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Feasibility of the Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) system for anesthesia avoidance in pediatric patients: A multicenter trial. International journal of radiation oncology, biology, physics Gutkin, P. M., Skinner, L., Jiang, A., Donaldson, S. S., Loo, B. W., Oh, J., Wang, Y. P., von Eyben, R., Snyder, J., Bredfeldt, J. S., Breneman, J. C., Constine, L. S., Faught, A. M., Haas-Kogan, D., Holmes, J. A., Krasin, M., Ccls, C. L., Marcus, K. J., Maxim, P. G., Iii, S. M., Murphy, B., Palmer, J. D., Perkins, S. M., Shen, C. J., Terezakis, S., Bush, K., Hiniker, S. M. 2023

Abstract

The AVATAR system was the first published radiotherapy (RT) compatible system to reduce the need for pediatric anesthesia through video-based distraction. We evaluate the feasibility of AVATAR implementation and effects on anesthesia use, quality of life (QoL), and anxiety in a multicenter pediatric trial.Pediatric patients 3-10 years of age preparing to undergo RT at 10 institutions were prospectively enrolled. Children able to undergo at least one fraction of RT using AVATAR without anesthesia were considered successful (S). Patients requiring anesthesia for their entire treatment course were non-successful (NS). PedsQL3.0 Cancer Module survey (PedsQL) assessed QoL and was administered to the patient and guardian at RT simulation, midway through RT, and final treatment. The modified Yale Preoperative Assessment Survey Short Form (mYPAS) assessed anxiety and was performed at the same three timepoints. Success was evaluated using Chi-square 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.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=0.04) and private versus public insurance (p<0.001). Both patient (p=0.008) and parent (p=0.006) PedsQL scores significantly improved over the course of RT for patients ages 5-7. Anxiety in the treatment room decreased for both S and NS patients over RT course (p<0.001), by age (p<0.001) and by S versus NS patients (p<0.001).In this 10-center prospective trial, anesthesia avoidance with AVATAR was 78% in children age 3-10 years, higher than among age-matched historical controls (49%, p<0.001). AVATAR implementation is feasible across multiple institutions and should be further studied and made available to patients who may benefit from video-based distraction.

View details for DOI 10.1016/j.ijrobp.2023.03.063

View details for PubMedID 37001762