Holistic approach to metastatic breast cancer symptoms with immersive virtual reality

Virtual reality (VR) has evolved from games to a useful medical intervention. The use of immersive VR in symptom management in women with metastatic breast cancer (mBC) was investigated by a team of psychologists and oncologists from the University of Auckland and the University of Wellington, both in New Zealand.1

Immersive VR is described as a head-mounted display that blocks the user’s view of the real world and presents “an interactive 3D human-computer interface that enables [users] to interact with and be immersed in a computer-generated environment in a naturalistic way.” The interface can include noise-canceling headphones so that the user feels as if they are immersed in a virtual world.

The technology has been used during chemotherapy, painful procedures such as burn debridement, and other therapeutic procedures. It has also been shown to reduce physical symptoms such as pain and nausea and vomiting. The researchers reported that its use led to an altered perception of elapsed treatment time, decreased anxiety and increased positive moods, and induced relaxation.


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Some symptoms of mBC have historically been difficult to treat. Previous studies have focused on using VR to manage a single symptom. In designing their study, the researchers sought to determine whether VR would be effective for more holistic symptom management. For example, the symptom that most affects quality of life for women with mBC is not pain, but fatigue, which can also be persistent.

An early study the researchers noted found that a VR intervention called the “Bedside Wellness System” reduced the fatigue in cancer patients. But that was just one study, and it was conducted in a hospital setting, not a patient’s home setting, the researchers noted. In fact, studies on the benefits of immersive VR for cancer patients have only been conducted in clinical settings. However, now that VR devices are easy to operate and portable, this intervention could be beneficial for patients in their own homes.

Immersive VR may produce short-term analgesia for patients using it, but the researchers wanted to determine the potential for longer-term effects. Therefore, their pilot study aimed to measure how long the effects of a home-based immersive VR system could last, as well as its effectiveness in reducing symptoms. In particular, how well did the home intervention work for study participants with mBC who were dealing with symptoms of pain, fatigue, anxiety, and depression?

The researchers enrolled 40 participants with mBC in this study. In addition to a diagnosis of mBC, eligibility criteria include age over 18; ability to wear the VR headset; and reports of fatigue, pain, or anxiety during the week prior to enrollment.

Each participant received a VR headset and headset, instructions and copies of the study questionnaires. The devices were equipped with 2 different VR applications: Happy Place and Ripple. Happy Place is a commercially available application that presents a calm, animated camping scenario. Ripple consists of a collection of 3 short interactive nature scenes: a beach, a waterfall and a mountain range. All invite the user to participate in one way or another.

The participants were divided into 2 groups according to age (younger than 50 and 50 years and older) and were instructed to use the interventions for a minimum of 10 minutes every day. Group 1 would use Ripple first and Group 2, Happy Place first for 1 week. A 1 week washout period – no VR use – was then scheduled. In the 3rd week, the groups used the other application.

Quality of life was the primary outcome measure as measured by the EQ-5D-5L. The questionnaires evaluated participants’ functioning in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and participants completed them at 6 time points. The rating scale was no problemslight problems, moderate problemssevere issues, and extreme problems† Other instruments were used to evaluate chronic fatigue, depression, anxiety and stress and pain. After each intervention session, participants also rated how well they liked it, whether they thought they would use the VR intervention again, and what suggestions they had for improvement.

Acceptance in both groups was high, with participants indicating that they would likely use VR interventions again. Participants also reported having more energy after VR so they could function at work and after they got home. Several women reported that their memory was better. Many enjoyed spending time in nature through immersive VR, and many found VR-induced relaxation helpful as well.

The researchers reported that the home-based immersive VR intervention showed improvements in the quality of life of women with mBC. It also significantly and markedly reduced fatigue, in addition to those symptoms – pain, depression and anxiety – already known to be reduced by VR use.

The findings of this study showed that patients can manage immersive VR interventions at home rather than being in a hospital or medical facility, an option proven to be acceptable to patients as well.

Finally, the beneficial effects of VR use by patients with mBC can persist for at least 48 hours after each intervention. The researchers suggest that further research could examine a longer duration of use and a wider range of results.

Reference

Reynolds LM, Cavadino A, Chin S, et al. The benefits and acceptability of virtual reality interventions for women with metastatic breast cancer at home; a randomized pilot studyBMC cancer† 2022;22(1):360. doi:10.1186/s12885-021-09081-z

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