Effect of virtual reality on time perception in patients receiving chemotherapy

Brain Signatures of Time Perception in Virtual Reality

Achieving a high level of immersion and adaptation in virtual reality (VR) requires precise measurement and representation of user state. While extrinsic physical characteristics such as locomotion and pose can be accurately tracked in real-time, reliably capturing mental states is more challenging. Quantitative psychology allows considering more intrinsic features like emotion, attention, or cognitive load. Time perception, in particular, is strongly tied to users' mental states, including stress, focus, and boredom. However, research on objectively measuring the pace at which we perceive the passage of time is scarce. In this work, we investigate the potential of electroencephalography (EEG) as an objective measure of time perception in VR, exploring neural correlates with oscillatory responses and time-frequency analysis. To this end, we implemented a variety of time perception modulators in VR, collected EEG recordings, and labeled them with overestimation, correct estimation, and underestimation time perception states. We found clear EEG spectral signatures for these three states, that are persistent across individuals, modulators, and modulation duration. These signatures can be integrated and applied to monitor and actively influence time perception in VR, allowing the virtual environment to be purposefully adapted to the individual to increase immersion further and improve user experience. A free copy of this paper and all supplemental materials are available at https://vrarlab.uni.lu/pub/brain-signatures.

The Effect of Virtual Reality on Chemotherapy-Associated Stress (Cortisol Value), Anxiety, and Pain Symptoms of Mastectomy Patients: A Randomized Controlled Pilot Study

BACKGROUND

Pain, anxiety, and stress are the most common symptoms experienced by patients receiving chemotherapy after breast surgery. Virtual reality (VR) can be used as a method to manage these symptoms.

OBJECTIVE

To determine the effect of VR on chemotherapy-associated stress (salivary cortisol value), anxiety, pain, and vital signs of mastectomy patients.

METHODS

A total of 62 participants were enrolled in this randomized, 2-group design. Participants in the experimental group watched videos with VR glasses during their chemotherapy treatments. Saliva samples were collected from participants in both the control and experimental groups before and immediately after their chemotherapy treatments. The Personal Information Form, state anxiety component of the State-Trait Anxiety Inventory, visual analog scale, and the patients' vital signs were also collected.

RESULTS

The State-Trait Anxiety Inventory state anxiety component and visual analog scale scores and the stress value mean scores differed significantly between the 2 groups at the second data point. There was also a statistically significant decrease in systolic blood pressure and diastolic blood pressure after chemotherapy in the experimental group.

CONCLUSION

The use of VR in women receiving chemotherapy significantly reduced their pain, anxiety, stress and blood pressure from before to immediately following the chemotherapy infusion.

IMPLICATIONS FOR PRACTICE

VR can be an appropriate intervention to reduce pain, anxiety, and stress in patients receiving chemotherapy after mastectomy.

Effectiveness of virtual reality in cancer patients undergoing chemotherapy. Systematic review

Virtual reality is on the rise and is currently postulated as one of the most innovative and promising techniques in the management of pain and anxiety in cancer patients, in the face of painful processes or the stress involved in chemotherapy treatment. The objective has been to find out the effectiveness of virtual reality in patients undergoing chemotherapy. Several literature reviews were conducted between November 2023 and January 2024 in the Pubmed, Web of Science and PEDro databases. The keywords "virtual reality," "cancer," "oncology," "exercise" and "chemotherapy" were combined using the Boolean operator AND. 641 manuscripts were selected as potential manuscripts and after elimination of duplicates and application of the inclusion and exclusion criteria, six articles comprised the final review sample. Virtual reality has proven to be an effective technique in reducing the anxiety, pain, asthenia and stress suffered by patients diagnosed with cancer and chemotherapy treatment. The distraction generated by this therapeutic modality, with a wide range of scenarios, helps to reduce the painful perception and worry of these procedures. However, there are no standard application guidelines or application protocols that demonstrate the superiority of one technique over another. Virtual reality could be a valid complementary tool in the treatment of patients undergoing chemotherapy, showing positive results in pain reduction, anxiety, stress or asthenia. More studies are needed, with larger sample sizes and long-term follow-ups to establish treatment protocols in relation to the frequency, intensity, duration and periodicity of interventions with virtual reality.

Heterogeneity in Pancreatitis: Recognizing Heterogeneity and Its Role in the Management of Pancreatitis Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop

ABSTRACT

Both the clinical management and study of recurrent acute pancreatitis and chronic pancreatitis are complicated by significant heterogeneity in the etiology, mechanisms, symptoms, and complications of pancreatitis. The National Institutes of Diabetes and Digestive and Kidney Disease recently convened a workshop to address current knowledge and knowledge gaps in the field. Preclinical models that better replicate human disease are important for development of new therapies. Pain is often the most common and most difficult symptom to treat, as the causes are multifactorial and effective treatment may vary depending on whether pain is neuropathic or nociceptive in origin, and the placebo effect can complicate evaluation of the efficacy of medical and procedural interventions. Novel technologies like functional magnetic resonance imaging and virtual reality may offer novel means for assessing and treating pain, respectively. Clinical trial designs will need to consider best approaches to addressing the heterogeneity of chronic pancreatitis, including careful attention to designing eligibility criteria, and establishing accepted and validated core outcomes criteria for the field. The latter may be informed by consensus in pain research. Recruitment of participants into clinical trials has been challenging, often requiring multiple centers. Establishment of a clinical trials network would facilitate greater opportunities for therapeutic trials in pancreatitis.

Effects of Virtual Reality on Pain, Stress, and Affect in an Outpatient Chemotherapy Infusion Clinic: A Randomized Controlled Trial

BACKGROUND

Virtual reality (VR) is a useful therapeutic tool in various patient populations. Patients with cancer may benefit from VR during chemotherapy to address concerns like negative affect, stress, and physical side effects.

OBJECTIVES

The aim of this study was to evaluate the effects of VR on pain, stress, and affect in patients with cancer receiving chemotherapy.

METHODS

Ninety patients were randomized into control and study groups. The study group received a 12-minute VR session while undergoing chemotherapy. Participants took surveys measuring stress, pain, affect, cybersickness, and satisfaction, and heart rates were measured before and halfway through.

FINDINGS

There were statistically significant decreases in stress and pain among patients using VR. Positive affect was significantly elevated, and negative affect was significantly reduced. Heart rate measurements indicated reduced stress. Most patients reported high satisfaction with VR and experienced no feelings of cybersickness.

Virtual reality therapy in managing cancer pain in middle-aged and elderly: a systematic review and meta-analysis

Background

Virtual reality technology has been proposed to rehabilitate cancer patients. This study aimed to summarize the effectiveness of virtual reality (VR)--based therapies for pain management in middle-aged and elderly cancer patients.

Methods

This meta-analysis was registered in PROSPERO (CRD42023400432). We searched the randomized controlled trials (RCTs) in PubMed, Scopus, the Cochrane Library, Web of Science, and Embase, conducted from construction until November 1, 2024. The study examined the effects of VR treatment on pain levels in middle-aged and elderly cancer patients using RCTs as primary or secondary outcome measures. Articles were evaluated for eligibility according to predetermined criteria, and each of the three researchers independently collected the data. The researchers used the heterogeneous selection effects model to calculate the mean effect sizes.

Results

This meta-analysis included seven RCTs involving 476 patients. The meta-analysis confirmed the significant effect of VR therapy on the management of pain, anxiety, and depression in the middle-aged and elderly cancer population.

