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Drug-free distractions for kids with cancer

Jordan Feradi, 7, watches a movie on an iPad during a demonstration of a radiation treatment at the Tom Baker Cancer Centre in Calgary on June 06, 2012.

Chris Bolin/The Globe and Mail

For six weeks, Jordan Feradi settled onto a raised bed under a linear accelerater machine in a spartan room for his daily dose of radiation.

The seven-year-old Calgary boy was diagnosed with a brain stem glioma last February – a diagnosis that once required sedation to help prevent fidgeting and keep kids calm during cancer therapy. But that would make each treatment appointment longer, recovery slower and force already worried parents to further juggle work or childcare.

Instead, Jordan arrived eager to watch a show about a pet platypus who doubles as a secret agent on an iPad mounted on a specially designed arm during each of his 33 10-minute sessions.

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"Phineas and Ferb," said Jordan in response to his favourite thing to pass the time.

Use of a computer tablet is part of an innovative approach to cancer treatment developed for Alberta Health Services by SAIT Polytechnic in Calgary, which has already dramatically reduced the number of pediatric oncology patients who require sedation before enduring radiation. It started when health care workers wondered whether there was a better way to reduce reliance on medication, painlessly distract young patients and ease the stress on their families.

When local radiation therapists began experimenting with entertainment devices almost two years ago, most patients under the age of 7 were sedated for treatment – radiation requires the patient to remain motionless for the equipment to zero in on malignant cells.

But in the past year, health care workers have eliminated sedation for five out of eight young patients – aged 4 to 7 – by introducing tablets, which helps keep young minds occupied, and little bodies from moving.

Mona Udowicz, radiation therapy manager at the Tom Baker Cancer Centre in Calgary, said the effects of sedation can last far longer than the treatment period. Kids cannot eat or drink before treatment and the medication often leaves them too groggy to play or attend school. Her staff wanted to do something to improve quality of life – and cut costs to the health care system.

"There was a lot of doubt at first," she said. "We said, let us try."

A study published last year in the Journal of Pediatric Hematology/Oncology looked at managing painful procedures in children with cancer and concluded that while there have been "significant advances" in the past 25 years, more needs to be done to help youngsters cope.

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The authors, from Texas Children's Hospital in Houston and Baylor College of Medicine, pointed out that three commonly used types of sedation – minimal, moderate and general anesthesia – often comes with side effects. Those can include agitation, hypertension, nausea, vomiting, hallucinations, drop in heart rate and blood pressure, hypoxia, oxygen desaturation and respiratory problems.

They noted that "distraction is a powerful coping strategy," and advocated for the use of non-pharmacologic interventions, such as cognitive-behavioural interventions, or CBI, to help ease anxiety and distress. Strategies include television, video games, music, story-telling, deep breathing, relaxation, guided imagery and massage.

"Continued use of CBI for all children should be standard of care, and creative interventions developed and tested to increase children's coping skills are still needed," they concluded.

In Calgary, officials with Alberta Health Services started with a DVD player taped to an IV pole, but they couldn't come up with a working design.

That's when they turned to the mechanical expertise at SAIT for a creative solution.

For kids to safely use the tablet, it required some kind of stable holding device. There were 40 to 50 different concepts, several prototypes as beds were measured, treatment sessions were observed and tiny patients were considered. Eventually, an arm was designed that won't interfere with radiation equipment and is simple enough for pre-schoolers to use.

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"It's there for the child to be entertained in this pretty scary process," said Lyndal Turner, an instructor with SAIT's school of manufacturing and automation.

Prof. Turner said the design could easily be commercialized, although there's no patent on the concept, but this project was never really about making money.

"Students really get engaged with projects that have an altruistic element," he said. "It was a great motivator."

This year, AHS estimates 50 children in southern Alberta will undergo radiation therapy, a small slice of national cancer projections. According to the Canadian Cancer Society, 7,878 people under the age of 19 will be diagnosed with cancer or die from the disease this year.

While cancer among children and young people accounts for just 1 per cent of all cases diagnosed across the country, childhood cancer exerts a "disproportionate" negative impact on medical, economic and social systems in the burden it places on families and lingering health effects.

Officials have long noted that parents also experience high levels of stress while their children are receiving treatment. Replacing sedation with simple computer tablets has made a huge difference for Jordan's mother, Shawna Feradi.

There's no cure for her son's disease, but radiation (and now chemotherapy) has given her family more time with Jordan, who turns 8 next month.

"I was almost relieved when they said he could watch a show," she said. "It seems less scary."

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