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SPARI: Seattle Proton Anesthesia Reduction Initiative, with Dr. Blau

SPARI: Seattle Proton Anesthesia Reduction Initiative, with Dr. Blau

Young children often have a hard time lying still during proton therapy or might be more frightened by the process than adult patients. Anesthesia is frequently used with small children to help them lie entirely still during this precise treatment method.

“Until last year, most patients who were six years old and younger, and even some seven- and eight-year-olds, underwent anesthesia for proton therapy,” says Molly Blau, MD, MS, chief resident of radiation oncology at UW Medicine.

While anesthesia is considered safe and is delivered by Seattle Children’s anesthesiologists, it is not entirely without drawbacks: Treatment courses can be six weeks long, which means patients need daily anesthesia; children are not allowed to eat or drink before anesthesia, and it can be stressful for the patients and their families.

 Dr. Blau has a particular interest in treating childhood cancer and wanted to explore whether fewer children could be treated with anesthesia. With the support of attending pediatric radiation oncologists Ralph Ermoian, MD and Stephanie Schaub, MD, Dr. Blau developed the Seattle Proton Anesthesia Reduction Initiative (SPARI) in an effort at the Center to reduce the number of pediatric patients undergoing anesthesia proton therapy.

SPARI is a collaboration between the various clinical staff at the Center, including child life, nursing, radiation therapists, attending radiation oncologists and anesthesiologists. Erin Behen, MS, CLSS - the Center’s child life specialist, meets with children and families to help them understand what will happen during treatment. She and the team have developed various tools to help educate both parents and patients about what the process will look and feel like.

“When children go into an experience with a better idea of what to expect — through seeing the real tools and being able to interact with these tools — they build up their ability to cope during those tougher moments,” says Behen. At the Center, we provide patients with many opportunities to ask questions, see the equipment and learn to communicate during treatment if they need a break.

“My goal is to set these children up for success from the very first moment,” adds Behen. “That means paying close attention to every sensory experience: what they might see, feel, hear, and in some cases smell.” The team checks in with the patient frequently, adjusting accommodations and increasing comfort.

Nurses and radiation therapists also take more time to coach children. Through SPARI, they have come up with ideas such as playing music, using iPads to distract children with videos, giving countdown stickers and choosing a toy from the treasure chest after each week’s session. Sometimes, children who start with anesthesia will no longer need it after a few weeks of coaching.

“The anesthesiologists have been critical partners in this,” says Dr. Blau. “They are willing to be on hand as a backup, too, if necessary.”

Thanks to this initiative, none of the 10 children currently being treated at the Center is receiving anesthesia — including a four-year-old patient. Among patients age 10 or younger, anesthesia use has decreased by 30%.

SPARI is a work in progress, with new ideas and fine-tuning happening every week. The team began the process in autumn 2020 and implemented it in early 2021.

Dr. Ermoian summarizes: “SPARI has really transformed the experience of many of our youngest and most vulnerable patients; being treated without anesthesia has been better for them and their families.”