Conclusions

Our research shows that VR could be a significant device for cancer pain management in the middle-aged and elderly and that VR scene therapy may be more effective. Nevertheless, it is essential to use caution when interpreting the findings since the number of research included is small.

Workout at a virtual gym: Surrounding avatar's motion speed and exercise intensity effect on the user's time perception

This study explored the relationship between surrounding avatars and time perception in a virtual reality (VR) gymnasium. Previous research has highlighted that motion speed and exercise intensity significantly influence time perception. In VR, time perception is shaped by various factors, such as an avatar's embodiment at different levels. However, the specific effects of the surrounding avatar on time perception in a VR gymnasium context remain unclear. Thus, this study focuses on two key attributes of the surrounding avatar: (1) motion speeds and (2) exercise intensity. Participants in a VR gymnasium either rode a stationary bike or sat on one while observing avatars performing exercises in the virtual environment(VE). They were then asked to estimate the duration judgment and the feeling of the passage of time for each task. The results revealed that when the surrounding avatars exercised at a faster motion speed, participants perceived the duration of time as longer and felt that time passed more quickly. Additionally, high-intensity exercise led participants to perceive the passage of time as faster.

Virtual Reality for Postoperative Pain Management: A Review of Current Evidence

PURPOSE OF REVIEW

With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures.

RECENT FINDINGS

Severe postoperative pain is associated with an increased risk of medical complications and may lead to the development of chronic pain. VR-based interventions are a form of distraction therapy that attenuates pain perception and have been shown to reduce activity in central pain-processing regions. In patients undergoing cardiac surgery, VR may reduce postoperative pain and improve physiological parameters such as heart rate and blood pressure. VR technology was found to have a high satisfaction rate in patients undergoing laparoscopic abdominal surgeries. Three-dimensional (3D) VR interventions may be useful for postoperative pain control in patients undergoing head and neck surgery. VR technology has revealed mixed results for postoperative pain control following orthopedic procedures although it has beneficial effects on functional outcomes during postoperative rehabilitation. In the pediatric population, VR is notable for its applicability in postoperative pain control and anxiety. VR technology is a novel, non-pharmacologic adjunct in the management of postoperative pain. Current studies are limited regarding therapy adaptations for the elderly population. High-quality randomized controlled trials are needed to establish the clinical effectiveness of VR-based therapies in the postoperative setting.

The Efficacy of Virtual Reality-Based Interventions on Pain, Anxiety, Depression, and Quality of Life Among Patients With Cancer: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Although cancer patients are living longer, the numerous physical and psychological outcomes of cancer can still be burdensome. Pain, anxiety, depression, and decreased quality of life are symptoms that are highly impacted by cancer. The availability of modalities to cope with these symptoms is critical. Virtual reality-based interventions have been used among patients with cancer, but their effects on pain, anxiety, depression, and quality of life remain unclear.

OBJECTIVE

To determine the efficacy of virtual reality-based interventions on pain, anxiety, depression, and quality of life among cancer patients and to assess the efficacy of different contents and duration.

METHODS

Nine databases were retrieved from inception to July 31, 2024. The methodological quality was evaluated via the Cochrane Risk of Bias 2.0 tool. Data synthesis was conducted with Stata version 16.0, and sensitivity analysis and subgroup analysis were also performed.

RESULTS

Virtual reality-based interventions can soothe pain and anxiety. Subgroup analysis revealed that interventions focused on playing games and watching videos were effective at reducing pain. In addition, enjoying landscapes, receiving treatment-related health education, and watching videos were effective at decreasing anxiety; moreover, short-term (≤6 weeks) interventions were effective at relieving pain.

CONCLUSIONS

Virtual reality-based interventions are effective at decreasing pain and anxiety. The contents and duration of the intervention had an impact on their effectiveness.

IMPLICATIONS FOR NURSING PRACTICE

Symptom management is a paramount aspect of clinical cancer care. In daily oncology nursing, we encourage nurses to utilize the benefits of virtual reality-based interventions to improve cancer patients' experience with medical treatment.

Chemotherapy infusion for cancer patients with the assistance of immersive virtual reality (IVR): a scoping review of the literature

PURPOSE

To summarize scientific findings related to cancer patients undergoing chemotherapy infusions assisted by Immersive Virtual Reality (IVR). The study focused on the involvement of nurses, the sole healthcare professionals authorized to administer the chemotherapy infusion, and evaluated the extent to which IVR helped reduce anxiety and distress.

METHOD

To conduct this review, various databases, including Medline (via Pubmed), Web of Science (WoS), CINAHL, Scopus, and Google Scholar were searched. The PRISMA guidelines were followed in accordance with the EQUATOR checklist.

RESULTS

Relevant articles were identified by searching for studies that explored the use of IVR to support cancer patients undergoing chemotherapy infusions, assessed their perceived anxiety and stress levels, and discussed the role of nurses in this context. A total of 23 papers were included in the review.

CONCLUSIONS

Most of these studies indicated that using IVR to distract patients during chemotherapy infusions led to a reduction in anxiety and distress levels. This not only facilitated the nursing care process but also improved the patient's compliance with the therapy regimen.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PURPOSE

The purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia.

DESIGN

This was a randomized controlled experimental trial.

METHODS

The research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate.

FINDINGS

When the groups' VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05).

CONCLUSIONS

VR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial

Background

Patients with breast cancer endure high levels of psychological and physical pain. Virtual reality (VR) may be an acceptable, safe intervention to alleviate the negative emotions and pain of patients with cancer.

Objective

We aimed to test the long-term effects of VR on psychological distress and quality of life (QOL) with traditional care in Chinese patients with breast cancer. We also explored the intervention mechanism and the acceptability of VR.

Methods

A total of 327 eligible participants were randomly assigned to a VR intervention group or a control group. The Distress Thermometer, QLQ-C30 (Quality of Life Questionnaire version 3.0), and Virtual Reality Symptom Questionnaire were assessed at baseline, postintervention (3 mo), and follow-up (6 mo). Analysis followed the intention-to-treat (ITT) principle. The generalized estimating equations model was used to analyze the longitudinal data, and the PROCESS macro was used to analyze the mediating effect.

Results

Compared with the control group, patients with breast cancer in the VR group had lower distress scores (P=.007), and higher health-related QOL scores (physical, role, emotional, cognitive, and social functioning) after 6 months (P<.05). Psychological distress had mediating effects on the longitudinal association between VR and the health-related QOL (indirect effect=4.572-6.672, all P<.05).

Conclusions

VR intervention technology may help reduce distress and improve QOL for patients with breast cancer over time. By incorporating a mediating analysis, we showed that the QOL benefits of VR intervention was manifested through positive effects on psychological distress risk factors.

Analgesic Use of Virtual Reality for Burn Dressing Changes in Low- and Middle-income Countries: A Feasibility Study

Background

The paucity of pain management options in resource-limited settings is a significant and systemically unaddressed problem. To improve global health equity, it is important to bridge this gap in care without introducing the peril of opioid dependence. We present a proof-of-concept case series wherein virtual reality (VR) was successfully used to manage discomfort in patients undergoing burn dressing changes in sub-Saharan Africa.

Methods

Nine patients presenting with burn injuries of variable severity underwent routine stabilization and dressing as part of standard-of-care treatment. During dressing changes, a VR intervention consisting of the Dream Flight interactive game displayed on an Oculus Quest 2 headset was offered to patients. Patient mood scores were collected before VR initiation and at the conclusion of the dressing change by a translator using the Youth Feelings Scale.

