Singapore students create anxiety-alleviating mask for paediatric cancer patients

Children diagnosed with cancer tend to develop anxiety alongside feelings of unease, fear, and dread as a result of foreign treatment procedures and separation from family and friends while hospitalised, which is fairly common in childhood (paediatric) cancer patients.

Healthcare Asia (HCA) learns more about anxiety and adherence to treatment in paediatric patients in a new interview with Radiation Therapy graduates from the Singapore Institute of Technology (SIT). The students have developed an ingenious child-centered alternative that reduces anxiety and minimises paediatric patients’ reliance on general anaesthesia during treatment.

[Responses are attributed to Tan Zu Qi, SIT Graduate and Radiation Therapist, Department of Radiation Oncology, National University Cancer Institute, Singapore, and Abigail Wong Pui Choo, SIT Graduate and Nuclear Medicine Technologist, Nuclear Cardiac Imaging, National Heart Centre Singapore.]

HCA: Can you share more about this project of creating a mask for paediatric cancer patients?

Paediatric brain tumours are frequently treated with radiotherapy to achieve local control and increase the cure rate of the disease. An immobilisation mask is required to ensure a fixed position for treatment accuracy and ensure that the child’s head is still during treatment. Besides having to be isolated in the treatment room, the child also must have his/her head clamped down on the treatment couch. This can cause much distress and anxiety to the child, making it difficult for him or her to cooperate with the treatment.

In current practice, patients who are unable to stay still during radiotherapy would require the administration of sedation or general anaesthesia. However, prolonged use of sedation or general anaesthesia poses the risk of medical complications such as psychological stress, sleep disruption, and affecting the cognitive functioning of the child.

The SIT team formulated the idea during our brainstorms for our honours thesis project. Under the supervision of Associate Professor Sharon Wong, Senior Manager, Division of Radiation Oncology, National Cancer Centre Singapore, we researched different interventions available and found some hospitals in the US and the UK implementing similar ideas. However, this intervention is not practised in Singapore and little is known about its safety and effectiveness in reducing paediatric fear and anxiety for radiotherapy treatments.

This spurred us to further our research in this area to make radiotherapy a less intimidating experience for paediatric patients, ultimately improving their overall experience and satisfaction. We also aim to study the radiation safety and efficacy of the painted mask under high radiation exposure. To our knowledge, this is the first of its kind in Singapore.

HCA: How will this help with their anxiety?

Instead of using sedation or anaesthesia to minimise movement during treatment, a painted mask of their favourite cartoon character personalised specifically for paediatric patients could make them feel less wary when undergoing treatment.

Having a sense of familiarity when looking at their favourite character on the immobilisation mask could help encourage these children in overcoming their fear of wearing it as well.

Providing such psychosocial support for paediatric patients can help them to better understand and cope with radiotherapy treatments. These innovative masks could be a form of support in improving the patient experience, particularly in terms of reducing anxiety and fears associated with the treatment.

Children are also easily influenced by the emotions of their parents – for instance, when they sense that their parents are anxious, it could cause them to feel more distressed. As such, beyond the patients, psychosocial support would also be beneficial for their caregivers. When caregivers are actively involved in the treatment of their children, it would also help to reduce their own anxiety as they would have full visibility, and this would give them the confidence to better support their children in their journey.

In our honours thesis project, we did a prospective pilot study to investigate radiation therapists’ perception of the feasibility of a painted immobilisation mask in alleviating paediatric patients’ fear and anxiety. We collected 48 questionnaires from the radiation therapists in National Cancer Centre Singapore, between 17th January 2021 to 3rd February 2021, and its results demonstrated the feasibility of the use of a painted immobilisation mask to:

● Alleviate fear and anxiety of paediatric patients

● Improve cooperation and compliance

● Improve overall patient experience

● Reduce likelihood of sedation/ general anaesthesia to complete treatment

Most of the respondents also rated that they were satisfied with the end product of the painted mask and would recommend it to caregivers.

HCA: What’s the value of patient agency and autonomy in tackling issues of anxiety amongst paediatric patients?

Allowing paediatric patients to have a say in what cartoon character they want to have painted on the immobilisation mask (used during radiation therapy) is an avenue for them to exercise their own agency.

Although it may not be much as most of their decisions are typically made by their caregivers, it’s something small that allows them to feel “involved” and empowered when they undergo their treatment, which we’ve found has played a role in alleviating anxiety.

Tags: anxiety-alleviating mask, paediatric cancer patients

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