Objective: Radiotherapy represents one of the pillars of the treatment of many pediatric tumors. However, it poses significant challenges for pediatric patients who often require analgosedation due to issues remaining still and associated discomfort. The objective of this systematic review is to examine possible non-pharmacological interventions aimed at reducing distress in pediatric patients undergoing radiotherapy for solid tumors, evaluating their effectiveness. Methods: The bibliographic research of the articles for the drafting of this review was carried out consulting the international Pubmed database with a specific search string to find publications that reported efficacy data (reduction of anxiety/distress and reduction of analgosedation rates) relating to non-pharmacological interventions aimed to alleviate distress in pediatric patients undergoing radiotherapy for solid tumors. Articles available online as full text, published in the last 40 years and provided with a title/abstract relating to the topic covered, were found. From the analysis of the 829 publications found by the search, 10 publications were identified that reported clinical studies relevant to the question. Results: From the review, 10 publications were identified. Among these, only 2 reported results related to randomized clinical trials, 1 reported the results of a single-arm interventional clinical trial, while 7 reported data from observational studies (2 prospective, 4 retrospective, 1 retrospective-prospective). All studies were monocentric and the number of patients included was generally quite small (number of patients included 11-313). Two studies, one on music therapy and one on the use of video projection (11 patients each) examined specific interventions, while 8 studies evaluated psychoeducational interventions, which often integrated different types of approaches (including therapeutic play), often without a clearly reported methodological framework. Only one non-randomized study (Tsai et al., 2013) observed a significant association between anxiety levels measured via the FAS scale in children who had performed the intervention and those who had not performed it, while two other studies (one prospective case-control study and a randomized study) did not observe significant differences in the levels of anxiety and distress measured using, respectively, the FAS/VAS-A scale and the OSBD scale. Of the eight studies that evaluated the impact of a psychoeducational intervention on analgosedation rates, only two observed a significant association between the intervention and lower analgosedation rates (Scott et al., 2002; Haeberli et al., 2008). In an additional study (Grissom et al., 2016), an increase in operation time was associated with a greater likelihood of partial rather than complete sedation. Finally, the study by Clerici et al. (2021) reported numerically lower S/A rates with the SIESTA protocol, while four other studies observed no significant differences. Conclusion: The present review suggests a potential impact of psycho-educational interventions in reducing distress and the need for analgosedation in pediatric patients undergoing radiotherapy. In this context, it is essential to conduct larger studies with greater methodological rigor in order to support the use of support interventions in this area. Keywords: solid tumors, radiotherapy, pediatric, non-pharmacological interventions, distress, analgosedation.
Background: La radioterapia rappresenta uno dei pilastri del trattamento di molte neoplasie dell’età pediatrica. Tuttavia, comporta sfide significative per i pazienti pediatrici che spesso necessitano di analgosedazione a causa della difficoltà nel rimanere immobili e del disagio che vi si associano. L’obiettivo di questa revisione sistematica è di esaminare possibili interventi non farmacologici volti a ridurre il distress nei pazienti pediatrici sottoposti a radioterapia per tumori solidi, valutandone l'efficacia. Metodi: La ricerca bibliografica degli articoli per la stesura della presente revisione è stata eseguita consultando il database internazionale Pubmed con apposita stringa di ricerca per reperire pubblicazioni che riportassero dati di efficacia (riduzione di ansia/distress e riduzione dei tassi di analgosedazione) relativi ad interventi non farmacologici volti ad alleviare il distress nei pazienti pediatrici sottoposti a radioterapia per tumori solidi. Sono stati reperiti articoli reperibili online come full text, pubblicati negli ultimi 40 anni e provvisti di titolo/abstract inerente l’argomento trattato. Dall’analisi delle 829 pubblicazioni reperite dalla ricerca, sono state identificate 10 pubblicazioni che riportavano studi clinici pertinenti al quesito. Risultati: Dalla revisione, sono state identificate 10 pubblicazioni. Tra queste, solo 2 erano relative a studi clinici randomizzati, 1 riportava i risultati di uno studio clinico interventistico a braccio singolo, mentre 7 riportavano i dati di studi osservazionali (2 prospettici, 4 retrospettivi, 1 retrospettivo-prospettico). Tutti gli studi erano monocentrici e la numerosità era generalmente piuttosto ridotta (numero di pazienti inclusi 11-313). Due studi, uno sulla musicoterapia e uno sull’utilizzo della proiezione di video (11 pazienti ciascuno) hanno esaminato interventi specifici, mentre altri 8 studi hanno valutato interventi di tipo psicoeducazionale, che integravano spesso