Rambam’s Pediatric Cancer Initiative Reduces Sedation during Radiotherapy
A program in Rambam Health Care Campus’ Ruth Rappaport Children’s Hospital is helping pediatric cancer patients undergo radiation therapy without sedation. This unique program receives funding from the Israel Children's Cancer Foundation (ICCF). Ido (not his real name) was a sweet, ten-year-old boy, living in Northern Israel with his parents and two siblings. Diagnosed with a fairly common brain tumor, pineal region germinoma, Ido had to undergo surgery to remove it. Due to the location of his tumor, Ido was going to have to lay completely still while receiving radiation therapy, wearing a custom-made mask bolted over his head to prevent movement. Radiotherapy is generally painless and non-invasive, but for children like Ido, it can be one of the most stressful and frightening aspects of having cancer. They already feel anxious about the unfamiliar treatment and meeting new medical staff, and the machines are large and scary. In some cases, sedation must be given, to ensure that the child does not move during treatment. However, daily repeated sedation increases the risks of complications. This is especially true for young children who may require a port implant, as this increases their risk for infection. Ido’s medical team wanted to try a different approach. The Joan and Sanford Weill Division of Pediatric Hematology Oncology and Bone Marrow Transplantation at Rambam has a program for children aimed at providing radiation therapy without sedation, simply by reducing the child’s anxiety level. The staff works to create a relationship with the patients and their families from the beginning, building a team that is focused on the needs of each young patient. Family involvement during radiation also helps to reassure the child. In agreement with Ido’s parents, and as part of the program, Dafna Lavi Haker, the department’s art therapist, began to work with Ido to prepare him for radiation without sedation. Ido was afraid of the upcoming radiation treatment, but found it hard to express his fears; the art therapy gave him a way to do that. Lavi Haker sat with Ido, explaining the process and inviting him to share his feelings. She told him about the hospital’s Radiation Therapy Institute and about having to lie motionless during treatment, and then played a game with Ido where he had to pretend to be a statue and not move. Lavi Haker also explained the entire procedure, from the importance of not moving to allow precise targeting of his tumor by the radiation, and the need to wear a mask to help him stay still. Following these sessions, Ido’s medical team agreed that he was prepared to undergo radiation without sedation, and could be trusted not to move. For five days a week over the course of one month, Ido received radiation treatments. At the end of the month, Ido, together with Lavi Haker, painted his mask in cheerful colors as a way of celebrating the end of his treatment. Today, Ido is happy and healthy, and has returned to school and his normal routine. “As we use this method of treatment with Ido and other children, we have been able to perfect the radiation preparation process in the department. Now we use different and more tangible accessories to explain the process to children and prepare them for it,” explains Professor Myriam Ben Arush, Director of the Division of Pediatrics in the Ruth Rappaport Children's Hospital and Director of Pediatric Hematology & Oncology. In the photo: Radiation therapy mask. In the photo: Where is my tumor?” Work with clay. In the photo: Counting down the radiation treatments; "How are my stress levels today?" Photography: Dafna Lavi Haker.
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