Results

There were no adverse events associated with use of the VR headset and no patients elected to terminate the VR during their procedure. Patients and physicians subjectively reported satisfaction with the device's utility in the procedure. Before VR initiation, the 95% confidence interval for patient mood score was 4.89 ± 1.725. After VR initiation, the 95% confidence interval for patient mood score was 8.78 ± 1.40.

Conclusions

Our results of this proof-of-concept case series to suggest both feasibility of use and positive influence on patient discomfort and periprocedural satisfaction. We propose that VR should be explored as an analgesic alternative and/or adjunct to narcotics in resource-limited countries, particularly for high-pain, low-duration procedures.

Application of virtual reality for supportive care in cancer patients: a systematic review

BACKGROUND

In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients.

METHOD

This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively.

RESULTS

A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported.

CONCLUSION

VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.

Effectiveness of Virtual Reality in the Management of Anxiety and Pain Peri-Treatment for Breast Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Breast cancer is the second most common cancer in humans. Its therapy procedures such as breast biopsy can cause anxiety and persistent pain in patients. Virtual reality (VR) has been applied to promote comfort in various populations. However, the effectiveness of VR in relieving pain and anxiety in patients undergoing breast cancer treatment is unclear.

PURPOSE

This study was designed to examine the effect of VR on anxiety and pain in people undergoing treatment for breast cancer.

METHODS

PubMed, Cochrane, Embase, Scopus, Web of Science, and MEDLINE databases were searched for studies involving VR, pain, and anxiety in patients with breast cancer published up to March 2022. The Cochrane Handbook for Systems quality evaluation standard 6.3.0 was followed to assess risk of bias in the identified studies, with the results reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Subsequently, a meta-analysis of the included data was conducted using RevMan 5.3 software.

RESULTS

Six randomized controlled trials and one quasi-experimental study were included. The strength of the evidence ranged from moderate to high. Although VR was found to ameliorate anxiety in patients with breast cancer, only three studies showed statistically significant changes. All of the included studies reported statistically significant improvement in pain levels. In addition, two of the studies reported cybersickness symptoms as a common side effect of VR.

CONCLUSIONS

VR has an important role to play in alleviating pain in patients with breast cancer. However, evidence demonstrating VR's importance in alleviating anxiety symptoms in this population is insufficient. Studies conducted with larger sample sizes and high-quality research methodologies will be necessary to clarify this issue. Clinical nurses should address the potential side effects of VR.

The Usefulness of Virtual Reality in Symptom Management during Chemotherapy in Lung Cancer Patients: A Quasi-Experimental Study

Background: Virtual reality (VR) emerges as a promising non-pharmacological intervention for managing symptoms and providing distraction during chemotherapy. This study aims to assess VR's effectiveness on cancer-related symptoms, vital signs, and the patients' perception of chemotherapy in lung cancer patients. Methods: A quasi-experimental study was conducted on 100 patients. Participants were allocated into an intervention group (n = 55), which experienced immersive VR, and a comparison group (n = 45), which received usual care. Data were collected through questionnaires and checklists, including feedback on the VR experience, pain, vital signs, and common cancer symptoms, assessed through the Edmonton Symptom Assessment Scale. Results: VR had a significant impact on reducing the perception of chemotherapy length. Patients reported high levels of satisfaction and tolerability. No adverse events were observed. VR did not have significant influence on pain intensity or vital signs. The only exceptions were oxygen saturation, where a significant difference (p = 0.02) was reported, and the perception of chemotherapy duration. Conclusions: As a non-pharmacological intervention, VR proves to be beneficial in minimizing the perceived length of chemotherapy sessions for lung cancer patients, enhancing their overall treatment experience. The intervention was found to be a safe, feasible, and well-accepted distraction technique. Future research should explore VR's potential effects on a wider range of symptoms and evaluate its impact on long-term outcomes.

Virtual Reality During Chemotherapy Infusion: An Innovative Intervention in Holistic Nursing Practice

Patients with cancer receiving infusional chemotherapy show negative symptoms such as worry about their survival, anxiety, anguish, depression, fear, magnified perception of the passage of time, and difficulty managing boredom. Patients also suffer various side effects produced by chemotherapy such as nausea, vomiting, pain, and fatigue, which, together with psychological distress, drastically reduce their quality of life and adherence to therapy with a corresponding reduction in the probability of the individual's survival. Virtual Reality is one of the most innovative and promising digital health interventions, capable of quickly and effectively producing a positive influence on the psychosomatic axis, improving patients' quality of life during chemotherapy. Virtual Reality, through its 3-dimensional multisensory technology, isolates sensory channels from the negative external environment and enables an experience of being physically and psychologically present within virtual scenarios, in which patients can perceive sensations, emotions, cognitions, and interactions as if they really were in different surroundings. This article systematically expounds the scientific conditions necessary for effective, appropriate, and safe implementation of Virtual Reality interventions in holistic nursing practice, describing the underpinning conceptual framework, the types, technological characteristics, methods of use, duration, type of virtual content, and implementation procedure of Virtual Reality.

The effects of emotion on retrospective duration memory using virtual reality

Our memories for temporal duration may be colored by the emotions we experience during an event. While emotion generally enhances some aspects of memory, temporal duration has been shown to be particularly susceptible to emotion-induced distortions. However, prior work has faced difficulty when studying this phenomenon, having to make some trade-offs on ecological validity or experimental control. Here, we sought to bridge this gap by studying the effects of emotion on temporal duration memory using virtual reality. In the present study, a final sample of 69 participants experienced a series of negative-emotional and neutral worlds within virtual reality. Following this, participants provided ratings of emotionality (arousal, valence, pleasantness) and retrospective duration estimates (i.e., remembered time). We hypothesized that negative events would be recalled as having a greater duration than neutral events (H1). We additionally hypothesized that negative, but not neutral, events would be recalled as being longer than the true duration (H2). The results supported H1 while failing to provide evidence in support of H2. Together, the results bolster the importance of emotion, especially negative emotion, in shaping how we remember the temporal unfolding of the past.

Virtual reality as a non-medical tool in the treatment of anxiety, pain, and perception of time in children in the maintenance phase of acute lymphoblastic leukemia treatment

Introduction

Management of pediatric cancer patients involves invasive procedures such as punctures, injections, catheter placements, and chemotherapy which can generate fatigue, nausea, vomiting, anxiety, and pain. Virtual Reality (VR) is a nonpharmacological intervention classified as a cognitive-behavioral method to relieve symptoms.

Methods

We designed a crossover protocol and included 20 patients between 9 and 12 years old; ten were male. All patients had acute lymphoblastic leukemia diagnosis and were treatedwith St. Jude's XV protocol in the maintenance phase. Pain and anxiety were measured with validated scales in the pediatric population.

Results

Although we used a small group of patients, we found statistical difference in the reduction of anxiety and perception of time.

Discussion

These results open a window to non-pharmacological treatments and show a strategy to improve quality of life in children inside the hospital.

