Reimagineering chemotherapy

Fun isn’t what you’d typically expect in a chemotherapy infusion room. Yet, that’s precisely the environment an adolescent and young adult oncologist and a former Disney Imagineer created with the Infusionarium concept.

Leonard Sender, MD, medical director of adolescent and young adult cancer care at Hyundai Cancer Institute, Children’s Hospital of Orange County (CHOC) in Orange, California, says that although he couldn’t change that teenagers with cancer would need chemotherapy, he could change the environment in which they received chemo and other types of infusion therapy. He did just that, while also creating a template for other hospitals or facilities to change any therapy room that keeps young patients captive into a virtual wonderland.

The Infusionarium at CHOC Children’s has transformed the sterile, cold infusion environment into an interactive distraction.

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“My passion has always been the teenagers and young adults and understanding the needs of that population of cancer patients. One of the things that I realized a long time ago is that there is a lot being done for our babies and the little kids at children’s hospitals who have cancer, but not a lot has been done for teenagers,” says Sender, who was chairman of Stupid Cancer, a decade-old nonprofit aimed at making “cancer suck less” for young adults, according to Stupidcancer.org. He also founded and serves as chairman of SeventyK.org, an advocacy foundation charged with improving survival rates for adolescents and young adults with cancer.

Imagine this

The jellyfish exhibit at the Monterey Bay Aquarium, Monterey, California, is Sender’s favorite place to escape. So, when he and a colleague brainstormed about where they’d like to heal if they had cancer and needed chemotherapy, being immersed in mesmerizing visions of floating jellyfish came to mind. “Out of that, we coined the term ‘Infusionarium,’ which is really an infusion room and an aquarium,” he says.

To bring the vision to life at CHOC Children’s, Sender contacted former Disney Imagineer Roger Holzberg, who later with Sender cofounded Reimagine Well (ReimagineWell.com), the Laguna Beach, California-based company that creates these immersive healing environments.

Holzberg has more than a knack for creating an imagined reality. He also has experience with being a cancer patient. Diagnosed with stage 1 thyroid cancer on the eve of his 50^th birthday, Holzberg endured high-dose radioactive iodine treatment.

“This involves being locked up in a lead-lined room in a hospital until the radioactivity levels in your body have ‘cooled’ down enough for you to be back in contact with the general public. I remember the experience as being surreal and freaky. I’m surprised it’s never been used in a horror movie!” Holzberg says. “This experience was part of my motivation to find a way to treat patients in a more healing way.”

Holzberg remembers beginning a swim off the coast of Malibu. He had just gotten past the surf break when a pair of dolphins and pups popped up no more than 6 feet away, he says.

“[The dolphins] spent the next 8 to 10 minutes checking me out, playing, and bringing total magic into my world. This was my healing place,” Holzberg says. “The light bulb went off. As a former Disney Imagineer, my job was to create theme park attractions, and I realized that, while in treatment, I could have been here in every way but physically.”

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Build it and they will come

To keep down construction costs, Sender and Holzberg came up with a plan to redesign the existing infusionvspace at CHOC Children’s withoutvtearing down walls or adding more space.

Sender presented the idea to Hyundai, the major donor to the CHOC Children’s cancer center, and the company funded the first Infusionarium in the world from the carmaker’s philanthropy.

Today, CHOC Children’s teenaged cancer patients get their chemo infusions while distracted by an entertaining world created by high technology. The options are not only to entertain but also to educate. Hospitals can tailor content featured in the Infusionarium to help patients and families better understand cancer, to learn about individual therapies, and to learn about the hospital itself and how to navigate it, according to Sender.

“You can watch TV. You can watch a DVD. You can play an Xbox game, so you can connect with other patients somewhere else, using videoconferencing. You can teleport yourself to somewhere else,” Sender says. “We regularly leave the hospital virtually for live events. Several times we’ve gone to NASA’s Jet Propulsion Laboratory in Pasadena [California] to pilot the Mars Rover. We had a planetary scientist give a tour-a virtual tour-by videoconferencing with our patients while we gave them chemotherapy. We’ve gone live to the Monterey Bay Aquarium to visit sea otters. We have had kids playing Xbox World Cup Soccer while watching the real live World Cup.”

