Research and Scholarship

Maintaining Survival While Improving Quality of Life: An Advanced Practitioner–Led Pilot Feasibility Study to Reduce Radiation Dose in Children With Brain Tumors

Jennifer L. Raybin,(1) PhD, RN, CPNP, Andrew Donson,(1) Nicholas K. Foreman,(1) MRCP, Rajeev Vibhakar,(1) MD, Michael H. Handler,(1) MD, and Arthur K. Liu,(2) MD, PhD

From (1)Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado; (2)Radiation Oncology, University of Colorado, Aurora, Colorado

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Jennifer L. Raybin, PhD, RN, CPNP, 13123 E. 16th Avenue, Aurora, CO 80045 E-mail: jennifer.raybin@cuanschutz.edu

ABSTRACT

Purpose: Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol. Methods: An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard. Results: Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years (M = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI. Conclusion: APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.

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