Effects of immersive virtual reality for alleviating anxiety, nausea and vomiting among patients with paediatric cancer receiving their first chemotherapy: protocol for a randomised controlled trial

INTRODUCTION

Anxiety, nausea and vomiting are common side effects suffered by paediatric patients receiving chemotherapy. Emerging evidence supports the efficacy of immersive virtual reality (IVR) on improving anxiety and distress symptoms including nausea and vomiting in this vulnerable group. This trial aims to evaluate the effects of IVR intervention on anxiety, chemotherapy-induced nausea and vomiting and anticipatory nausea and vomiting in patients with paediatric cancer receiving first chemotherapy.

METHOD AND ANALYSIS

An assessor-blinded, randomised controlled trial with a mixed methods evaluation approach. On the basis of our pilot results, 128 chemotherapy-naive patients with paediatric cancer scheduled to receive their first intravenous chemotherapy will be recruited from a public hospital and randomly allocated to intervention (n=64) or control groups (n=64). The intervention group will receive the IVR intervention for three sessions: 2 hours before the first chemotherapy, 5 min before and during their first chemotherapy and 5 min before and during their second chemotherapy, respectively. The control group will receive standard care only. A subsample of 30 participants in the intervention group will be invited for a qualitative interview. Study instruments are: (1) short form of the Chinese version of the State Anxiety Scale for Children, (2) visual analogue scale for anticipatory nausea and vomiting, (3) Chinese version of the Multinational Association of Supportive Care in Cancer Antiemesis Tool and (4) individual face-to-face semistructured interviews to explore intervention participants' perceptions of the IVR intervention.

ETHICS AND DISSEMINATION

This study has been approved by the Hong Kong Children's Hospital Research Ethics Committee (HKCH-REC-2021-009). The findings will be disseminated in peer-reviewed journals and through local or interventional conference presentations.

TRIAL REGISTRATION NUMBER

ChiCTR2100048732.

Research Trends and Highlights Toward Virtual Reality in Patients With Cancer: Bibliometric Analysis

This retrospective bibliometric analysis was conducted to explore research trends and identify studies in fields of nursing, virtual reality, and cancer. Data were obtained from the Web of Science database using an advanced search strategy. The study data were analyzed using the R Studio software and visualized using VOSviewer. A total of 594 studies were retrieved and analyzed from January 1995 to December 2021. It was determined that 59.4% of the studies were research articles and that these studies had been conducted by 2771 authors. The reviewed studies were produced by researchers from 25 countries and were published in 29 different journals. Of these, 169 were conducted by researchers in the United States. "Virtual reality" and "nursing" were found to be prominent topics. Studies on virtual reality in patients with cancer in the field of nursing have increased over the past 8 years. Researchers have actively conducted studies in this field. Prominent studies have covered various patients with cancer in all age groups and palliative care processes. It was seen that the majority of the studies were randomized controlled trials, reviews, and systematic reviews. In addition, studies have used virtual reality as a distraction method in the management of symptoms in patients with breast, lung, and pediatric cancers undergoing chemotherapy treatment. This study provides a detailed and up-to-date analysis of the findings obtained from the Web of Science database by emphasizing bibliometric models of virtual reality technologies in nursing patients with cancer. We believe that the current data on the use of virtual reality applications in patients with cancer will guide the clinical practice and scientific studies of healthcare professionals.

Remote cognitive behavioral therapy utilizing an in-home virtual reality toolkit (Vx Therapy) reduces pain, anxiety, and depression in patients with chronic cervical and lumbar spondylytic pain: A potential alternative to opioids in multimodal pain management

Background Context

Virtual reality (VR) reduces pain through visual and auditory distraction without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) improves pain-related disability and quality of life, but patient access remains a challenge. We hypothesized that in-home weekly CBT coordinated with daily use of a proprietary VR toolkit will reduce pain, anxiety, and depression for patients with non-operative chronic cervical and lumbar spondylitic pain with and without radiculopathy.

Methods

A total of 145 patients with chronic spondylitic pain (63 cervical, 46 noradicular lumbar, 36 radicular lumbar) were enrolled into a guided 14-week VR+CBT program (Vx Therapy) consisting of weekly encounters with a trained therapist and 50 modules. Pain/anxiety severity scores and time to pain recurrence were recorded prospectively by patients. PROMIS measures of overall daily pain intensity, behavior, interference, anxiety, and depression were recorded at baseline and conclusion of the program.

Results

A total of 52% of the 145 patients were male. The average (SD) age of the cohort was 51 (10.7) years (range: 24-76 years). Mean score for all PROMIS domains were significantly improved after 14 weeks of Vx Therapy (pain intensity 36±24 vs. 28±21, interference 39±25 vs. 24±21, behavior 35±21 vs. 25±16, anxiety 51±28 vs. 41±26, depression 58±32 vs. 48±32) for the entire cohort and each diagnosis group. Virtual reality acutely reduced pain on average by 33% (4.5±2.5 vs. 6.7±2.2, p<.05) across all 14 weeks, lasting a mean 2.8 hours after use. Duration of pain relief increased by the final vs. first month (4.5 hours vs. 2.5 hours, p<.05). Virtual reality acutely reduced anxiety on average by 46% (3.5±3 vs. 6.4±2, p<.05) across all 14 weeks lasting a mean 2.7 hours after use. The effect was similar for all 3 groups.

Conclusions

Fourteen weeks of a remote CBT guided in-home VR toolkit provided effective and sustained pain, anxiety, and depression relief in patients with chronic degenerative neck/back pain with and without radiculopathy. The non-invasive, non-pharmacological nature of Vx Therapy makes it an ideal option for pain management in the post-opioid epidemic era.

Effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography: a randomized controlled trial

OBJECTIVE

This study aims to examine the effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography.

METHODS

This randomized control trial was conducted on 126 women (42 in each intervention and control group). Virtual reality glasses group (n=42), mobile-assisted education group (n=42), and control group (n=42). The control group received only routine care. Comfort levels were evaluated at the beginning and end of the study using the General Comfort Scale and pain levels evaluated at the beginning and end of the study using the Visual Analog Scale.

RESULTS

The comfort theory-based nursing care (virtual reality glasses and mobile-assisted education group) was effective in increasing women's comfort with painful invasive procedures such as hysterosalpingography and reducing pain.

CONCLUSION

It is recommended that a nurse be present in the hysterosalpingography process, providing nursing care services continuously and introducing this program to working nurses.Clinical Trial Registration Number: NCT04676932.

VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey

Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.

Urology: a trip into metaverse

PURPOSE

Metaverse is becoming an alternative world in which technology and virtual experiences are mixed with real life, and it holds the promise of changing our way of living. Healthcare is already changing thanks to Metaverse and its numerous applications. In particular, Urology and urologic patients can benefit in many ways from Metaverse.

METHODS

A non-systematic literature review identified recently published studies dealing with Metaverse. The database used for this review was PubMed, and the identified studies served as the base for a narrative analysis of the literature that explored the use of Metaverse in Urology.

RESULTS

Virtual consultations can enhance access to care and reduce distance and costs, and pain management and rehabilitation can find an incredible support in virtual reality, reducing anxiety and stress and improving adherence to therapy. Metaverse has the biggest potential in urologic surgery, where it can revolutionize both surgery planning, with 3D modeling and virtual surgeries, and intraoperatively, with augmented reality and artificial intelligence. Med Schools can implement Metaverse in anatomy and surgery lectures, providing an immersive environment for learning, and residents can use this platform for learning in a safe space at their own pace. However, there are also potential challenges and ethical concerns associated with the use of the metaverse in healthcare.

CONCLUSIONS

This paper provides an overview of the concept of the metaverse, its potential applications, challenges, and opportunities, and discusses the implications of its development in Urology.