diversi tipi di approcci (tra cui il gioco terapeutico), spesso senza un quadro metodologico chiaramente riportato. Solo uno studio non randomizzato (Tsai et al., 2013) ha osservato una significativa associazione tra i livelli di ansia misurati tramite la scala FAS nei bambini che avevano eseguito l'intervento e quelli che non lo avevano eseguito, mentre altri due studi (uno studio caso-controllo prospettico ed uno studio randomizzato) non hanno osservato significative differenze nei livelli di ansia e distress misurati utilizzando, rispettivamente, la scala FAS/VAS-A e la scala OSBD. Degli otto studi che hanno valutato l'impatto di un intervento psicoeducazionale sui tassi di analgosedazione, solo due hanno osservato una significativa associazione tra l’intervento ed inferiori tassi di analgosedazione (Scott et al., 2002; Haeberli et al., 2008). In uno studio aggiuntivo (Grissom et al., 2016), un aumento del tempo di intervento si associava a una maggiore probabilità di sedazione parziale anziché completa. Infine, lo studio di Clerici et al. (2021) ha riportato tassi di S/A numericamente inferiori con il protocollo SIESTA, mentre altri quattro studi non hanno osservato differenze significative. Conclusioni: La presente revisione suggerisce un potenziale impatto di interventi psico- educazionali nel ridurre il distress e la necessità di analgosedazione nel paziente pediatrico sottoposto a radioterapia. In questo contesto, è fondamentale la conduzione di studi di maggiori dimensioni e di maggior rigore metodologico al fine di supportare l’utilizzo di interventi di supporto in tale ambito. Keywords: tumori solidi, radioterapia, pediatrico, interventi non farmacologici, distress, analgosedazione.
Interventi infermieristici volti alla riduzione del distress in pazienti pediatrici sottoposti a radioterapia per tumori solidi: una revisione della letteratura
LA TORRE, CHIARA
2023/2024
Abstract
Objective: Radiotherapy represents one of the pillars of the treatment of many pediatric tumors. However, it poses significant challenges for pediatric patients who often require analgosedation due to issues remaining still and associated discomfort. The objective of this systematic review is to examine possible non-pharmacological interventions aimed at reducing distress in pediatric patients undergoing radiotherapy for solid tumors, evaluating their effectiveness. Methods: The bibliographic research of the articles for the drafting of this review was carried out consulting the international Pubmed database with a specific search string to find publications that reported efficacy data (reduction of anxiety/distress and reduction of analgosedation rates) relating to non-pharmacological interventions aimed to alleviate distress in pediatric patients undergoing radiotherapy for solid tumors. Articles available online as full text, published in the last 40 years and provided with a title/abstract relating to the topic covered, were found. From the analysis of the 829 publications found by the search, 10 publications were identified that reported clinical studies relevant to the question. Results: From the review, 10 publications were identified. Among these, only 2 reported results related to randomized clinical trials, 1 reported the results of a single-arm interventional clinical trial, while 7 reported data from observational studies (2 prospective, 4 retrospective, 1 retrospective-prospective). All studies were monocentric and the number of patients included was generally quite small (number of patients included 11-313). Two studies, one on music therapy and one on the use of video projection (11 patients each) examined specific interventions, while 8 studies evaluated psychoeducational interventions, which often integrated different types of approaches (including therapeutic play), often without a clearly reported methodological framework. Only one non-randomized study (Tsai et al., 2013) observed a significant association between anxiety levels measured via the FAS scale in children who had performed the intervention and those who had not performed it, while two other studies (one prospective case-control study and a randomized study) did not observe significant differences in the levels of anxiety and distress measured using, respectively, the FAS/VAS-A scale and the OSBD scale. Of the eight studies that evaluated the impact of a psychoeducational intervention on analgosedation rates, only two observed a significant association between the intervention and lower analgosedation rates (Scott et al., 2002; Haeberli et al., 2008). In an additional study (Grissom et al., 2016), an increase in operation time was associated with a greater likelihood of partial rather than complete sedation. Finally, the study by Clerici et al. (2021) reported numerically lower S/A rates with the SIESTA protocol, while four other studies observed no significant differences. Conclusion: The present review suggests a potential impact of psycho-educational interventions in reducing distress and the need for analgosedation in pediatric patients undergoing radiotherapy. In this context, it is essential to conduct larger studies with greater methodological rigor in order to support the use of support interventions in this area. Keywords: solid tumors, radiotherapy, pediatric, non-pharmacological interventions, distress, analgosedation.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/80746