Virtual reality therapy has been shown to help primary brain tumor patients overcome “scanxiety” before brain scans, according to a new study published in the Journal for Neuro-Oncology.
For cancer patients, a scan functions as an oracle, a compass that may point them in myriad ways. The reality of what a CT, MRI or bran scan may bring expectantly leads many patients into a storm of anxiety. A phase two clinical trial study performed by AppliedVR, in collaboration with the National Cancer Institute (NCI), found that a month-long VR intervention led to 60% of participants reporting an improved quality of life and 95% stating they’d recommend VR to other patients prior to clinical appointments.
“One of the things about human beings is that our cognitive system is the most evolved of any organism and because of that, I think, we as humans are very cognition-centric,” Todd Maddox, vice president of research and development at AppliedVR, told Fierce Healthcare. “But the truth of the matter is that a lot of what really, really, really matters is preconscious, and VR can tap into that.”
Study participants were chosen from a pool of patients actively enrolled in another study led by the neuro-oncology branch of the NCI. Patients, all of which have been diagnosed with tumors in the central nervous system, were given VR devices that contained 41 scenarios. Scenarios fell into three categories: dynamic breathing, guided relaxation and instant escape.
Patients had the freedom to self-administer VR during the one-month duration of the study and choose any scenario they preferred. Of the participants, 90% classified the intervention as “worthwhile.” The same percentage said they would use the tool again in the future.
Brain tumors require a uniquely challenging treatment plan along with being marked as having a high symptom burden. For these reasons, patients with brain tumors have some of the highest prevalence of clinically significant distress.
The traditional clinical approach is to refer patients to mental health professionals. According to the NCI, screenings should be done to find if a patient “needs help adjusting to cancer,” speaking to the dominating nature of the diagnosis, disease and treatment plan. About half of patients do not access mental health support.
The institute warns that patients may have elevated anxiety during screenings while waiting for test results and even following remission when they may fear reoccurrence. Some patients experience anxiety so severe that they vomit before treatment, delay treatment altogether or miss check-ups.
“Virtual reality holds the potential to lessen some of the negative aspects that cancer patients endure, helping them escape and experience positive thoughts that assist them with coping,” said Amanda King, Ph.D., study lead Associate Investigator of NCI, in a press release. “However, while much of the previous VR research in oncology has focused on reducing distress symptoms associated with chemotherapy infusions or painful procedures, results from this interim analysis suggest that this novel interventional strategy is feasible in patients with primary brain tumors and has high reported acceptability to date.”
AppliedVR became the first VR provider to receive a unique healthcare common procedure coding system code from the Centers for Medicare and Medicaid Services (CMS) for its FDA-authorized RelieVRx. The treatment plan for the chronic pain management tool was slightly altered in the new study.
RelieVRx leads patients through a pre-determined path of scenarios over the course of eight weeks. According to Maddox, that eight-week course has been shown to have durable effects for up to two years.
As opposed to a set course, the new study allowed patients to sift through scenarios in a “Netflix for VR” manner. “Here's 41 pieces of content, pick and choose what you want, when you want it, as much as you want to help you deal with your anxiety, stress, distress, etc.,” Maddox said.
Maddox gave the example of one scenario whereby using deep breathing relaxation techniques patients are able to see a tree grow. The visualization works as a teaching technique. A patient’s subconscious adopts the new technique so that when they are in the lead-up to a scan or in the middle of a scan imagining all the possible results, their subconscious kicks on and reminds them to breathe slowly, decreasing anxiety.
“My background is in the neuroscience of learning, so it doesn't surprise me at all that this kind of immersive therapeutic that, simply put, broadly engages the brain is going to be effective for things like distress and anxiety, as well as for things like chronic low back pain,” Maddox said. “On the surface, those seem really disconnected, but if you look at how the brain responds to the kinds of immersive content, it's really not that surprising.”
According to Maddox, the VR headset itself is required to create this immersive learning experience that permeates the blinding reality of “scanxiety.” When it comes to the immersion that he says is necessary for these results, he also says the same effect cannot be replicated with only a mobile device. The FDA and CMS approved the RelieVRx not as software as a medical device but rather as software on a medical device, meaning a VR device must be used in conjunction with the software.
Following the successful results, Maddox now imagines the tool being used to support patients with a wide range of cancer diagnoses. AppliedVR’s wellness programs are already used by over 200 health systems and over 60,000 patients.