The Effect of Using Virtual Reality Glasses on Anxiety and Fatigue in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Pretest-Posttest Randomized Controlled Study

OBJECTIVE

To determine the effect of using virtual reality glasses on anxiety and fatigue in women with breast cancer receiving adjuvant chemotherapy.

DATA SOURCES

A total of 66 women with breast cancer receiving adjuvant chemotherapy. The intervention group watched and listened to beach and nature content with virtual reality glasses for 30 minutes. The control group also received standard care. An Introductory Information Form, the State Anxiety Scale, and the Cancer Fatigue Scale were used for data collection. The scales were administered to the groups before the intervention, followed by practice or standard care, and then the scales were re-administered. All patients were evaluated for each cycle over four cycles.

CONCLUSION

In the intervention group, the mean post-application anxiety scores decreased compared with the mean pretest scores, and the mean posttest anxiety scores decreased from the first cycle to the last cycle. In addition, the mean post-test anxiety scores of the intervention group were found to be lower in all four cycles than the mean post-test anxiety scores of the control group. In the intervention group, the mean post-test fatigue and subscales scores decreased in all cycles compared with the mean pre-test scores.

IMPLICATIONS FOR NURSING PRACTICE

This research has shown that the use of virtual reality glasses is effective in reducing anxiety and fatigue scale scores and their subscales in patients with breast cancer. For this reason, it is recommended to introduce the use of virtual reality glasses to patients and to present their use according to patients' preferences.

Virtual reality-assisted distraction during transcatheter aortic valve implantation under local anaesthesia: A randomised study

BACKGROUND

A minimal approach, using local anaesthesia alone, has been advocated to promote faster transcatheter aortic valve replacement (TAVR) procedures in intermediate-risk patients. Pre- and periprocedural anxiety and pain remain a concern. Virtual reality (VR) is a form of non-pharmacological distraction that can potentially modulate pain and anxiety. This randomised study explored whether VR reduces pain and anxiety during TAVR without sedation and compared the effects of VR with those of standard care.

METHODS AND RESULTS

Between June 2022 and March 2023, 207 patients underwent transfemoral TAVR (TF-TAVR). Of these, 117 (56.5%) patients were willing to participate in the study and met the educational background and mental status criteria for assessment. Fifty-nine patients underwent TF-TAVR with VR glasses (VR group). Fifty-eight patients underwent standard TF-TAVR without VR (control group; CG). Post-interventional anxiety scores (STAI-S) (31.5 ± 13.4 vs. 38.5 ± 19.2, p = 0.02) and the perceived duration of the procedure (60.1 ± 32.3 vs. 73.0 ± 32.4, p = 0.04) were lower in the VR than in the CG. Procedure time, pain, and anxiety scores (visual analogue scale) were similar between the groups. The complication rate was low and not associated with VR. Post-interventional delirium occurred in nine patients, and was similar between the groups (VR: 4 [6.8%] vs. CG: 5 [8.6%], p = 0.71). No periprocedural strokes were observed.

CONCLUSION

VR for TAVR is feasible and safe and expands the non-drug spectrum of therapy for anxiety and pain in patients undergoing TAVR with a minimalistic approach.

Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality

The treatment of pain and anxiety in cancer patients includes both pharmaceutical and non-pharmacological approaches. The researchers of this study aimed to compare the effectiveness of morphine versus Tramal with virtual reality therapy (VR) in reducing pain and anxiety in female patients with breast cancer. The sample was composed of 80 women with breast cancer who where treated at a specialized cancer center in Jordan. A quasi-experimental design was used in the study intervention. When used with VR, the tramal analgesics did not differe significactly from the effect of morphine in reducing the pain and anxiety. However, both groups had a significant drop in the level of pain and anxiety. When combined with VR, the use of weak opioids such as Tramal will have nearly the same effect as strong opioids such as Morphine in reducing pain and anxiety in breast cancer patients.

Virtual reality and surgical oncology

More than 80% of people diagnosed with cancer will require surgery. However, less than 5% have access to safe, affordable and timely surgery in low- and middle-income countries (LMICs) settings mostly due to the lack of trained workforce. Since its creation, virtual reality (VR) has been heralded as a viable adjunct to surgical training, but its adoption in surgical oncology to date is poorly understood. We undertook a systematic review to determine the application of VR across different surgical specialties, modalities and cancer pathway globally between January 2011 and 2021. We reviewed their characteristics and respective methods of validation of 24 articles. The results revealed gaps in application and accessibility of VR with a proclivity for high-income countries and high-risk, complex oncological surgeries. There is a lack of standardisation of clinical evaluation of VR, both in terms of clinical trials and implementation science. While all VR illustrated face and content validity, only around two-third exhibited construct validity and predictive validity was lacking overall. In conclusion, the asynchrony between VR development and actual global cancer surgery demand means the technology is not effectively, efficiently and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise cost-effective VR technologies with predictive validity for high demand, open cancer surgeries required in LMICs.

Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial

PURPOSE

Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation.

METHODS

English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews.

RESULTS

Fifty-five patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain).

CONCLUSION

This interim analysis supports feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy.

TRIAL REGISTRATION

NCT04301089 registered on 3/9/2020.

Using virtual reality to prepare patients for radiotherapy: A systematic review of interventional studies with educational sessions

Purpose

To understand the impact of radiotherapy educational sessions with virtual reality on oncologic adult patients' psychological and cognitive outcomes related to the treatment experience.

Methods

This review was performed according to the Preferred Reporting Items for Systematic Reviews guidelines. A systematic electronic search in three databases, MEDLINE, Scopus, and Web of Science, was conducted in December 2021 to find interventional studies with adult patients undergoing external radiotherapy who received an educational session with virtual reality before or during the treatment. The studies that provided qualitative or quantitative information about the impact of educational sessions on patients' psychological and cognitive dimensions related to RT experience were retained for analysis.

Results

Of the 25 records found, eight articles about seven studies were analysed that involved 376 patients with different oncological pathologies. Most studies evaluated knowledge and treatment-related anxiety, mainly through self-reported questionnaires. The analysis showed a significant improvement in patients' knowledge and comprehension of radiotherapy treatment. Anxiety levels also decreased with virtual reality educational sessions and throughout the treatment in almost all the studies, although with less homogeneous results.

Conclusion

Virtual reality methods in standard educational sessions can enhance cancer patients' preparation for radiation therapy by increasing their understanding of treatment and reducing anxiety.

Immersive and Non-Immersive Virtual Reality for Pain and Anxiety Management in Pediatric Patients with Hematological or Solid Cancer: A Systematic Review

Invasive and painful procedures, which often induce feelings of anxiety, are necessary components of pediatric cancer treatment, and adequate pain and anxiety management during these treatments is of pivotal importance. In this context, it is widely recognized that a holistic approach, including pharmacological and non-pharmacological modalities, such as distraction techniques, should be the standard of care. Recent evidence suggested the use of virtual reality (VR) as an effective non-pharmacological intervention in pediatrics. Therefore, this systematic review aims to analyze previously published studies on the effectiveness of VR for the management of pain and/or anxiety in children and adolescents with hematological or solid cancer. Medline, SCOPUS, Web of Science, ProQuest, CINAHL, and The Cochrane Central Register of Controlled Trials were used to search for relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Randomized controlled trial, crossover trial, cluster randomized trial, and quasi-experimental studies were included. Thirteen studies, published between 1999 and 2022, that fulfilled the inclusion criteria were included. Regarding the primary outcomes measured, pain was considered in five studies, anxiety in three studies, and the remaining five studies analyzed the effectiveness of VR for both pain and anxiety reduction. Our findings suggested a beneficial effect of VR during painful vascular access procedures. Limited data are available on the reduction of anxiety in children with cancer.

Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial

Purpose: Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation. Methods: English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews. Results: 55 patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain). Conclusion: This interim analysis confirmed feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy. Trial Registration: NCT04301089 registered on 3/9/2020.

Opportunities and challenges of virtual reality-based interventions for patients with breast cancer: a systematic review

BACKGROUND

Breast cancer is one of the most common cancers diagnosed worldwide and the second leading cause of death among women. Virtual reality (VR) has many opportunities and challenges for breast cancer patients' rehabilitation and symptom management. The purpose of this systematic review is to look into the benefits and drawbacks of VR interventions for breast cancer patients.

METHODS

A systematic search was conducted on PubMed, Web of Science, Scopus, IEEE, and the Cochrane Library, from inception until February 6, 2022. The inclusion criteria were: (1) original studies without restriction in study design; (2) a study population consisting of patients with breast cancer; (3) any type of VR-based interventions (immersive and non-immersive); and (5) studies published in English. To assess the risk of bias, the Effective Public Health Practice Project (EPHPP) Tool was used.

RESULTS

Eighteen articles were included in this systematic review. The result showed that VR could provide many opportunities for patients with breast cancer, including reducing anxiety, time perception, pain, fatigue, chemotherapy-related symptom distress levels, and depression severity, as well as improvement in the range of motion, strength, and function. Cybersickness symptoms, the weight of headsets and helmets, the quality of the visual image, and the cost of the equipment are some of the challenges in using this technology on these patients.

CONCLUSIONS

The systematic review showed that VR interventions have opportunities and challenges for patients with breast cancer. VR can be effective for rehabilitation and symptom management and is used in different stages of treatment to improve the condition of patients with breast cancer. However, before using it, the researcher should consider its challenges.

Virtual reality mobility for burn patients (VR-MOBILE): A within-subject-controlled trial protocol

In the acute phase, burn patients undergo several painful procedures. Pediatric burn care procedures conducted in hydrotherapy have been known to generate severe pain intensity and moderate to high levels of anxiety. Hydrotherapy treatments are done with the use of opioids and benzodiazepines for pain and anxiety. Unfortunately, nonpharmacological methods are rarely combined with pharmacological treatments despite evidence showing that distraction can serve as an effective method for pain management and can potentially decrease analgesic requirements in other painful medical procedures. Virtual reality (VR) is a method that uses distraction to interact within a virtual environment. The use of VR is promising for pain reduction in varying settings. Considering the lack of optimal pain and anxiety management during burn wound care and the positive effect of an immersive distraction for painful procedures, using VR for burn wound care procedures may show promising results. This is a within-subject randomized controlled trial design in which each participant will serve as his/her own control. A minimum of 20 participants, aged 7 to 17 years old undergoing a burn care session, will receive both standard and experimental treatments during the same session in a randomized order. The experimental treatment will consist of combining VR distraction using the video game Dreamland® to the current standard pharmacological care as per unit protocol. The control group will only receive the unit's standard pharmacological care. The mean difference in both pain intensity scores and in anxiety between the two different sequences will be the primary outcomes of this study. This study evaluates the effect of VR on burn wound care. If results from this study show a positive effect of VR compared to standard care, this protocol may provide guidance on how to implement this type of immersive care as part of the tools available for distraction of painful procedures for acute burn victims.

How immersive virtual reality can become a key tool to advance research and psychotherapy of eating and weight disorders

Immersive virtual reality technology (VR) still waits for its wide dissemination in research and psychotherapy of eating and weight disorders. Given the comparably high efforts in producing a VR setup, we outline that the technology's breakthrough needs tailored exploitation of specific features of VR and user-centered design of setups. In this paper, we introduce VR hardware and review the specific properties of immersive VR versus real-world setups providing examples how they improved existing setups. We then summarize current approaches to make VR a tool for psychotherapy of eating and weight disorders and introduce user-centered design of VR environments as a solution to support their further development. Overall, we argue that exploitation of the specific properties of VR can substantially improve existing approaches for research and therapy of eating and weight disorders. To produce more than pilot setups, iterative development of VR setups within a user-centered design approach is needed.

Augmented Reality Neuronavigation for En Bloc Resection of Spinal Column Lesions

BACKGROUND

Primary tumors involving the spine are relatively rare but represent surgically challenging procedures with high patient morbidity. En bloc resection of these tumors necessitates large exposures, wide tumor margins, and poses risks to functionally relevant anatomical structures. Augmented reality neuronavigation (ARNV) represents a paradigm shift in neuronavigation, allowing on-demand visualization of 3D navigation data in real-time directly in line with the operative field.

METHODS

Here, we describe the first application of ARNV to perform distal sacrococcygectomies for the en bloc removal of sacral and retrorectal lesions involving the coccyx in 2 patients, as well as a thoracic 9-11 laminectomy with costotransversectomy for en bloc removal of a schwannoma in a third patient.

RESULTS

In our experience, ARNV allowed our teams to minimize the length of the incision, reduce the extent of bony resection, and enhanced visualization of critical adjacent anatomy. All tumors were resected en bloc, and the patients recovered well postoperatively, with no known complications. Pathologic analysis confirmed the en bloc removal of these lesions with negative margins.

CONCLUSIONS

We conclude that ARNV is an effective strategy for the precise, en bloc removal of spinal lesions including both sacrococcygeal tumors involving the retrorectal space and thoracic schwannomas.

Psychophysiological restorative potential in cancer patients by virtual reality (VR)-based perception of natural environment

The positive significance of nature to human’ self-reported well-being has been widely confirmed, but less attention has been paid to the study of cancer patients, as well as the role of time on the restorative effects. Therefore, using virtual reality (VR) and the inclusion of patients with esophageal and gastrointestinal cancer as participants, this study conducted indoor experiments to explore patients’ psychophysiological recovery through the perception of five different environmental types with three to five interventions per week. There were 63 participants selected from the People’s Hospital in Shaanxi Province. Depending on their psychophysiological state, they would participate in three to five interventions in a week to compare the number of interventions needed to achieve maximum restoration. The five environmental types utilized varied in land cover, vegetation structure, and landscape characteristics, and were identified as blue space (BS), open green space (OGS), semi-open green space (SOS), closed green space (CGS), and gray space (GrS). Before and after viewing landscapes, the changes of psychophysiological indicators were measured to explore the influence of different environmental types on participants. The results showed that the participants preferred and received the highest perceived restorative potentials in BS and lastly, GrS. The green and blue spaces measurably increased positive emotions and perceived restoration while a decreasing negative emotions and the heart rate (HR) compared with the GrS. Participants had the highest level of relaxation while their eyes were closed in the EEG baseline stage. Moreover, participants received the most relaxation when they contacted with nature three times a week, which indicated that excessive natural participation may not be conducive to the sustained development of cancer patients’ psychophysiological health. Instead of field appreciation, VR could be utilized to increase the access of cancer patients to nature and then be used as an approach to landscape interaction.

