cranial radiation with partial sedation over full sedation. The study was published in the June 2016 issue of Supportive Care in Cancer.

“The child life specialist will set up practice sessions where the patient will have the opportunity to lie on the table to see what it will be like before the actual radiation therapy session,” said lead author Shawna Grissom, director of Child Life at St. Jude. “The specialist will work with the child to practice lying still and will work with the patient on coping skills. Child life specialists can also help during radiation sessions by reading books to the children, leading them through guided imagery or checking on them during breaks to make sure they are coping well.”

“Play-based programming implemented by a certified child life specialist can help provide a sense of accomplishment for the patients that they can get through these treatment sessions often with less or no sedation,” concluded Ms. Grissom, who added that “less sedation for the children means fewer clinical risks, less time in treatment sessions, and reduced health care costs that can approach USD 80,000 per patient.”

CNS tumors are the most commonly diagnosed solid tumors in childhood, accounting for nearly 20% of all pediatric cancers in the U.S. Although RT is effective, it is stressful for children who must lie still throughout the process to avoid unintended exposure to their developing brains. Sedation is often used to ensure precise positioning, but on the other hand, sedation in children may be associated with several health risks, including respiratory ailments and cognitive functioning deficits.

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St. Jude Children's Research Hospital