Pediatric radiotherapy preparation: a scoping review

Background: Pediatric radiotherapy (RT) presents unique challenges due to the need for young patients to remain still during treatment, often in unfamiliar and intimidating environments. To achieve compliance and immobilization, many children, particularly those under six, are routinely administered general anesthesia (GA) or sedation, despite the associated risks and complications. These include respiratory and neurocognitive side effects, increased healthcare costs, and the strain on clinical resources. To address these challenges, various preparatory strategies have been developed globally, aiming to reduce the need for GA by enhancing patient understanding, cooperation, and comfort through physical, psychological, and educational interventions. This scoping review examines the current landscape of pediatric RT preparation, focusing on identifying service gaps, evaluating the effectiveness of existing approaches, and exploring opportunities for improvement. Methods: A scoping review was conducted using PubMed, Embase, Scopus, and ScienceDirect databases, covering literatures from 2000 to 2023. The search strategy focused on terms related to pediatric RT preparation. Studies were included if they detailed preparation services, and data extraction emphasized intervention types, outcomes, and identified service gaps. Results: Of 593 papers identified, 73 met the inclusion criteria. Approximately 24% of the papers highlighted challenges faced by pediatric patients and their carers, including anxiety and misunderstandings about RT. Notably, for all paediatric patients aged under 21 years, 46% of them require GA or sedation for RT. For the age group below 3 years, 60% patients require GA or sedation for RT. For the age group above 3 years, 37% patients require GA or sedation for RT. Furthermore, 19% of papers reported rare but severe neurocognitive and respiratory complications associated with GA. Emerging strategies such as pre-treatment visits, virtual reality (VR) simulations, play therapy, and distraction techniques show promise in reducing GA reliance. However, significant gaps remain, including limited multidisciplinary collaboration and a lack of specialized pediatric facilities. Conclusions: This review highlights the urgent need for enhanced preparatory strategies in pediatric RT. Emphasizing pre-treatment support, gamification, advanced technologies, multidisciplinary collaboration, and specialized facilities can foster more positive treatment experiences and potentially decrease the dependence on GA or sedation.