Supporting paediatric patients to receive radiation therapy without sedation or general anaesthetic

Abstract

Radiation therapy is used in the optimum management of paediatric cancers, 1,2 with good outcomes, but there is the potential for adverse consequences. 3 Unintended radiation to critical organs 3 and the possibility of longterm side effects mean that children must remain still for treatment. 4,5 When children are non-compliant and cannot remain still, often due to anxiety and distress, a decision is often made to administer sedation/anaesthetic (S/A), usually a general anaesthetic (GA). However, daily S/A over a period of 6-7 weeks can have a negative impact on the child due to risks related to medical complications, and the effect S/A may have on nutrition, hydration and overall health and wellbeing. 2,6,7 Organisational challenges include increased time for the delivery of radiation therapy and the necessity for the paediatric anaesthesia and recovery team to travel to an adult facility; 4,8,9 increased costs due to the delivery of S/A; and scheduling constraints. 10 These factors also increase health costs. 10 As such, there is a need for interventions to reduce distress and anxiety, and support paediatric patients to remain still during radiation therapy. Our systematic review 11 identified that very few studies have been conducted to test interventions designed to reduce psychological distress. Out of six studies, which reported significant effects, only one study reported group differences in children's reported anxiety after receiving an intervention. Our review concluded that cognitivebehavioural approaches need to be explored further so that patients can be better supported. In our review, we also highlighted that therapeutic play may be beneficial.An example of an intervention using such approaches was reported by McCoola et al. 12 who evaluated the use and efficacy of behavioural therapy techniques used by the paediatric radiation therapy group in their