Feasibility of the Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) System for Anesthesia Avoidance in Pediatric Patients: A Multicenter Trial.

Autor:	Gutkin PM; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Medical College of Wisconsin, Wauwatosa, Wisconsin., Skinner L; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Jiang A; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Donaldson SS; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Loo BW Jr; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Oh J; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Wang YP; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., von Eyben R; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Snyder J; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Bredfeldt JS; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Breneman JC; Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio., Constine LS; Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York., Faught AM; Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee., Haas-Kogan D; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Holmes JA; Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana., Krasin M; Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee., Larkin C; Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio., Marcus KJ; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Maxim PG; Department of Radiation Oncology, University of California, Irvine, California., McClelland S 3rd; Departments of Radiation Oncology and Neurologic Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio., Murphy B; Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon., Palmer JD; Department of Radiation Oncology, Ohio State University School of Medicine, Columbus, Ohio., Perkins SM; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri., Shen CJ; Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina., Terezakis S; Department of Radiation Oncology, University of Minnesota School of Medicine, Minneapolis, Minnesota., Bush K; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California., Hiniker SM; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California. Electronic address: shiniker@stanford.edu.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2023 Sep 01; Vol. 117 (1), pp. 96-104. Date of Electronic Publication: 2023 Mar 30.
DOI:	10.1016/j.ijrobp.2023.03.063
Abstrakt:	Purpose: The Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) system was the first published radiation therapy (RT)-compatible system to reduce the need for pediatric anesthesia through video-based distraction. We evaluated the feasibility of AVATAR implementation and effects on anesthesia use, quality of life, and anxiety in a multicenter pediatric trial. Methods and Materials: Pediatric patients 3 to 10 years of age preparing to undergo RT at 10 institutions were prospectively enrolled. Children able to undergo at least 1 fraction of RT using AVATAR without anesthesia were considered successful (S). Patients requiring anesthesia for their entire treatment course were nonsuccessful (NS). The PedsQL3.0 Cancer Module (PedsQL) survey assessed quality of life and was administered to the patient and guardian at RT simulation, midway through RT, and at final treatment. The modified Yale Preoperative Anxiety Scale (mYPAS) assessed anxiety and was performed at the same 3 time points. Success was evaluated using the χ 2 test. PedsQL and mYPAS scores were assessed using mixed effects models with time points evaluated as fixed effects and a random intercept on the subject. Results: Eighty-one children were included; median age was 7 years. AVATAR was successful at all 10 institutions and with photon and proton RT. There were 63 (78%) S patients; anesthesia was avoided for a median of 20 fractions per patient. Success differed by age (P = .04) and private versus public insurance (P < .001). Both patient (P = .008) and parent (P = .006) PedsQL scores significantly improved over the course of RT for patients aged 5 to 7. Anxiety in the treatment room decreased for both S and NS patients over RT course (P < .001), by age (P < .001), and by S versus NS patients (P < .001). Conclusions: In this 10-center prospective trial, anesthesia avoidance with AVATAR was 78% in children aged 3 to 10 years, higher than among age-matched historical controls (49%; P < .001). AVATAR implementation is feasible across multiple institutions and should be further studied and made available to patients who may benefit from video-based distraction. (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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