Virtual reality may ease distress, anxiety among individuals with brain tumors
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A virtual reality therapy designed to ease anxiety associated with neuroimaging tests for patients with primary brain tumors appeared feasible, according to an interim analysis of a phase 2 clinical trial.
Researchers also reported a high level of patient acceptance.
The study — led by NCI Center for Cancer Research’s Neuro-Oncology Branch — is part of an ongoing collaboration between NCI and AppliedVR, an immersive therapeutics company.
Researchers supplied study participants with virtual reality devices containing content that aims to target symptoms and promote relaxation through 41 scenarios. These scenarios fell into three main categories — dynamic breathing, guided relaxation and instant escape.
After an initial session with the study team, participants self-administered virtual reality for 1 month. During this time, they could use the headset as often as they desired and choose any scenario offered.
“The unique thing about virtual reality is that, when you put the headset on, it offers an immersive environment that helps the patient cope,” researcher Terri S. Armstrong, PhD, ANP-BC, FAAN, FAANP, senior investigator in NCI Center for Cancer Research’s Neuro-Oncology Branch, told Healio. “People who do this learn skills that they can then apply going forward, even when they don’t have the headset on. We can facilitate these techniques that allow these virtual environments to close out everything around them and bring that anxiety down.”
Armstrong spoke with Healio about the impetus for this project, the results observed so far, and the potential for virtual reality technology to decrease the psychological burdens associated with cancer care.
Healio: What motivated you to test this intervention?
Armstrong: I’m a clinical researcher and a nurse practitioner. I have cared for patients with primary brain tumors for more than 30 years, and I often noticed patients would call us the week before they were scheduled to come in for an imaging study to report more symptoms and concerns. They also would have a lot of anxiety about test results. I think this is common across cancer types, but it seems especially pronounced with brain tumors. When you have something in your brain and there’s no other way to know what’s happening besides these scans, they become incredibly meaningful and stressful.
A few years back, I studied the concept of uncertainty among people with cancer. I learned about the use of virtual reality for other symptoms from a trainee who was working in my group as a summer intern. This young trainee came to me with an interest in exploring this novel interventional strategy for symptom management. At that time, only two studies — one in Korea and one in Italy — had looked at virtual reality for this patient population. Amanda King, PhD, an iCURE postdoctoral fellow, then joined my group and brought her expertise in stress, leading to the work in the current study.
Healio: What does the intervention consist of?
Armstrong: Applied VR supplied the headsets, and we have a few scenarios that people can select. Some scenarios are just distraction — pretty scenery or fish floating by. There are guided meditation scenarios, and others encourage slow rhythmic breathing or cardiac coherence breathing. [They] provide visual feedback that the user is doing the breathing in a way that facilitates relaxation. We allow people to choose the scenario they want. We track what they choose and how this impacts their distress and mood.
Healio: Can you describe the interim results?
Armstrong: We first assessed feasibility. When working with people with brain tumors, there may be concern that will not be able to complete certain interventions due to cognitive issues or physical limitations. Our initial questions were: Can people participate in this? Can they set it up? Can they do the scenarios? So far, we have shown they can participate in this kind of study, and they were able to do it in a way that proved helpful to them.
Another question is whether people need to have a certain level of anxiety or distress [at baseline] to benefit [from the intervention]. We began to explore that and found that people are reporting distress- and anxiety-related symptoms that otherwise may not be addressed. We published the protocol — to share with others how we set up the study — and the interim results. We are about halfway through enrollment, but we’re excited by what we’re seeing.
People think the anxiety associated with scans for [patients with brain tumors] is about claustrophobia associated with an MRI. That can happen, but there also is anxiety associated with the importance of the test and the meaning of the results. The discussion about results is an important time for patients. Sometimes we hear people physically exhale when they hear that the MRI looks good. That is the part we’re really targeting.
Healio: What are the potential long-term implications?
Armstrong: One of the first goals is to expand this research to evaluate virtual reality for other cancers within the next year. This anxiety people feel is particularly elevated prior to MRI, but it stays with them throughout their illness. They have a low-level anxiety that continues in their day-to-day life. Even though our study’s main intervention occurs around the time of the MRI, we let the patient keep the headset for the next month to manage stress and anxiety. At the end of that month, we re-evaluate them relative to stress and anxiety, and we do a qualitative interview to determine how they used it. We think it’s an important question — how to provide ongoing management for these patients — because we know this generalized anxiety often doesn’t just go away.
Healio: Is there anything else you feel is important to mention?
Armstrong: Our group plans to collect saliva samples to evaluate stress hormones and try to understand the biology of what is happening when these patients are experiencing anxiety. We believe there may be a lot more to the interaction between mood and the cancer itself. We’ve done a review looking at psychological symptoms among people with cancer, and some people may have preexisting depression and anxiety that may influence how they cope with their cancer. We really believe these interventions may be an important approach to target these kinds of symptoms. We want people to have improvements in quality of life. We hope to improve their experience and possibly improve the way they tolerate their treatment and their clinical courses. The patient is always at the center of what we do. We now want to go a step further and understand the biology — that translational aspect of it — so we can identify those at risk and perhaps modify that risk.
For more information:
Terri S. Armstrong, PhD, ANP-BC, FAAN, FAANP, can be reached at National Cancer Institute, Building 82, Room 201, Bethesda, MD 20892; email: terri.armstrong@nih.gov.
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