Cognitive load, fatigue and aversive simulator symptoms but not manipulated zeitgebers affect duration perception in virtual reality

The perceived duration of an interval depends on numerous aspects of the passed event both endogenous, including physiological arousal, level of wakefulness, attention, and surprise, as well as exogenous such as valence, salience, or context in the environment. There is some evidence that "time-giving" cues from the environment (zeitgebers) are coupled with time perception. The movement of the sun on the horizon was demonstrated to affect interval perception in a study conducted by Schatzschneider et al. (2016) claiming that the sun’s motion is a zeitgeber that influences time perception. In the present study, we undertake the first to our knowledge replication of this effect, extending the analysis to confounding aspects of the used paradigm. We aimed to test the effect of immersion, cognitive load, and changes in the speed of the sun on the horizon of the virtual environment on the perceived interval duration. We did not replicate the original effect, as reported by Schatzschneider et al., however, we did find that the perceived duration of an interval was affected by cognitive load, fatigue, and unpleasant symptoms caused by VR. In our analysis, we used Bayesian statistics to support our conclusion and offer its results as having some important consequences for the field.

Use of virtual reality in oncology: From the state of the art to an integrative model

Over the past 20 years, virtual reality (VR) has been the subject of growing interest in oncology. More and more researchers are studying the effects of virtual environments to contribute to current thinking on technologies likely to support patients undergoing oncological treatment. Recent research highlights how VR can divert attention while reducing anxiety in stressful healthcare situations through its multisensory and participative nature. VR appears to be a promising tool capable of reducing cancer-related anxiety symptoms, improving treatment adherence, and increasing satisfaction with oncology care. While the literature reports these positive effects in the therapeutic management of cancer, few studies have focused on theoretical models capable of explaining the psychological benefits of virtual immersion. This literature review provides a theoretical framework combining results from all relevant empirical work in oncology. The review can help researchers identify the optimal conditions for using VR in oncology and bridge the gap between divergent devices, modalities, and practices (e.g., headmounted displays, environments, interactivity, immersion time).

Virtual reality exercises at home for post COVID-19 condition: a feasibility study

BACKGROUND

Between 30-76% of COVID-19 patients have persistent physical and mental symptoms, sometimes up to 9 months after acute COVID-19. Current rehabilitation is mostly focused on the physical symptoms, while experts have agreed on the need for a biopsychosocial approach. A novel approach such as Virtual Reality (VR) rehabilitation at home might benefit patients and therapists, especially considering the expected rush of patients with post-COVID-19-condition needing rehabilitation.

OBJECTIVE

To investigate the feasibility of self-administered VR exercises at home for post COVID-19-condition.

METHODS

This is a single-arm feasibility study in an outpatient care setting. Patients who needed physiotherapy because of post COVID-19 condition were included as determined by the treating physiotherapist. Participants performed VR physical exercises at home for a period of 6 weeks and were allowed to perform VR mental exercise apps available at the VR platform to reduce stress and anxiety and promote cognitive functioning. Main outcomes were related to feasibility, i.e. duration and frequency of VR use, safety i.e. adverse events, patient satisfaction, and reasons to withdraw. Physical performance, daily activities, cognitive functioning, anxiety and depression, and quality of life were measured before and after.

RESULTS

Forty-eight patients were included. One patient did not start VR and seven patients (15%) withdrew, mostly due to dizziness. Almost 70% of participants reported any adverse event during VR exercising. However, only 25% recalled these events at the end of the intervention period. The majority of patients described VR as having a positive influence on their recovery and the global satisfaction score was 67%. Average VR use was 30 minutes per session 3-4 times a week for 3-6 weeks. Overall use of VR applications was almost equally distributed over the three sets of VR exercises (physical, relaxing, cognitive). However, use frequency of physical exercises seemed to decrease over time, whereas use of cognitive and relaxation exercises remained stable. Physical performance and quality of life outcomes were significantly improved after six weeks.

CONCLUSIONS

VR physical exercises at home is feasible and safe with good acceptance in a significant percentage of patients with post COVID-19 condition.

CLINICALTRIAL

ClinicalTrials.gov NCT04505761.

Effects of Virtual Reality-Based Aerobic Exercise on Perceptions of Pain and Fatigue in Individuals with Spinal Cord Injury

Virtual reality (VR) has become an effective alternative to promote exercise. However, limited studies have investigated the effect of VR on pain and fatigue in individuals with spinal cord injury (SCI). Objective: The purpose of this study was to investigate the effects of using VR during exercise on pain and fatigue in individuals with SCI. This study employed a concurrent nested mixed-methods design. Materials and Methods: Eleven individuals with SCI completed a 6-minute exercise test using arm ergometry with and without VR. Pain and fatigue questionnaire data were collected using Pain Self Efficacy Questionnaire, the Fatigue Severity Scale, and the Fatigue Assessment Scale. Qualitative data were collected after the VR session. Results: Participants experienced less pain and fatigue during VR exercise than during non-VR exercise. Qualitative data were consistent with the questionnaire results. Conclusion: Clinicians should consider the use of VR in reducing pain and fatigue.

The influence of visual objects and music on anxiety levels of breast cancer patients scheduled to experience chemotherapy for the first time: a prospective randomized clinical study

OBJECTIVE

To investigate the influence of music together with visual objects as an ambiance in the waiting room on anxiety levels of breast cancer patients scheduled to receive chemotherapy in outpatient setting for the first time.

MATERIAL AND METHOD

Breast cancer patients planned to receive adjuvant or neoadjuvant chemotherapy for the first time between November 1, 2020, and July 31, 2021, were included. Two designs, including a standard waiting room (StWR) and an intervention waiting room (IWR) that was created by adding music and visual objects to the standard room, were constructed. These 2 designs were repeated sequentially in monthly periods, and a total of 104 patients with 52 in each group were randomized. The State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADs) were used for assessments. Results of the patients in StWR and IWR groups were compared.

RESULTS

Both HADs anxiety and STAI-state anxiety scale scores were lower in patients who waited in IWR compared to those who waited in StWR (p = 0.041, p = 0.012, respectively). In patients in the IWR group, mean heart rate was lower by 7.6 bpm (p = 0.009). No difference was found between the groups with regard to HADs depression score and STAI-trait anxiety score (p = 0.305, p = 0.535, respectively). For all patients, HADs anxiety scale (r = 0.400, p =  < 0.001) and STAI-state anxiety scale (r = 0.475, p =  < 0.001) scores increased as the waiting time increased.

DISCUSSION AND CONCLUSION

The present study is the first to investigate the influence of adding music together with visual objects to the standard ambiance of the chemotherapy waiting room on anxiety levels of breast cancer patients. We propose that introduction of paintings, artificial plants, and music to the ambiance of the waiting room has a significantly positive effect on alleviating anxiety levels of cancer patients waiting for chemotherapy.

Using a Virtual Reality and Communication Intervention to Reduce Pain and Anxiety in Patients Undergoing Lipoma Excision With Local Anesthesia: A Randomized Controlled Trial

In this randomized controlled trial, we assessed the effects of using a virtual reality (VR) and communication intervention on pain and anxiety in patients undergoing lipoma excision under local anesthesia. We conducted the study at a large hospital in Turkey between March 15 and September 15, 2019, with 100 participants. We used a pretest and posttest design to collect data with a personal information form, the Numeric Pain Rating Scale, and the State-Trait Anxiety Inventory. The intervention group participants watched a video using a VR headset during the procedure and communicated with an investigator; the control group participants only received routine surgical treatment. The intervention had a significant effect on pain during the procedure (P < .001) and a moderate effect on anxiety 60 minutes after the procedure (P = .01). Use of VR and active communication may help reduce pain and anxiety for patients undergoing procedures performed with local anesthesia.

