Movie ‘distraction therapy’ improves children’s experience of radiation
In the 2016 animated film “Moana,” the title character bravely battled a volcanic demon and saved her people.
At University of Colorado Cancer Center, this same computer-generated princess gave a 5-year-old child with cancer the courage to face 6 weeks of radiation treatment.
“Moana” is one of a wide selection of movies and TV shows available through CU Cancer Center’s “RadFlix” program, which provides entertainment for children during what otherwise might be one of the most traumatic experiences of their young lives.
“One of the first patients who used RadFlix during her radiation therapy was a 5-year-old girl with an aggressive brain tumor. She was nervous when she arrived in our department on the first day, but she relaxed as soon as we turned on her favorite movie,” Sarah Milgrom, MD, associate professor of radiation oncology at University of Colorado’s Anschutz Medical Campus, said in an interview with Healio. “She smiled and held perfectly still, entranced by Moana, as we made the face mask for her radiation treatments. She enjoyed watching movies with RadFlix during her entire 6-week course of radiation therapy.”
The girl enjoyed her movie time so much that she needed to be coaxed out of the radiation department — a rare occurrence in most hospitals.
“She wanted to keep watching the movies after her treatments were over, so her parents would need to bribe her to leave the radiation oncology department each day,” Milgrom said. “This was the first time that I recognized the power of RadFlix.”
A ‘very rigid’ schedule
The RadFlix program was created in 2018 by Douglas Holt, MD, radiation oncology resident at CU School of Medicine, and Brian W. Miller, PhD, 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 distraction used during radiation therapy at Stanford University.
“We thought this was a great idea, and that we should implement something like that here in Colorado,” Miller said in an interview with Healio. “We came back and looked at how our treatments are different in terms of delivery.”
They identified several challenges, including potential disruption of the targeted radiation beam.
“The key thing is that when you deliver radiation therapy, you cannot perturb the beam,” Miller said. “So, I started working with Doug with the goal of making something we could apply to any type of treatment, starting with their first CT scan and continuing throughout the whole treatment.”
The “whole treatment” can be an exhaustive, 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 if we’re treating the head region,” 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 create a radiation plan for the patient. Depending upon the tumor type and site being treated, the radiation treatments may be given daily for up to 6 weeks or longer.
“This can be very challenging for children, depending on their maturation level,” Holt said. “They need to be in a still position, 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 needs to fast overnight. The treatment schedule is less flexible for children requiring anesthesia. This can be hard for patients and families.”
This rigorous schedule would be an ordeal for many adults, much less a young child. Perhaps most upsetting is the fact that these children must endure this confusing and potentially frightening experience alone, because no one can be in the room with them during the treatments.
“This may be intimidating, and even traumatizing, to these kids. 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 really tough for them.”
After considering the logistical challenges to applying this type of “distraction therapy” to their radiation program, Miller and Holt devised a system that uses a radiotransparent projector screen that allows radiation to pass through it. Miller created a multi-lens custom long-throw projector system that casts the image from far enough away to keep it relatively small. This enables it to be mounted on the foot of the radiation table and move with the patient as they are moved.
“This custom long-throw projector system is perfect because it gets the projector out of the way of the treatment machine,” Holt said, “There are no issues of collisions and no risk of changing the beam.”
Patients choose their favorite show or movie options and watch it for the duration of the treatment session. The patient can resume where they left off in their next session.
According to Milgrom, frequent requests are 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 minds off of their situation and surroundings. One patient said that 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 major comfort to worried parents, Milgrom said.
“RadFlix reduces our pediatric patients’ stress level, so it reduces their parents’ stress level, as well,” she said. “Parents are relieved that their children are calm and actually enjoying their time in our department.”
The program has proved to be valuable to clinicians, as well, especially in its ability to reduce patients’ requirement for anesthesia.
“What RadFlix and other types of video distraction therapy have been able to do is to reduce the age for which we have to use anesthesia,” Holt said. “There’s a borderline age when this provides enough of a positive distraction that the patient doesn’t need anesthesia. They come to treatment looking forward to it. So, it’s definitely been a game-changer.”
Coming to a hospital near you
The program has been so successful, Holt and Miller want to extend it to other institutions.
“We have five centers we’ve been working with to try 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.
“Many people don’t realize this, but the radiation side is typically siloed and does not receive the same funds or resources,” he said. “A child coming in to get radiation is coming to an adult center, which is not typically geared toward children 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 child doesn’t want to go,” he said. “Now, we’re hearing kids saying they can’t wait to go to their treatment.”
Holt said he and Miller are seeking a partner to help them spearhead this program and scale it for widespread use. They have already formed a nonprofit consortium and want to continue to grow.
“We think if we got the right partner, we could scale it and get it out there,” he said.
Holt said he believes physicians sometimes lose sight of the vulnerability and fear their patients experience during treatments.
“This can be somewhat of a blind spot for providers and physicians — 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 to not only help patients and families, but also increase physician knowledge and awareness.
“Some of these long-term survivors and family members may develop PTSD from their treatment,” he said. “We don’t want to treat these children only to leave them with emotional scars. It’s a challenge to put it on physicians’ radars that it’s not just about giving them the best treatment, it’s about giving them the best experience, as well.”
For more information:
Douglas Holt, MD, can be reached at University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Aurora, CO 80045; email: email@example.com.
Sarah Milgrom, MD, can be reached at University of Colorado Hospital Radiation Oncology, 1665 Aurora Court, Suite 1032, Aurora, CO 80045; email: firstname.lastname@example.org.
Brian W. Miller, PhD, can be reached at Anschutz Cancer Pavilion, 1665 Aurora Court, 1st Floor, Aurora, CO 80045.