Virtual reality (VR) has evolved from games to a useful medical intervention. The use of immersive VR in the management of symptoms in women with metastatic breast cancer (mBC) was explored by a team of psychologists and oncologists at 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 allows [users] to interact with and become immersed in a computer-generated environment in a naturalistic fashion.” The interface may include noise cancelling headphones to allow the user to feel as though they are immersed in a virtual world.
The technology has been used during chemotherapy, painful procedures such as burn wound debridement, and other therapeutic procedures. It also has been shown to reduce physical symptoms such as pain and nausea and vomiting. The researchers reported its use has resulted in altered perception of elapsed treatment time, decreased anxiety, and increased positive moods, and induced relaxation.
Some symptoms of mBC are historically difficult to treat. Previous studies focused on using VR to manage a single symptom. When conceiving their study, the researchers sought to determine if VR would be effective for more holistic symptom management. For example, the symptom that affects quality of life the most for women with mBC is not pain but fatigue, which can also be intractable.
One early study the researchers noted found that a VR intervention, the “Bedside Wellness System,” reduced cancer patients’ fatigue. But that was only one study, and it was conducted in a hospital setting, not in a patient’s home environment, the researchers commented. In fact, studies on the benefits of immersive VR for cancer patients have been undertaken only in clinical settings. However, now that VR devices are easy-to-operate and portable, this intervention may be useful for patients in their own home.
Immersive VR may produce analgesia in the short term for patients who use it, but the researchers wanted to determine the potential for longer term effects. Therefore, their pilot study sought to measure how long the effects of a home-based immersive VR system might last, as well as its effectiveness at reducing symptoms. Specifically, how well did the intervention work in the home setting for study participants with mBC who were dealing with symptoms of pain, fatigue, anxiety, and depression?
The researchers enrolled 40 participants with mBC for this study. In addition to a diagnosis of mBC, eligibility criteria included age older than 18; ability to wear the VR headset; and reports of experiencing fatigue, pain, or anxiety during the week before enrollment.
Each participant received a VR headset and headphones, 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 envisions a tranquil animated camping scenario. Ripple comprises a collection of 3 short interactive nature scenes: a beach, a waterfall, and a mountain range. All invite the user to participate in some way.
The participants were assigned by age to 2 groups (younger than 50 and 50 years and older) and instructed to use the interventions for a minimum of 10 minutes each day. Group 1 was to use Ripple first and Group 2, Happy Place first for 1 week. Then, a 1-week washout period — no VR use — was scheduled. In the 3rd week, the groups used the other application.
Quality of life was the primary outcome, measured with the EQ-5D-5L. The questionnaires evaluated participants’ functioning in areas of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and participants completed them at 6 time points. The rating scale was no problems, slight problems, moderate problems, severe problems, and extreme problems. Other tools were used to evaluate chronic fatigue, depression, anxiety and stress, and pain. After each intervention session the 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.
Acceptability in both groups was high, with participants reporting 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 their memory was better. Many enjoyed spending time in nature through immersive VR, and many also found VR-induced relaxation helpful.
The researchers reported that the home-based immersive VR intervention demonstrated improvements in quality of life for women with mBC. It also importantly and clearly reduced fatigue, in addition to those symptoms — pain, depression, and anxiety — already known to be reduced with VR use.
The findings of this study showed that patients can manage immersive VR interventions at their home rather than being in a hospital or medical facility, an option proven to be acceptable by patients as well.
Lastly, the beneficial effects of VR use by patients with mBC can be sustained for at least 48 hours after each intervention. The researchers suggest further research could explore longer duration of use and a wider range of outcomes.
Reynolds LM, Cavadino A, Chin S, et al. The benefits and acceptability of virtual reality interventions for women with metastatic breast cancer in their homes; a pilot randomised trial. BMC Cancer. 2022;22(1):360. doi:10.1186/s12885-021-09081-z