The benefits and acceptability of virtual reality interventions for women with metastatic breast cancer in their homes; a pilot randomised trial

Background

Women with metastatic breast cancer (MBC) report debilitating physical and psychological symptoms, including fatigue, anxiety, and pain, that greatly impact their quality of life. Immersive virtual reality (VR) has been proposed as an adjunctive pain therapy for patients with cancer, and evidence suggests it may also decrease symptoms of anxiety and depression. The purpose of this pilot study was to assess whether VR should be pursued as a feasible and acceptable adjunctive therapy to alleviate physical and psychological symptoms in women with MBC.

Methods

We conducted a pilot study testing the acceptability and efficacy of VR interventions with MBC patients to improve quality of life and to produce enduring decreases in fatigue, pain, depression, anxiety, and stress. Participants completed two different week-long VR experiences, reporting the prevalence of symptoms immediately before and after each study week, and 48 h later. Linear mixed models including fixed effects (VR intervention, counterbalancing order, and study week) and random effects (participant) were used to assess the effect of immersive VR on all outcome measures.

Results

Thirty-eight women with MBC completed the VR interventions and were included in analyses. Significant improvements post-intervention and/or 48 h later were demonstrated for quality of life, fatigue, pain, depression, anxiety, and stress. Across the entire study period, these differences met the criteria of a clinically important difference for quality of life, fatigue, depression, and stress. Participants reported feelings of relaxation and enjoyment and were highly likely to use the interventions gain.

Conclusions

Our results demonstrate that VR experiences offer enduring benefits to the physical and psychological well-being of women with MBC. VR interventions are a feasible and acceptable intervention that can be conducted in a patient’s own home. Such interventions are worthy of future investigation as a novel approach to improving quality of life in a patient population that have often been overlooked.

Trial registration

Prospectively registered on 25th October 2019 with Australian New Zealand Clinical Trials Registry (ref: ACTRN12619001480178).

Larger visual changes compress time: The inverted effect of asemantic visual features on interval time perception

Time perception is fluid and affected by manipulations to visual inputs. Previous literature shows that changes to low-level visual properties alter time judgments at the millisecond-level. At longer intervals, in the span of seconds and minutes, high-level cognitive effects (e.g., emotions, memories) elicited by visual inputs affect time perception, but these effects are confounded with semantic information in these inputs, and are therefore challenging to measure and control. In this work, we investigate the effect of asemantic visual properties (pure visual features devoid of emotional or semantic value) on interval time perception. Our experiments were conducted with binary and production tasks in both conventional and head-mounted displays, testing the effects of four different visual features (spatial luminance contrast, temporal frequency, field of view, and visual complexity). Our results reveal a consistent pattern: larger visual changes all shorten perceived time in intervals of up to 3min, remarkably contrary to their effect on millisecond-level perception. Our findings may help alter participants' time perception, which can have broad real-world implications.

Experiences of Patients Undergoing Chemotherapy With Virtual Reality: Mixed Methods Feasibility Study

Background

Current research into virtual reality (VR) use during chemotherapy shows that it can be an effective distraction intervention. However, there is limited research in adult patients and to investigate how VR can be sustainably implemented in health care organizations.

Objective

The aim of this study was to explore the feasibility and acceptability of using VR for adult patients undergoing chemotherapy, and to identify the factors that would enable the sustained use of VR during chemotherapy in health care organizations.

Methods

Patients undergoing chemotherapy were recruited to participate in a VR intervention during chemotherapy infusion. Participants were observed during the session and completed a postintervention survey. Each participant was invited to participate in a semistructured interview about their experience.

Results

A total of 18 patients participated in the study, 5 of whom participated in semistructured interviews. Findings indicated that the use of VR was acceptable for patients undergoing chemotherapy and the intervention was also feasible. Some participants felt that the VR was an effective distraction during chemotherapy infusion, although most still seemed to be aware of how long their treatment was taking. Although VR was acceptable and feasible to patients, interviews identified several barriers to sustained implementation, including access to a reliable app library and impact on staff workloads.

Conclusions

VR was acceptable to patients with a diagnosis of cancer undergoing chemotherapy treatment. Patients found VR beneficial for breaking up the monotony of treatment, to provide an additional choice of activity in addition to other recreation, and in some instances as a distraction from the treatment itself. However, there are challenges to address if VR is to be implemented in practice for this patient group.

SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting?

OBJECTIVES

The SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being and quality of life.

DESIGN

A two-phase study. Phase I determined key characteristics using an experienced-based codesign approach. Phase II evaluated the intervention using various measures and qualitative interviews in a mixed methods approach. Descriptive statistics were used to analyse measures data and framework analysis to analyse interviews.

SETTING

A specialist cancer centre, UK.

PARTICIPANTS

11 in phase I and 21 in phase II. Participants were in cancer treatment, recovery or palliative care.

PRIMARY AND SECONDARY OUTCOME

Primary outcome: acceptability of the intervention, assessed by >60% uptake of three sessions.

SECONDARY OUTCOMES

impact on psychological well-being using EQ-5D/QLQ-C30, Profile of Mood Scale, Warwick and Edinburgh Mental Well-being Scale, Depression and Anxiety Severity Scale 21, Self-Compassion Scale, Acceptance and Action Questionnaire and a locally developed questionnaire to capture self-compassion post use. Physiological impact was assessed by change in heart rate (HR)/HR variability and electrodermal activity (EDA).

RESULTS

Twenty participants (mean age=48.7 years; SD=16.87); 65% (n=13) completed three sessions. Mental well-being improved following each use and from baseline to after session 3 (VR 1-z=2.846, p≤0.01; VR 2-z=2.501, p≤0.01; VR 3-z=2.492, p≤0.01). There was statistically significant difference in mean scores for EDA at mid-session and post session compared with pre session (F (1.658, 4.973)=13.364, p<0.05). There was statistically significant reduction in stress levels from baseline to post session 3. Participants found the intervention acceptable and highlighted areas for development.

CONCLUSION

The intervention is acceptable and feasible and has shown positive effects on mental well-being/stress in the oncology setting. Larger studies are needed to confirm findings.

Virtual reality for management of cancer pain: Study rationale and design

Background

Patients with cancer commonly experience acute and/or chronic moderate to severe pain related to disease, treatment, or both. While pain management strategies typically focus on drug therapies, non-pharmacological interventions may prove beneficial without risk of significant clinical side effects or contraindications. One novel strategy, virtual reality, has been shown to improve pain control in addition to usual pharmacological interventions.

Methods

This is a prospective, two-armed, single center randomized controlled study of a virtual reality intervention in 128 hospitalized subjects with cancer reporting pain rated at least 4/10 compared to an active control intervention, two-dimensional guided imagery. The primary outcome is change in self-reported pain score. Secondary end points include changes in self-reported distress, quality of life, and satisfaction with pain management. We will also explore patient preferences for distraction therapy content and themes through quantitative analysis of survey data, semi-structured interviews, and a collaging exercise.

Conclusion

This randomized controlled study aims to provide empiric data to support application and expansion of novel technologies such as virtual reality to augment usual pharmacological pain management strategies in hospitalized patients with cancer.