Jan. 30, 2004 DURHAM, N.C. -- Women with breast cancer have fewer adverse effects from chemotherapy and less fatigue when using virtual reality as a distraction intervention during treatments, according to a study from the Duke University School of Nursing and Case Western Reserve Comprehensive Cancer Center.
In the study, published in the January 2004 issue of Oncology Nursing Forum, the researchers described how chemotherapy patients eased their fatigue and discomfort by solving a mystery, touring an art gallery or going deep-sea diving in a virtual environment as they underwent treatment.
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, N.C. 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," said 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 program at Duke University School of Nursing and lead author on the paper, said 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," said 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."
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 programs, such as walking on a beach, touring an art gallery or deep-sea diving.
"We carefully reviewed these programs. They had to be G-rated and interactive, but not overstimulating," said 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 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," said 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 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.
Honneycutt, who participated in a similar trial of Schneider's at Duke University Medical Center, said she benefited greatly from using virtual reality.
"I just did not get sick," she said. "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."
Schneider's results confirm other studies she has conducted in pediatric 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. Schneider is encouraged by the results and said that virtual reality is a cost-effective intervention that works in a real world setting.
"The headsets and programs 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 said. "A clinic can purchase a headset, computer and software for about $1,800, and the cost of using virtual reality for a single treatment is about $5."
Schneider said 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.
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