Learning In 360 Degrees: The Use of Virtual Reality for Radiation Therapy Patient Education

Abstract

Purpose: External beam radiation therapy (EBRT) is not well understood by the cancer patient population and this lack of understanding can increase anxiety around the procedure. Conventional written or verbal education may not provide patients with a clear picture of the complex technical aspects of EBRT treatment. Commercially available technologies such as Virtual Reality (VR) can immerse an individual in a 360degree virtual world and are increasingly being used to manage anxiety through exposure and education in various medical settings. The purpose of this study was to determine if the integration of a VR video depicting EBRT from the patient's point of view into conventional patient education decreases patient anxiety prior to treatment. Methods: The study population included patients having EBRT to the pelvis in a supine position. Participants were assigned to one of 3 study arms: Control, Early Intervention or Intervention. All participants completed the National Comprehensive Cancer Network's Distress Thermometer (DT) as a pre-intervention assessment of anxiety and received standard patient education. Participants in the Early Intervention and Intervention arms also watched the VR video. Early Intervention participants viewed the VR video 2 weeks prior to treatment at their CT planning appointment while Intervention participants viewed the VR video just prior to treatment on the day of their first treatment fraction appointment. All participants completed a post-intervention DT and a modified Cancer Treatment Survey (CaTS) on the first day of treatment after all education was completed. Descriptive statistics were calculated for all variables of interest. The primary endpoint of pre-post anxiety between groups was assessed using general linear mixed model for repeated measures. Results: 82 patients were approached to participate in this investigation, 61 consented and 4 withdrew. 19 participants were assigned to each of the 3 arms. Mean pre-intervention anxiety levels on the DT scale (0-10) were generally low and not significantly different between the three arms (Control X=2.4, SD=2.3; Early Intervention X=2.6, SD=2.0; Intervention X=2.1, SD=2.3). The difference between pre and post-intervention anxiety was not significant in the Control (p=0.92, SE=0.10) or the Early Intervention arms (p=0.69, SE=0.04). However, the difference between pre and post-intervention anxiety was statistically significant in the Intervention arm (p<0.01, SE=0.07) with post-intervention anxiety being lower (X=1.3, SD=1.4). Responses to Likert scale questions on the CaTS showed similar levels of satisfaction with education received in all arms. Conclusion: Participants in the Intervention arm reported significantly less anxiety on the first day of treatment following the VR video. This suggests VR is a valuable tool for reducing radiation treatment-related anxiety. However, timing is an important factor as the anxiety reducing effect was no longer observed when the VR video was viewed two weeks before the first radiation treatment.