The Use of Immersive Virtual Reality for Cancer-Related Cognitive Impairment Assessment and Rehabilitation: A Clinical Feasibility Study

Enhancing cancer-supportive care through virtual reality: a policy brief

BACKGROUND

Virtual reality (VR) technology has been useful in enhancing cancer-supportive care by alleviating pain, anxiety and emotional distress. However, its integration into oncology faces multiple barriers, including limited funding, insufficient clinician training, accessibility challenges, absence of standard guidelines and reimbursement policies. This policy brief highlighted policy options needed for VR technology interventions in cancer-supportive care.

METHODS

This policy brief was developed upon a previous systematic review that examined the role of VR in cancer-supportive care. To translate these findings into actionable recommendations, we conducted a secondary analysis of policy-related opportunities and challenges. The extracted evidence was synthesized to propose strategic policy options that facilitate VR adoption in oncology.

RESULTS

A total of five key policy options were identified: (1) increasing funding for VR research and development, (2) training programs for healthcare professionals, (3) expanding patient access through financial support mechanisms, (4) establishing standard clinical guidelines and (5) developing reimbursement policies. These recommendations aim to bridge the gap between technological advancements and their practical implementation in cancer care.

CONCLUSIONS

Integrating VR into cancer-supportive care requires a coordinated effort among policymakers, healthcare institutions and technology developers. By implementing these evidence-based policy strategies, stakeholders can enhance patient access, improve clinical outcomes and ensure sustainable adoption of VR in oncology.

Extended reality for neurocognitive assessment: A systematic review

OBJECTIVE

The objective of this study is to evaluate the effectiveness, feasibility, and clinical relevance of extended reality (XR) technologies for neurocognitive assessment.

METHODS

A systematic review of published literature on augmented reality (AR), mixed reality (MR) and fully immersive virtual reality (VR) technologies for neurocognitive assessment was conducted. Studies were included if they evaluated XR for assessing neurocognitive domains, with outcomes related to diagnostic accuracy or usability.

RESULTS

28 studies met the inclusion criteria. VR-based tools (n = 26) were the most commonly utilized, offering immersive environments for assessing several cognitive domains including memory, attention and executive function. AR applications (n = 2) were less frequently utilized but showed promising potential in cognitive impairment detection. No studies utilized MR technology for assessing neurocognitive functions. XR technologies were found to be more sensitive, ecologically valid, and engaging compared to traditional assessment tools.

DISCUSSION

XR technologies offer a transformative approach to neurocognitive assessments by providing immersive, interactive environments that go beyond the limitations of traditional methods. Despite their potential, XR technologies face limitations such as high costs and technical challenges like motion sickness. Future efforts should focus on improving accessibility, user interfaces, and incorporating social and emotional dynamics to create more realistic assessments.

Impact of Cognitive Rehabilitation on Cognitive and Functional Outcomes in Adult Cancer Survivors: A Systematic Review

OBJECTIVES

This systematic review (PROSPERO CRD42021275421) synthesized evidence on the efficacy of cognitive rehabilitation on cognitive and functional outcomes in adult cancer survivors.

METHODS

Articles were identified though PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science from inception through June 30, 2023. Studies included participants ≥18 years old, diagnosed with cancer. Primary outcomes were validated measures of subjective and objective cognition. Articles were dual reviewed for eligibility and data extraction. Risk of bias was assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields.

RESULTS

The search yielded 3,811 articles; 65 full-text articles were reviewed; 53 articles (15 cognitive training, 14 strategy-based, 21 combinations, three inpatient rehabilitation), representing 52 unique studies, were included. Positive effects were observed in at least one objective cognitive measure in 93% of strategy training, 81% of cognitive training, 79% of combination rehabilitation interventions. Positive effects were observed in subjective cognition in 100% of strategy training, 55% of cognitive training, and 92% of combination interventions. Among studies with comparator groups, processing speed improved in 60% of cognitive training studies, while strategy training did not improve processing speed; otherwise, cognitive domain effects were similar between intervention types. Impact on functional outcomes was inconclusive.

CONCLUSIONS

Cognitive rehabilitation appear beneficial for cancer-related cognitive impairment (CRCI). Differential effects on specific cognitive domains (eg, processing speed) and subjective cognition may exist between intervention types.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should increase patient and provider awareness of the benefits of cognitive rehabilitation for CRCI.

Assessing the virtual reality perspectives and self-directed learning skills of nursing students: A machine learning-enhanced approach

AIM

This study aims to investigate nursing students' perspectives on virtual reality technologies and their self-directed learning skills, specifically focusing on how these variables interact and influence each other in the context of nursing education. We also discern potential disparities in these skills based on descriptive characteristics, using both traditional statistical and advanced machine learning approaches for a comprehensive analysis.

BACKGROUND

Rapid developments in technology, particularly during the Covid-19 pandemic, have brought virtual reality technologies to the forefront of nursing education. However, there is a gap in understanding how nursing students' perceptions of these technological relate to their development of self-directed learning skills.