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In addition to the Infusionarium in the hospital’s outpatient infusion center, Reimagine Well has since added an in-hospital lounge space with a built-in Infusionarium, where hospitalized teenagers gather at night, watch movies together, play games, and visit their immersive healing places.

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No formal studies, but a lot of thumbs-up

Although Sender hasn’t formally studied outcomes from use of the Infusionarium, he says, anecdotally, that the concept diminishes fear, is a positive distraction for patients and families, and might help with compliance.

Studies looking at distractions in cancer treatment are scant. In a study published in 2015, researchers reported that using iPads to introduce meditation and reduce distress was a promising approach for patients undergoing chemotherapy.¹

“We do a lot of clinical trials and basic research in our program, but this is about the kids. What can we do for the kids to make their lives easier and make them feel special?” Sender says.

Teenaged patients have asked to stay in the infusion room after their treatment because they were having so much fun, according to Sender.

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Ali Langdon, RN, BSN, CPON, clinical nurse manager, outpatient services, at the Hyundai Cancer Institute, CHOC Children’s, says she could go on and on about the good that comes from having the Infusionarium.

“Our patients absolutely love the Infusionarium. Children who have received their chemotherapy or infusions in the Infusionarium have required significantly less, if any, supportive medications to tolerate their treatment. To see patients who went from needing antinausea medicine with every treatment to not utilizing any medications is a testament to the effects of the Infusionarium,” Langdon says.

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Not only teenagers but also younger patients and their families benefit, according to Langdon.

“It is so wonderful to see parents, sitting with their little ones in the Infusionarium chair, lost in a movie. They forget that they have chemotherapy infusing and are stuck at the hospital for the day,” she says. “Parents and patients have said to me that they do not even hear the constant beeping from intravenous poles, overhead pages, and so on. They are relaxed enough to just watch a movie with their sweet baby and forget about cancer treatment, if only for a few hours, even with the medicine infusing as they sit there.”

These children go through a lot, and the Infusionarium makes the experience less scary, Sender says.

“We really did this more because we thought it was the right thing. It comes down to my concept of how can we change the experience of anyone who goes through cancer. Can we actually create an environment where cancer becomes less fearful?” he says.

It’s catching on

Other hospitals in the United States have built Infusionariums as well. St. Joseph’s Children’s Hospital in Tampa, Florida, has its own Infusionarium, with its own set of immersive healing experiences for patients. In addition, there are 2 Infusionariums at Baptist Hospital South Florida and a brand new Infusionarium at the new Miami Cancer Institute, Miami, Florida.

“Inside the Infusionarium, our patients have the opportunity to explore the world through immersive videos, watch a movie on a jumbo screen, play their favorite video games, and more. Future phases of the technology will provide the opportunity for the hospitalized kids to participate in live events and to access the Infusionarium library from the TV in their patient room or portable audiovisual Infusionarium units,” according to Jazleen Vecchiarelli, manager of clinical services for St. Joseph’s Children’s Hospital.

Sender says, depending on a room’s size, it costs from $70,000 to $200,000 and more to transform an infusion area into an Infusionarium.

“As a cancer physician, our goal is to cure the kids of cancer, but we don’t always do that. The question is, for the time that they have, why don’t we give them the best?” Sender says.

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The concept isn’t limited to cancer treatment. It can be used anywhere children have to receive therapy, including dialysis.

“My goal is to have [Infusionariums] around the country at all the children’s hospitals, and then connect the kids from different geographies to talk to one another while they’re going through therapy to make friends and learn, together,” Sender says.

REFERENCE

1. Millegan J, Manschot B, Dispenzieri M, et al. Leveraging iPads to introduce meditation and reduce distress among cancer patients undergoing chemotherapy: a promising approach. Support Care Cancer. 2015;23(12):3393-3394.