In the 2016 animated film “Moana”, the main character bravely fought a volcanic demon and saved his people.
At the University of Colorado Cancer Center, this same computer-generated princess gave a 5-year-old with cancer the courage to face 6 weeks of radiation therapy.
“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 might otherwise be one of the most traumatic experiences of their young life.
“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 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 the University of Colorado’s Anschutz Medical Campus, said in an interview with Healio. “She smiled and stood perfectly still, fascinated by Moana, as we made the face mask for her radiation treatments. She enjoyed watching movies with RadFlix throughout her 6 week radiation therapy period.
The girl enjoyed her movie time so much that she had to be cuddled out of the radiation therapy department – a rare occurrence in most hospitals.
“She wanted to continue watching the movies after her treatments were finished, so her parents would have to bribe her to quit the radiation oncology department every day,” Milgrom said. “It was the first time I recognized the power of RadFlix.”
A “very rigid” schedule
The RadFlix program was created in 2018 by Douglas Holt, MD, resident in radiation oncology at 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 in other pediatric procedures, including a similar video distraction used during radiation therapy at Stanford University.
“We thought it 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 were different in terms of delivery. “
They identified several challenges, including a potential disruption of the targeted radiation beam.
“The bottom line is that when you give radiation therapy, you can’t disrupt 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 scan and continuing through the treatment. “
“Full treatment” can be an exhaustive and 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 make molds or a mask if we are treating the head area,” Holt said. “We need devices to prevent them from moving. This first step usually takes half an hour to 45 minutes.
After that, clinicians create a radiation therapy plan for the patient. Depending on the type of tumor and the site to be treated, radiation therapy treatments may be given daily for 6 weeks or more.
“It can be very difficult for children, depending on their level of maturity,” said Holt. “They have to be in a still position, and some need anesthesia for that; 30 sessions of anesthesia is a lot. For patients treated with anesthesia, treatment is done early in the morning and the child must fast overnight. The treatment schedule is less flexible for children requiring anesthesia. This can be difficult for patients and families.
This rigorous schedule would be a test for many adults, let alone a young child. Perhaps most upsetting is the fact that these children have to go through this confusing and potentially frightening experience on their own, as no one can be in the room with them during the treatments.
“It can be intimidating, even traumatic, for these children. They can have separation anxiety with their parents, ”said Holt. “Parents also have separation anxiety. They cannot be with their loved one during radiation therapy, and it is really difficult for them.
A “game changer”
After examining the logistical challenges of applying this type of “distraction therapy” to their radiation therapy program, Miller and Holt designed a system that uses a radiolucent projection screen that allows radiation to pass through it. Miller created a custom multi-lens long throw projector system that projects the image far enough to keep it relatively small. This allows it to be mounted on the leg of the irradiation table and to move with the patient as they move.
“This custom long throw projector system is perfect because it keeps the projector away from the processing machine,” said Holt. “There is no collision problem and no risk of changing the beam.”
Patients choose their favorite show or movie options and watch it throughout the treatment session. The patient can pick up where he left off during his next session.
According to Milgrom, frequent requests are for “Frozen”, “Moana”, “The Lion King”, “Coco” and various superhero movies.
“Our pediatric patients love RadFlix,” she said. “Movies are a perfect distraction to distract from their situation and their surroundings. One patient said that the characters in her favorite movie “kept her company” when she was alone in the safe during her radiation treatments.
The fact that their children don’t feel alone during their radiation therapy is also a great comfort to worried parents, Milgrom said.
“RadFlix reduces the stress level of our pediatric patients, so it also reduces the stress level of their parents,” she said. “Parents are relieved that their children are calm and really enjoying their time in our department. “
The program has also proven to be valuable to clinicians, particularly in its ability to reduce patients’ anesthesia needs.
“What RadFlix and other types of video distraction therapy have been able to do is reduce the age at which we have to use anesthesia,” said Holt. “There is an age limit where this provides enough positive distraction that the patient does not need anesthesia. They come to treatment impatiently. So, it definitely changed the game.
Come to a hospital near you
The program has been so successful that Holt and Miller want to expand it to other institutions.
“We have five centers that we’re working with to try to get that to them,” said Holt, adding that 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 therapy 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 it, but the write-off side is usually siled and doesn’t receive the same funds or resources,” he said. “A child who comes in for radiation comes to an adult center, which is generally not for children or suitable for children.”
Miller noted that published research has shown how children typically dislike radiation therapy.
“A lot of kids hate going to radiation therapy, and it’s hard for parents to take their kids because the kid doesn’t want to go,” he said. “Now we are hearing from children saying they can’t wait to get treatment. “
Holt said he and Miller were looking for a partner to help them lead this program and evolve it for widespread use. They have already formed a non-profit consortium and want to continue to grow.
“We believe that if we have the right partner, we could evolve it and spread it,” he said.
Holt said he believes doctors sometimes lose sight of their patients’ vulnerability and fear during treatment.
“It can be a bit of a blind spot for providers and doctors – they have a hard time understanding the patient experience,” he said. “You’re an oncologist, you’ve treated hundreds, thousands, or tens of thousands of patients, but you don’t know what it’s like to have that experience. You can not.
Holt said that by sharing their technology and experiences with other institutions, he and Miller hope to not only help patients and their families, but also increase physician knowledge and awareness.
“Some of these long-term survivors and family members may develop PTSD as a result of their treatment,” he said. “We don’t want to treat these children just to leave them emotional scars. It’s a challenge to put doctors on radar that it’s not just about giving them the best treatment, but also giving them the best experience.
For more information:
Douglas Holt, MD, can be reached at the University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Aurora, CO 80045; email: [email protected]
Sarah Milgrom, MD, can be contacted at University of Colorado Hospital Radiation Oncology, 1665 Aurora Court, Suite 1032, Aurora, CO 80045; email: [email protected]
Brian W. Miller, PhD, can be reached at Anschutz Cancer Pavilion, 1665 Aurora Court, 1st Floor, Aurora, CO 80045.