DESIGN

A descriptive and cross-sectional study design is employed to both quantify nursing students' perspectives on virtual reality in their education and assess their self-directed learning skills. This approach integrates traditional statistical methods with advanced machine learning techniques, with the intention of offering a comprehensive and nuanced analysis to inform future teaching strategies in nursing.

METHODS

The study used a blend of survey scales and a tree-based machine learning model to measure and analyze nursing students' views, attitudes and self-directed learning levels. This dual approach allows for a more detailed assessment of the factors influencing self-directed learning abilities. Traditional statistical techniques were also applied to assess the reliability of the machine learning findings.

RESULTS

Findings reveal that nursing students generally held positive views towards virtual reality technologies and exhibited a high level of self-directed learning skills. Notable differences in self-directed learning skills were influenced by gender on the overall scale (p <0.001), with male students scoring higher than their female counterparts in both specific sub-dimensions and on the overall scale, but not by academic year. The machine learning analysis provided deeper insights into these variations, highlighting subtle distinctions in student demographics that traditional statistical methods did not fully capture.

CONCLUSIONS

The study offers valuable insights into interconnected nature of nursing students' views on virtual reality technologies and their self-directed learning skills. The results support the integration of virtual reality in nursing curriculum programs and underscore the importance of customizing teaching strategies based on insights gained from machine learning analyses. This approach has the potential to substantially improve both the learning experience and the overall quality of nursing education.

Technology: A metaparadigm concept of nursing

Undoubtedly, technology continues to permeate the world at an unprecedented pace. The discipline of nursing is not alien to this phenomenon as nurses continue to employ various technological objects and applications in clinical practice, education, administration and research. Despite the centrality of technology in nursing, it has not been recognised as a metaparadigm domain of interest in the discipline of nursing. Thus, this paper sought to examine if technology truly reflected a metaparadigm domain using the four requirements posited by Fawcett. Using these requirements, we examined the onto-epistemology of technology in relation to nursing and conclude that technology potentially represents a distinct domain that intersects with nursing (particularly, from the humanities perspective). Also, technology encompasses some phenomena of interest to the discipline of nursing, demonstrates perspective-neutrality, and is international in scope and substance albeit with some nuances which do not fit well with nursing onto-epistemology. Put together, it is highlighted that technology intersects with the existing metaparadigm domains (person, health, environment and nursing) which positions it as a potential phenomenon of interest to the discipline of nursing requiring further work to articulate its position and role.

Evaluating the Effectiveness of Visuospatial Memory Stimulation Using Virtual Reality in Head and Neck Cancer Patients-Pilot Study

The prevalence of Cancer-related Cognitive Impairment (CRCI) in cancer patients necessitates the search for methods to help stimulate cognitive function. An innovative and repeatedly used method in oncology departments is virtual reality (VR). To date, no one has used VR for head and neck cancer patients in an attempt to stimulate their working memory. The goal of our research is to intervene with off-the-shelf VR applications in HNC patients to lower the risk of CRCI. Twenty-two patients with head and neck cancer were enrolled in this pilot study to characterize their visuospatial memory capacity, a form of working memory. During the oncological treatment, the patient had 30 min sessions, three times a week, using publicly available applications of VR. No significant changes were observed in the pre- and post-study. The individual patient results present a favorable trend of changes in their working memory after the intervention: despite oncological treatment, visual-spatial memory did not deteriorate in 88% of patients, including 28% of patients with higher scores than before the intervention. In this pilot study, VR was safely used in patients with head and neck cancer with no negative side effects. The use of VR may prevent CRCI in most HNC patients and, in some, VR may improve their cognitive functioning. A more rigorous study with larger numbers and controls is advised.

A self-administered immersive virtual reality tool for assessing cognitive impairment in patients with cancer

Objective

This study was aimed at exploring the feasibility and validity of a self-administered immersive virtual reality (VR) tool designed to assess cognitive impairment in patients with cancer.

Methods

In a cross-sectional survey study, an immersive tool was used to rate the previously recommended core assessment domains of cancer-related cognitive impairment-comprising attention, verbal learning memory, processing speed, executive function and verbal fluency-via an interactive VR scenario.

Results

A total of 165 patients with cancer participated in this study. The participants' mean age was 47.74 years (SD ​= ​10.59). Common cancer types included lung, liver, breast and colorectal cancer, and most patients were in early disease stages (n ​= ​146, 88.5%). Participants' performance in the VR cognition assessment showed a moderate to strong positive correlation with their paper-and-pencil neurocognitive test results (r ​= ​0.34-0.76, P ​< ​0.001), thus indicating high concurrent validity of the immersive VR cognition assessment tool. For all participants, the mean score for the VR-based cognition assessment was 5.41 (SD ​= ​0.70) out of a potential maximum of 7.0. The mean simulation sickness score for the VR-based tool, as rated by the patients, was 0.35 (SD ​= ​0.19), thereby indicating that minimal simulation sickness occurred during the VR-assisted cognition assessment.

Conclusions

Given its demonstrated validity, and the patients' high presence scores and minimal sickness scores, this VR-based cognition assessment tool is a feasible and acceptable instrument for measuring cognitive impairment in patients with cancer. However, further psychometric assessments should be implemented in clinical settings.