Virtual Reality Aids Women During Chemotherapy Treatment

Distraction Takes Focus Off Treatment

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 report in the Oncology Nursing Forum.

The researchers, from the Duke University School of Nursing and Case Western Reserve Comprehensive Cancer Center, 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.

Patient Recounts Chemotherapy Experience

That stressful environment was almost too much for chemotherapy patient Donna Honeycutt of Elon, NC. She worried that she would not 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," says Honeycutt. "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."  Honeycutt underwent chemotherapy two years ago and completed a portion of her treatments using virtual reality.

Dr. Susan Schneider, 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 Dr. Schneider. "For some that distraction intervention might be knitting or reading a book, but our study examined the effectiveness of virtual reality, specifically in breast cancer patients."

Walking on a Beach, Deep-sea Diving

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 programs, such as walking on a beach, touring an art gallery, or deep-sea diving.

"We carefully reviewed these programs," Dr. Schneider says. "They had to be G-rated and interactive, but not overstimulating. 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.

Distress and Fatigue Lessened

The results 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," said 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 rather than using no intervention, and 95 percent of the participants 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 Dr. 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."

Dr. 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.

Dr. 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," she says. "The equipment can be set up in five minutes and several patients can use a single set of equipment throughout the day. 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."

Dr. 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.

Always consult your physician for more information.

Online Resources

American Cancer Society

American Society for Clinical Oncology

Centers for Disease Control and Prevention (CDC)

National Cancer Institute

National Institutes of Health (NIH)

National Institutes of Mental Health

National Women's Health Information Center 

March 2004

Virtual Reality Aids Women During Chemotherapy Treatment

Patient Recounts Chemotherapy Experience

Distress and Fatigue Lessened

What Is Chemotherapy?

Experiencing Chemotherapy

Online Resources

Other Resources:

St. John's Mercy Cancer Services

Find a St. John's Mercy Physician

Breast Health Information

Women's Health Information

St. John's Mercy Classes and Programs

What Is Chemotherapy?

Chemotherapy is the use of anticancer drugs to treat cancerous cells. Chemotherapy has been used for many years and is one of the most common treatments for cancer. 

In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce.

Different groups of drugs work in different ways to fight cancer cells. Chemotherapy may be used alone for some types of cancer or in combination with other treatments such as radiation or surgery.

Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer being treated.

While chemotherapy can be quite effective in treating certain cancers, chemotherapy drugs reach all parts of the body, not just the cancer cells.

Because of this, there may be many side effects during treatment. Being able to anticipate these side effects can help you and your caregivers prepare, and, in some cases prevent these symptoms from occurring.

Chemotherapy can be given in many different places: at home, a physician's office, a clinic, a hospital's outpatient department, or as an "inpatient" in a hospital, states the National Cancer Institute (NCI).

The choice of where a woman receives chemotherapy depends on which medications she is getting, her insurance, and sometimes her own and her physician's wishes.

Most patients receive their treatment as an "outpatient" and are not hospitalized. Sometimes, a patient starting chemotherapy may need to stay at the hospital for a short time so that the medication's effects can be watched closely and any needed changes can be made.

Chemotherapy can be given in several ways:

Experiencing Chemotherapy

According to the National Cancer Institute (NCI), most women receiving chemotherapy find that they tire easily, but many feel well enough to continue to lead active lives.

Each woman and treatment is different, so it is not always possible to tell exactly how a person will react.

An individual's general state of health, the type and extent of cancer she has, and the kind of medications that are given can all affect how someone feels.

Women may want to have someone available to drive them to and from treatment if, for example, they are taking medicine for nausea or vomiting that could make them tired.

Following treatment, a woman may feel especially tired from the chemotherapy as early as one day later and for several days.

It may help for individuals to schedule treatment when they can take off the day of and the day after their treatment. If they have young children, scheduling the treatment with someone at home the day of and at least the day after treatment is helpful.  

Most women can continue working while receiving chemotherapy.

However, they may need to change a work schedule for a while if chemotherapy makes results in fatigue or other side effects.

Women should talk with their employer about needs and wishes. It may be possible to agree on a part-time schedule, find an area for a short nap during the day, or perhaps work at home.

Questions to ask a physician include:

• What are the short-term side effects that may occur?
  
  
• What are the long-term side effects that may occur?
  
  
• How serious are the side effects likely to be?
  
  
• How long will the side effects last?
  
  
• What can I do to relieve or lessen the side effects?
  
  
• When should I call my physician or nurse about side effects?
  
  
• What can I do to feel better emotionally while trying to cope with the side effects?
  

Always consult your physician for more information.