Virtual reality enables people to immerse themselves in a computer-generated visual and aural environment by wearing a head-mounted display device. The researchers believe that virtual reality makes for an excellent distraction intervention because it is interactive, engages several senses simultaneously and immerses participants in a new world, thereby blocking out their current and often stressful environment.
That stressful environment was almost too much for chemotherapy patient Donna Honeycutt of Elon, North Carolina. She worried that she wouldn't be able to complete the entire series of treatments she needed to have the best chance of beating her breast cancer. "You're in a room with many other people receiving chemotherapy. Some are very sick and you tend to always look at the individual who's sickest. For me, I felt sicker when I was in this environment", stated Donna Honeycutt, who underwent her chemotherapy two years ago and completed a portion of her treatments using virtual reality.
Susan Schneider, Ph.D., director of the oncology programme at Duke University School of Nursing and lead author on the paper, explained that helping patients keep their minds off the stresses of chemotherapy can be both physically and mentally important to patients. "I've been a nurse for more than 20 years, and I've noticed if patients can focus on something other than their treatments, they have less nausea and vomiting and they tolerate the treatments better", stated Dr. Schneider. "For some that distraction intervention might be knitting or reading a book, but our study examined the effectiveness virtual reality, specifically in breast cancer patients."
Dr. Schneider and researchers at Case Western Reserve enrolled 20 breast cancer patients, between the ages of 18 and 55, who were scheduled to receive chemotherapy. Participants alternatively received chemotherapy treatments with the help of virtual reality and without. While using virtual reality, patients could choose between a variety of commercially available programmes, such as walking on a beach, touring an art gallery or deep-sea diving.
"We carefully reviewed these programmes. They had to be G-rated and interactive, but not overstimulating", stated Dr. Schneider. "Fast movements can cause nausea or dizziness, and scenarios requiring too much focus on details can be overly demanding for patients receiving chemotherapy."
The goal of the intervention was to ease anxiety, fatigue and symptom distress. Symptom distress encompasses the discomfort the patients experienced from receiving chemotherapy. Such symptoms include nausea and vomiting, inability to concentrate, and fatigue. According to the researchers, such distress interferes with a person's ability to perform activities of daily living and affects quality of life. Nearly 60 percent of chemotherapy patients report some form of symptom distress.
After each treatment, the women were asked to complete surveys about their symptom distress, anxiety level and fatigue level. After treatments using the virtual reality, the participants answered open-ended surveys about their thoughts and opinions on the technology. The results of trial showed that women who used virtual reality during chemotherapy treatments reported significant decreases in symptom distress and fatigue immediately following treatments. Anxiety levels were not directly impacted by the intervention, found the researchers.
"Our data show a drop in anxiety levels directly after the treatment, but we attributed this to the patient's relief about the treatment being over", stated Dr. Schneider. "However, one added benefit was that the virtual reality seemed to make patients feel as though time was moving faster. For example, on average, a chemotherapy treatment might last 67 minutes, but patients would perceive that it only lasted 42 minutes."
All the study participants preferred chemotherapy treatments with virtual reality than using no intervention, and 95 percent of them said they would be willing to use it again. No participants reported "cyber sickness", which is dizziness, queasiness or visual disturbances resulting from use of virtual reality. No patients reported headaches due to the eight-ounce headsets or from using the technology.
Donna Honneycutt, who participated in a similar trial of Dr. Schneider's research at Duke University Medical Center, stated that she benefited greatly from using virtual reality. "I just did not get sick", she stated. "I did not get nauseated. I didn't get violently ill like most people. And I think it's because you separate yourself from that initially. The virtual reality helps take you away from it all."
Dr. Schneider's results confirm other studies she has conducted in paediatric cancer patients and women over 55 with breast cancer. Currently she is conducting a larger trial of 120 patients to study how the virtual reality intervention works for patients with colon, lung and breast cancer. The goal of the study, open to men and women over the age of 21, will determine if age, diagnosis or coping style influence how well the virtual reality works during chemotherapy treatments. Dr. Schneider is encouraged by the results and stated that virtual reality is a cost-effective intervention that works in a real world setting.
"The headsets and programmes are cost-effective and easy to use for both patients and providers. The equipment can be set up in five minutes and several patients can use a single set of equipment throughout the day", she stated. "A clinic can purchase a headset, computer and software for about $1800, and the cost of using virtual reality for a single treatment is about $5."
Dr. Schneider stated that larger studies are needed to further understand for whom virtual reality works best, how virtual reality compares to other distraction interventions and how to achieve lasting reductions in symptom distress and fatigue for patients after they have left the clinical setting.
The study was funded by the Comprehensive Cancer Center at Case Western Reserve University and University Hospitals of Cleveland, as well as an American Cancer Society Institutional research grant. Co-authors include Maryjo Price-Paul of Hospice of the Western Reserve and Lorain County Community College; Paula Silverman, M.D., Case Western Reserve University Comprehensive Cancer Center at University Hospitals Health System; and Deborah Talaba, Centers for Dialysis Care in Cleveland.