Impacts of Intrafraction Virtual Reality-Based Environment Modification on Procedural Anxiety, Heart Rate, and Overall Radiation Therapy Experience During External Beam Radiation Therapy

Abstract

Procedural anxiety of cancer treatments may negatively impact patients and treatments. Mindfulness-promoting environment modification with virtual reality (VR) is increasingly used across medicine to minimize procedural anxiety. We aimed to assess the impacts of intrafraction mindfulness-promoting VR use during external beam radiation therapy (EBRT) on radiation therapy experience and physiological measures of distress. Adult patients receiving EBRT between May and October 2023 at our institution without contraindications to wearing VR were eligible. Participants had heart rates recorded before and after EBRT and completed a post-EBRT survey for 1 treatment without intervention, and 1 using VR. Participants completed the Radiotherapy Experience Questionnaire and additional questions regarding VR. Quantitative data were compared between conditions using paired samples t test. Fifty-two participants completed the project. Between pre- and post-EBRT, a significant decrease in heart rate with VR was noted (80.35 bpm vs 71.79 bpm; P < .0001*), but not in the control condition (78.90 bpm vs 78.10 bpm; P = .44). Post-EBRT heart rate was significantly lower with VR than without (71.79 bpm vs 78.10 bpm; P < .01*). Radiotherapy Experience Questionnaire responses showed participants had significantly lower situational unease (1.46 vs 2.02; P < .001*), a more beneficial situational response (1.55 vs 2.12; P < .01*), and improved environment acceptance (1.30 vs 1.60; P < .01*) when using VR. Most endorsed VR as comfortable (94%), improved treatment experience (86%), and would recommend it to others (86%). We report the first evidence of the impacts of intrafraction mindfulness-promoting VR use during EBRT. Physiological measures of distress and patient perspectives suggest that VR can minimize procedural anxiety, is well tolerated, and improves the overall treatment experience. Further research should explore modifying this tool for patients unable to wear headsets and determining where the most clinically significant benefits can be found.