The role of stereotactic radiation therapy in the management of children with brain tumors

A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients

Background

Radiotherapy (RT) has become an important treatment modality in pediatric oncology, but its delivery to young children with cancer is challenging and general anesthesia is often needed.

Methods

To evaluate whether a psychoeducational intervention might reduce the need for anesthesia, 223 consecutive pediatric cancer patients receiving 4141 RT fractions during 244 RT courses between February 1989 and January 2006 were studied. Whereas in 154 RT courses corresponding with 2580 RT fractions patients received no psychoeducational intervention (group A), 90 RT courses respectively 1561 RT fractions were accomplished by using psychoeducational intervention (group B). This tailored psychoeducational intervention in group B included a play program and interactive support by a trained nurse according to age to get familiar with staff, equipment and procedure of radiotherapy.

Results

Group A did not differ significantly from group B in age at RT, gender, diagnosis, localization of RT and positioning during RT. Whereas 33 (21.4%) patients in group A got anesthesia, only 8 (8.9%) patients in group B needed anesthesia. The median age of cooperating patients without anesthesia decreased from 3.2 to 2.7 years. In both uni- and multivariate analyses the psychoeducational intervention significantly and independently reduced the need for anesthesia.

Conclusion

We conclude that a specifically tailored psychoeducational intervention is able to reduce the need for anesthesia in children undergoing RT for cancer. This results in lower costs and increased cooperation during RT.

Minimising the use of sedation/anaesthesia in young children receiving radiotherapy through an effective play preparation programme

The delivery of radiotherapy to young children is a challenging process, yet little research has been undertaken to examine practice. Many centres routinely sedate or anaesthetise young children to overcome problems relating to non-adherence to treatment. This can lead to an increased risk of clinical complications, sub-optimal nutrition, sleep disruption and is time consuming and costly. This article describes how sedation can be minimised in young children through an effective play preparation programme. To examine the effectiveness of such a programme, which had been in progress for a number of years, an audit was undertaken on a paediatric oncology unit within a regional radiotherapy centre. This took place over a 5-year period (1994-1999), on all patients aged 2-5 years. Information was collated on age, tumour type, site, duration of radiotherapy, the need for involuntary immobilisation, days requiring sedation, and whether radiotherapy was given with curative or palliative intent. Outcome data presented on 63 children suggest sedation can be minimised in this age group through the implementation of an effective play preparation programme. Of 1030 treatment days, only 111 days required sedation (10.8%), over the whole age range. No general anaesthetics were given. Only 6 patients were sedated for the whole of their treatment (9.5%), with 52 patients requiring no sedation at all (82.5%).

Posterior fossa tumors in children: a case study

Brain tumors are the second most common malignancy to occur during childhood and the posterior fossa is the most common region of the brain affected. Diagnosis and treatment are complex and challenging. Once a child suffering from a posterior fossa tumor is identified, a multidisciplinary team must be assembled to provide comprehensive care through all phases of treatment. The nursing staff is vital to this team because they are often the individuals who coordinate services involved in the care of the child with a posterior fossa tumor. This case study illustrates the phases of diagnosis and treatment of a child with a medulloblastoma and highlights critical care nursing challenges. Following the case study presentation, a summary describes posterior fossa tumors including epidemiology, pathophysiology, clinical manifestations, and outcome. The case study is integrated throughout this review to highlight key issues for critical care nurses to explore.