Improving the Pediatric Patient Experience During Radiation Therapy-A Children's Oncology Group Study

Douglas E. Holt*, Susan M. Hiniker, John A. Kalapurakal, John C. Breneman, Jay C. Shiao, Nicole Boik, Benjamin T. Cooper, Paige L. Dorn, Matthew D. Hall, Natalie Logie, John T. Lucas, Iain J. MacEwan, Adam C. Olson, Joshua D. Palmer, Samir Patel, Luke E. Pater, Stephanie Surgener, Derek S. Tsang, Jennifer H. Vogel, Alyssa WojcikCheng Chia Wu, Sarah A. Milgrom

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: Treatment with radiation therapy (RT) can cause anxiety and distress for pediatric patients and their families. Radiation oncology teams have developed strategies to reduce the negative psychological impact. This survey study aimed to characterize these methods. Methods and Materials: A 37-item questionnaire was sent to all radiation oncology members of the Children's Oncology Group to explore strategies to improve the pediatric patient experience. The Wilcoxon rank-sum test was used to assess factors associated with use of anesthesia for older children. Results: Surveys were completed by 106 individuals from 84/210 institutions (40%). Respondents included 89 radiation oncologists and 17 supportive staff. Sixty-one percent of centers treated ≤50 children per year. Respondents described heterogenous interventions. The median age at which most children no longer required anesthesia was 6 years (range: ≤3 years to ≥8 years). Routine anesthesia use at an older age was associated with physicians’ lack of awareness of these strategies (P = .04) and <10 years of pediatric radiation oncology experience (P = .04). Fifty-two percent of respondents reported anesthesia use added >45 minutes in the radiation oncology department daily. Twenty-six percent of respondents planned to implement new strategies, with 65% focusing on video-based distraction therapy and/or augmented reality/virtual reality. Conclusions: Many strategies are used to improve children's experience during RT. Lack of awareness of these interventions is a barrier to their implementation and is associated with increased anesthesia use. This study aims to disseminate these methods with the goal of raising awareness, facilitating implementation, and, ultimately, improving the experience of pediatric cancer patients and their caregivers.

Original languageEnglish (US)
Pages (from-to)505-514
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - Feb 1 2021

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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