Child's Nervous System

, Volume 29, Issue 7, pp 1123–1129 | Cite as

Efficacy of therapeutic play for pediatric brain tumor patients during external beam radiotherapy

  • Yu-Li Tsai
  • Shiow-Chwen Tsai
  • Sang-Hue Yen
  • Kai-Lin Huang
  • Pei-Fan Mu
  • Hueh-Chun Liou
  • Tai-Tong Wong
  • I-Chun Lai
  • Pin Liu
  • Hsiao-Ling Lou
  • I-Tsun Chiang
  • Yi-Wei Chen
Original Paper



External beam radiotherapy (EBRT) is frequently used to improve disease control for pediatric brain tumor patients. However, to facilitate the radiotherapy (RT) procedure, “forced” type interventions including conscious sedation or general anesthesia are frequently used to manage patients’ fear and anxiety. The aim of this study was to investigate the effects of therapeutic play (TP) in reducing anxiety for pediatric brain tumor patients treated by EBRT.


Between April 1st and September 30th, 2009, 19 young brain tumor patients, aged 3–15 years and recommended for RT, were recruited: ten to a control group and nine to the study intervention group. The study group was introduced with TP during EBRT. The Beck Youth Anxiety Inventory and the Faces Anxiety Scale were used to evaluate patients’ psychological levels of anxiety. The heart rate variability and salivary cortisol concentrations were used to indicate the patients’ physical levels of anxiety. Both the psychological and physiological tests were administered to all subjects before and after the RT procedure.


The study group had significantly lower anxiety scores and expressed fewer negative emotions than did the control group before EBRT.


TP can not only improve the quality of medical services but can also reduce costs and staffing demands. In addition, it can help lower young patients’ anxiety and fear during medical procedures. As a result, it further decreases the potential negative impacts of hospitalization on these young patients.


Radiotherapy Anxiety Sedation Therapeutic play Quality of life Brain tumor 



The authors are grateful for the financial support received for this study via grant nos.: V95A-118, VGH97B1-006, VGH100B1-022, and VGH102B008; NSC94-2516-S-154-001; DOH100-TD-C-111-007 (Department of Health, R.O.C.); and the Charity Foundation of JUT Land Development Group, Taiwan

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Yu-Li Tsai
    • 1
  • Shiow-Chwen Tsai
    • 5
  • Sang-Hue Yen
    • 1
    • 6
  • Kai-Lin Huang
    • 2
  • Pei-Fan Mu
    • 7
  • Hueh-Chun Liou
    • 1
  • Tai-Tong Wong
    • 3
    • 9
  • I-Chun Lai
    • 1
  • Pin Liu
    • 4
  • Hsiao-Ling Lou
    • 4
  • I-Tsun Chiang
    • 10
  • Yi-Wei Chen
    • 1
    • 8
    • 9
    • 11
  1. 1.Division of Radiation Oncology, Cancer CenterTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Division of Child and Adolescent Psychiatry, Department of PsychiatryTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Division of Pediatric Neurosurgery, Neurological InstituteTaipei Veterans General HospitalTaipeiTaiwan
  4. 4.Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Graduate Institute of Transition and Leisure Education for Individuals with DisabilitiesTaipei Physical Education CollegeTaipeiTaiwan
  6. 6.Department of Biomedical Imaging and Radiological SciencesNational Yang-Ming UniversityTaipeiTaiwan
  7. 7.Department and Institute of NursingNational Yang-Ming UniversityTaipeiTaiwan
  8. 8.Institute of Clinical MedicineNational Yang-Ming UniversityTaipeiTaiwan
  9. 9.Faculty of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  10. 10.Graduate Institute of Sports and HealthNational Changhua University of EducationChanghuaTaiwan
  11. 11.Cancer CenterTaipei Veterans General HospitalTaipeiTaiwan

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