The Role of Engagement in Virtual Reality to Enhance Emotional Well-Being in Breast Cancer Patients: A Mediation Analysis

INTRODUCTION

Virtual reality (VR) has garnered increasing attention in oncology due to its potential to enhance patient care by alleviating anxiety and emotional distress. The present work evaluates the hypothesis proposed by a recent theoretical model that engagement and the sense of presence are key mediators that impact the degree of beneficial effects that VR may have on the emotional well-being of breast cancer patients.

METHODS

This study draws on data from three previous studies comprising 156 breast cancer patients. The psychological variables of well-being studied included emotional dimensions measured before and after exposure to a virtual environment, as well as factors related to immersive qualities. Correlation and mediation analyses were conducted to explore relationships among said variables, namely, one's tendency to be immersed in an activity, engagement, spatial presence, and emotional well-being (i.e., valence and arousal) of the patients.

RESULTS

Engagement plays a crucial mediating role between tendency of immersion, spatial presence, and positive emotional responses. Patients with a greater tendency toward immersion and higher engagement in the virtual environment showed significant emotional improvements. However, tendency of immersion and spatial presence alone did not directly lead to more positive emotional experiences; their influence was primarily exerted through engagement.

CONCLUSIONS

Engagement emerges as a fundamental lever for maximizing the psychological benefits of VR in oncology. Clinical interventions using VR should prioritize optimizing engagement in immersive environments to improve patients' emotional state throughout their cancer treatment journey.

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).

Contemplating or Acting? Which Immersive Modes Should Be Favored in Virtual Reality During Physiotherapy for Breast Cancer Rehabilitation

Background

Even though virtual reality (VR) is more and more considered for its power of distraction in different medical contexts, the optimal conditions for its use still have to be determined in order to design interfaces adapted to therapeutic support in oncology.

Objective

The objective of this study was to examine the benefits of VR using two immersion methods (i.e., one participatory, one contemplative) and comparing them with each other in a population of women with breast cancer who have undergone breast surgery, during scar massage sessions.

Methods

In a physiotherapy center, each patient participated in four experimental conditions in a random order: two sessions used virtual immersion (i.e., one participatory and one contemplative), one session proposed musical listening and the fourth one was a standard session care. The impact of the level of patient involvement in the virtual world was apprehended through the evaluation of the feeling of presence; the estimation of elapsed time of the physiotherapy sessions and particular attention was paid to the evaluation of patient emotional state.

Results

Our study showed an increase in positive emotions (i.e., joy and happiness) and a decrease in anxiety regardless which support methods were offered. Participatory VR created a feeling of more intense spatial presence.

Conclusion

Our results highlight the importance of the context in which VR should be offered. The presence of the practitioner and his interactions with the patient can provide a context just as favorable in reducing anxiety as the emotional regulation tools used (VR, music). The use of technological tools should be favored when the practitioner is unavailable during the treatment phase or, even, in order to reduce the monotonous nature of repetitive therapeutic sessions.