We want to change the environment for children to see if it changes their stress levels or makes getting chemotherapy easier. Many of the kids who used to be anxious can’t wait to be up here now.
—Leonard Sender, MD
Getting a cancer diagnosis and going through treatment are difficult for patients of any age, but the experience can be especially traumatizing for the nearly 16,000 infants, children, and adolescents diagnosed each year with cancer,1 especially during the early days of treatment. Young cancer patients who need an imaging test typically enter a stark room filled with scary-looking medical machinery and are told to lie still while the test is performed. The loud noises and close enclosure of the imaging machine can be so frightening for children, they may require sedation to safely complete the examination.
Now physicians at the new University of California, San Francisco (UCSF) Benioff Children’s Hospital are hoping to make the experience less frightening for young patients. Entering the hospital’s child-friendly scanning suites, instead of intimidating medical equipment, the first thing children see is a colorful cable car. During their scans, images projected on the wall help distract children by letting them take in the sights of San Francisco, the majestic Muir Woods, or the Pacific Ocean while listening to the soothing sounds of nature or music.
“Instead of kids hopping up on a table surrounded by medical equipment, they imagine they’re going for a boat ride,” said John MacKenzie, MD, Chief of Pediatric Radiology at UCSF, who helped design the new treatment suites. “And a medical technician says ‘Hi, I’m the captain. Can you please hop on?’” If the children prefer, they can don video goggles and watch a movie instead.
Although the treatment suites have only been open for a short time, Dr. MacKenzie said he is already seeing how the new child-friendly environment is resulting in helping to calm young patients. “We are seeing more young patients below the age of 6 (who typically need anesthesia) go through an MRI without any anesthesia or sedation, and some of our older children who previously needed medication for anxiety now complete the MRI comfortably without anxiolytics or anesthesia,” said Dr. MacKenzie.
The new facility is just one example of how hospitals around the country are re-imagining cancer care to make it less stressful and traumatic for children with cancer and their families. “Being treated for cancer is a shock at any age,” said Lisa Scherber, Director of Patient and Family Programs at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. “But children lose their childhood, their innocence, their feeling of ‘I can do anything.’”
Many hospitals are turning to technology to help distract young children from challenging procedures. The theater-like Infusionarium at Children’s Hospital of Orange County in Orange, California, lets young patients access five broadcast channels, use social media, watch movies, or play video games on giant screens while they sit in comfortable recliners getting their chemotherapy.
“Kids are very resilient,” said Leonard Sender, MD, Director of the Adolescent and Young Adult Cancer Programs at the hospital. “They take to their environment pretty well. But the hospital is still the hospital. We want to change the environment for children to see if it changes their stress levels or makes getting chemotherapy easier.” The hospital is now studying whether patients who use the facility experience less pain or nausea, but according to Dr. Sender, it appears the Infusionarium is already making a difference. “Many of the kids who used to be anxious can’t wait to be up here now,” he said.
Like the Infusionarium, the new Kiran Stordalen and Horst Rechelbacher Pediatric Pain, Palliative, and Integrative Medicine Clinic at Children’s Hospitals and Clinics of Minnesota in Minneapolis is tackling children’s pain and fears by caring for both their physical and emotional well-being. Built with natural materials, including wood walls and rock, and designed throughout with nature photos and soothing music, the 10,000 square-foot outpatient clinic features a Snoezelen room, a controlled multisensory environment that combines sounds, scents, colors, and lighting effects to stimulate and soothe young patients who may be coping with pain or fear. The facility also has nine rooms where children can experience a variety of modalities to fight pain and other symptoms, including biofeedback, physical therapy, massage therapy, aromatherapy, and acupuncture.
Putting the Human Touch on Cancer
However, helping pediatric cancer patients cope better with their disease and treatment does not require a lot of technologic bells and whistles to be successful. Hospitals and cancer centers have long used visits from clowns and magicians as well as music and art therapists to bring at least a brief respite from the fear many children go through during cancer treatment.
Like other medical facilities, St. Jude Children’s Research Hospital in Memphis, Tennessee, relies heavily on a team of child life specialists focused on the psychosocial needs of children facing a challenging illness to minimize the stress and fear that often accompany hospital stays.
“[The child life specialists] are with the patients from the time they walk through the door to the end of their journey,” said Shawna Grissom, MS, CCLS, CEIM, Director of the Child Life Program at St. Jude Children’s Research Hospital. “We help children understand at an age-appropriate level why they’re here and prepare them for everything that’s happening, so they can get through it in the best way possible.”
When children face scary or painful procedures, depending on the child’s age, the team employs a number of tools, from toys and games to guided imagery and deep breathing, to comfort them.
“We also do our best to normalize the environment, for instance by helping parents keep infants and toddlers on feeding and napping schedules and keeping them on track developmentally,” said Ms. Grissom. The hospital also has a program specifically designed for teenagers, which includes staging big events like graduation ceremonies and formal dances to provide activities “they would be doing if they were not here,” said Ms. Grissom. The hospital designs play and activity areas for different age groups to specially meet developmental milestones and allow for socialization with their peers.
Young children and adolescents with cancer receive age-appropriate treatment at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center as well. “Being an adolescent with cancer is very different from being a 5-year-old with cancer,” said Ms. Scherber. “A diagnosis of cancer makes you feel and look different. It makes you miss all those things that make you who you are.”
At Dana-Farber, there are myriad programs designed to ease the stress of young patients with cancer, including treatment lounges with computers, iPads, and video cameras children can use to make films. The hospital also sponsors out-of-town trips during the year, including one to see the Boston Red Sox at spring training in Fort Myers, Florida, accompanied by a team of doctors and nurses. “These events make treatment more bearable,” said Ms. Scherber. “And they give teens time away from cancer to feel like regular kids.” And oncologists benefit from these outings, too. “A doctor will say ‘I feel like I’m a better doctor because of this trip,’” said Ms. Scherber.
The hospital also holds holiday celebrations throughout the year for patients in all age groups, their families, and their care team members. “At Christmas, the doctors dress as elves,” said Ms. Scherber. “One of the goals is to show the children that even though the doctors are the ones giving treatments, they also want to make the children feel happy. As soon as the first-year fellows start their training, they are fitted for their tights,” laughed Ms. Scherber.
“Programs such as these make kids’ lives better when they’re feeling awful,” said Robert B. Noll, PhD, Professor of Pediatrics, Psychiatry, and Psychology at the University of Pittsburgh Cancer Institute in Pennsylvania. “They make it easier to go through these experiences.” Dr. Sender adds, “Whether it’s a sophisticated Infusionarium, a visit from a clown, or just a hug, we’re all working toward the same goal [to ease the trauma of cancer and its treatment on young patients].” ■
Disclosure: Dr. MacKenzie has received research support from General Electric Healthcare to study PET/MRI in pediatric patients. Dr. Sender, Ms. Grissom, Dr. Noll, and Ms. Scherber reported no potential conflicts of interest.
1. National Cancer Institute: Cancer in Children and Adolescents Fact Sheet. Available at http://www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood. Accessed March 6, 2015.
Here are several steps for helping pediatric and adolescent patients to cope with cancer and its treatment.