Integrating Audiovisual Immersion Into Pediatric Radiation Therapy Across Multiple Centers: Methodology, Timeliness, and Cost of the Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy Prospective Multi-Institutional Trial

Justin Oh; Lawrie Skinner; Paulina M Gutkin; Alice Jiang; Sarah S Donaldson; Billy W Loo Jr; Yi Peng Wang; Agnes Ewongwo; Jeremy S Bredfeldt; John C Breneman; Louis S Constine; Austin M Faught; Daphne Haas-Kogan; Jordan A Holmes; Matthew Krasin; Charlene Larkin; Karen J Marcus; Peter G Maxim; Shearwood McClelland 3rd; Blair Murphy; Joshua D Palmer; Stephanie M Perkins; Colette J Shen; Stephanie Terezakis; Karl Bush; Susan M Hiniker

doi:10.1016/j.adro.2024.101589

Integrating Audiovisual Immersion Into Pediatric Radiation Therapy Across Multiple Centers: Methodology, Timeliness, and Cost of the Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy Prospective Multi-Institutional Trial

Adv Radiat Oncol. 2024 Aug 10;9(10):101589. doi: 10.1016/j.adro.2024.101589. eCollection 2024 Oct.

Authors

Justin Oh^{1

2}, Lawrie Skinner¹, Paulina M Gutkin^{1

3}, Alice Jiang¹, Sarah S Donaldson¹, Billy W Loo Jr¹, Yi Peng Wang¹, Agnes Ewongwo¹, Jeremy S Bredfeldt⁴, John C Breneman⁵, Louis S Constine⁶, Austin M Faught⁷, Daphne Haas-Kogan⁴, Jordan A Holmes⁸, Matthew Krasin⁷, Charlene Larkin⁵, Karen J Marcus⁴, Peter G Maxim⁹, Shearwood McClelland 3rd¹⁰, Blair Murphy¹¹, Joshua D Palmer¹², Stephanie M Perkins¹³, Colette J Shen¹⁴, Stephanie Terezakis¹⁵, Karl Bush¹, Susan M Hiniker¹

Affiliations

¹ Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
² Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.
³ Medical College of Wisconsin, Wauwatosa, Wisconsin.
⁴ Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
⁵ Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁶ Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
⁷ Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
⁸ Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
⁹ Department of Radiation Oncology, University of California Irvine, Irvine, California.
¹⁰ Departments of Radiation Oncology and Neurological Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
¹¹ Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon.
¹² Department of Radiation Oncology, Ohio State University School of Medicine, Columbus, Ohio.
¹³ Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
¹⁴ Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
¹⁵ Department of Radiation Oncology, University of Minnesota School of Medicine, Minneapolis, Minnesota.

Abstract

Purpose: The Audiovisual-Assisted Therapeutic Ambience in Radiotherapy (AVATAR) trial was a prospective multicenter study (NCT03991156) examining the combination of video immersion with radiation therapy and was successfully conducted through the collaboration of pediatric radiation oncology teams at 10 institutions independent of any pre-existing consortium. We sought to analyze and report the methodology of trial conception and development, process map, and cost.

Methods and materials: The study enrolled patients aged 3 to 10 years preparing to undergo radiation therapy, integrated the combination of AVATAR-based video immersion with radiation therapy at each institution, and offered AVATAR use as an alternative to anesthesia, with rates of anesthesia use and outcomes of serial standardized anxiety and quality-of-life assessments assessed among the 81 children enrolled. A process map was created based on the trial timeline with the following components: study development time (time from conception of the trial to the accrual of the first patient, including design phase, agreement and approval phase, and site preparation phase), and accrual duration time (time from the first to last accrual). Costs and institutional success rates were calculated.

Results: Time from inception of study to last accrual was 3.6 years (1313 days). The study development time was 417 days (31.7%), and accrual duration time was 896 days (68.3%), with the final 50% of accrual occurring in <6 months. Equipment cost was approximately $550 per institution and was covered by funding from the lead study institution. All 10 centers were successful with AVATAR implementation, defined as ≥50% of patients able to avoid anesthesia with the use of AVATAR, including centers with both photon and proton therapy.

Conclusions: This report elaborates on the methodology and timeline of trial conception and development using data from a previously published supportive care study combining video immersion with radiation therapy among 10 cooperating pediatric oncology institutions. It highlights the potential for multicenter collaborations on prospective trials integrating supportive care therapies with radiation therapy.