Movie ‘distraction therapy’ improves children’s experience of radiation

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disclosures:
Holt, Milgrom and Miller report no relevant financial disclosures.

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In the 2016 animated film “Moana,” the title character bravely battled a volcanic demon and saved her people.

At the University of Colorado Cancer Center, the same computer-generated princess gave a 5-year-old child with cancer the courage to undergo 6 weeks of radiation.

Patients taking RadFlix.

Source: Catch It In Time.

“Moana” is one of a wide selection of movies and TV shows available through the CU Cancer Center’s “RadFlix” program, which provides entertainment for children during what would otherwise be one of the most traumatic experiences of their young lives. can be.

“One of the first patients to use RadFlix during her radiation therapy was a 5-year-old girl with an aggressive brain tumor. She was nervous when she arrived at our ward the first day, but she relaxed as soon as we turned on her favorite movie,” Sarah Milgrom, MD, associate professor of radiation oncology at the University of Colorado Anschutz Medical Campus, said in an interview with Healio. “She smiled and kept quiet, mesmerized by Moana, as we made the face mask for her radiation treatments. She enjoyed watching movies with RadFlix during her entire 6 weeks of radiation therapy.”

The girl enjoyed her movie time so much that she had to be taken out of the radiation ward – a rarity in most hospitals.

“She wanted to keep watching the movies after her treatments were over, so her parents would have to bribe her to leave the radiotherapy ward every day,” Milgrom said. “This was the first time I recognized the power of RadFlix.”

A ‘very rigid’ schedule

The RadFlix program was created in 2018 by Douglas Holt, M.D., radiation oncology resident at the CU School of Medicine, and Brian w. Miller, doctorate, assistant professor of radiation oncology at CU Cancer Center. They were inspired to develop the program after witnessing “distraction-based” interventions used during other pediatric procedures, including similar video-based distractions used during radiation therapy at Stanford University.

“We thought this was a great idea and that we should implement something like this here in Colorado,” Miller said in an interview with Healio. “We came back and looked at how our treatments differ in delivery.”

They identified several challenges, including possible distortion of the focused radiation beam.

“The important thing is that when you’re administering radiation therapy, you can’t interfere with the beam,” Miller said. “So I started working with Doug with the goal of creating something that we could apply to any type of treatment, starting with their first CT scan and continuing through the entire treatment.”

The “whole treatment” can be an exhausting, time-consuming process for children and their parents. According to Holt, the first step is to do a simulation session, which he described as a “CT planning session.”

“We build molds or a mask when we treat the head area,” Holt said. “We need devices to keep them from moving. This first step usually takes half an hour to 45 minutes.”

After this, the clinicians make a radiation plan for the patient. Depending on the tumor type and the site to be treated, the radiation treatments can be given daily for up to 6 weeks or longer.

“This can be quite challenging for kids, depending on their level of maturity,” Holt said. “They have to lie still, and some need anesthesia for that; 30 sessions of anesthesia is a lot. For patients treated with anesthesia, the treatment is done early in the morning and the child is required to fast overnight. The treatment schedule is less flexible for children who need sedation. This can be difficult for patients and families.”

This strict schedule would be an ordeal for many adults, let alone a young child. Perhaps most shocking is the fact that these children have to endure this confusing and potentially frightening experience on their own, as no one is allowed to be in the room with them during the treatments.

“This can be intimidating and even traumatizing for these children. They may have separation anxiety from their parents,” Holt said. “Parents also have separation anxiety. They can’t be with their loved one during the radiation, and it’s very hard for them.”

A ‘game changer’

After considering the logistical challenges of applying this type of “distraction therapy” to their radiation program, Miller and Holt devised a system that uses a radio-transparent projection screen that transmits radiation. Miller created a custom multi-lens long-throw projector system that casts the image from far enough away to keep it relatively small. This allows it to be mounted on the base of the radiation table and move with the patient.

“This custom long-throw projector system is perfect because it moves the projector out of the way of the treatment machine,” said Holt, “There are no collision issues and no risk of changing the beam.”

Patients choose their favorite show or movie options and watch them during the treatment session. The patient can pick up where he left off in the next session.

According to Milgrom, there are regular requests for “Frozen”, “Moana”, “The Lion King”, “Coco” and various superhero movies.

“Our pediatric patients absolutely love RadFlix,” she said. “The movies are a perfect distraction to take their mind off their situation and environment. One patient said the characters from her favorite movie “kept her company” when she was alone in the vault during her radiation treatments.”

The fact that their children don’t feel alone during their radiation treatment is also a great comfort to concerned parents, Milgrom said.

“RadFlix lowers the stress levels of our pediatric patients, and thus their parents’ stress levels,” she said. “Parents are relieved that their children are calm and really enjoying their time in our ward.”

The program has also proved valuable to clinicians, especially as it reduces patients’ need for anesthesia.

“What RadFlix and other types of video distraction therapy have been able to do is lower the age for which we need to use anesthesia,” Holt said. “There’s a cut-off age when this provides enough positive distraction that the patient doesn’t need anesthetic. They enjoy coming to treatment, so it’s definitely been a game-changer.”

Are you coming to a hospital near you

The program has been so successful that Holt and Miller are looking to expand it to other institutions.

“We have five centers that we’ve worked with to get this to them,” Holt said, adding that the Ohio State University, University of Pittsburgh, New York Proton Center and St. Jude Children’s Research Hospital have expressed interest in the program.

Holt pointed out that radiation treatment sites are often separate from pediatric hospitals and therefore do not have access to the same resources as pediatric hospitals.

“A lot of people don’t realize this, but the radiation side is usually isolated and doesn’t receive the same funds or resources,” he said. “A child who comes in to receive radiation will come to an adult center, which is usually not child-oriented or kid-friendly.”

Miller noted that published research has shown how much children generally dislike radiation treatment.

“A lot of kids hate going to radiation, and it’s hard for parents to take their kids because the kid doesn’t want to go,” he said. “Now we hear kids say they can’t wait to get to their treatment.”

Holt said he and Miller are seeking a partner to help them lead and scale this program for widespread use. They have already formed a non-profit consortium and want to continue to grow.

“We think if we have the right partner, we can scale it up and get it out there,” he said.

Holt said he believes doctors sometimes lose sight of vulnerability and fear their patients during treatments.

“This can be a bit of a blind spot for healthcare providers and doctors — they have a hard time understanding the patient experience,” he said. “You’re an oncologist, you’ve treated hundreds or thousands or tens of thousands of patients, but you don’t know what it’s like.” to go through this experience, you just can’t.”

Holt said by sharing their technology and experiences with other institutions, he and Miller hope not only to help patients and families, but also to increase the knowledge and awareness of doctors.

“Some of these long-term survivors and family members can develop PTSD through their treatment,” he said. “We don’t want to treat these children just to leave them with emotional scars. It’s a challenge to put on doctors’ radars that it’s not just about giving the best treatment, but also about giving the best experience.”

For more information:

Douglas Holt, MD, can be reached at the Anschutz Medical Campus of the University of Colorado, 1635 Aurora Court, Aurora, CO 80045; email: douglas.holt@cuanschutz.edu.

Sarah Milgrom, MD, can be reached at the University of Colorado Hospital Radiation Oncology, 1665 Aurora Court, Suite 1032, Aurora, CO 80045; email: sarah.milgrom@cuanschutz.edu.

Brian W. Miller, PhD, can be reached at Anschutz Cancer Pavilion, 1665 Aurora Court, 1st Floor, Aurora, CO 80045.

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