Virtual reality for improving pain and pain-related symptoms in patients with advanced stage colorectal cancer: A pilot trial to test feasibility and acceptability.

Sarah A Kelleher,Shannon N Miller,Joseph G Winger,Hannah M Fisher,Tamara J Somers,Francis J Keefe,Grace H Amaden,Luana Colloca,Hope E Uronis

doi:10.1017/s1478951521002017

Abstract

Objective.Virtual reality (VR) has the potential to improve pain and pain-related symptoms. We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/sea environment (VR Blue) for reducing pain and pain-related symptoms in advanced colorectal cancer patients. A qualitative exit interview was conducted to understand preferences, thoughts, and feelings about the VR session.Method.Participants (N = 20) had stage IV colorectal cancer and moderate-to-severe pain. Participants completed a 30-min VR Blue session that visually and aurally immersed them in virtual ocean scenarios. Feasibility was assessed by accrual (N = 20), protocol adherence (≥80% completing VR Blue), and completed data (≥80% assessment completion). Acceptability was determined by patients reporting ≥80% intervention satisfaction. Safety was determined by ≥80% of patients completing the session without self-reported side effects. Measures of pain, tension, relaxation, stress, anxiety, and mood were collected before, during, and after the VR Blue session. A semi-structured qualitative interview was conducted after VR Blue to assess participants’ VR experiences.Results.All participants (100%) completed the VR Blue session. There was 100% data collection at the pre- and post-assessments. Satisfaction with VR Blue was high M = 3.3 (SD = 0.4) (83%). No significant side effects were reported. Pain decreased by 59% (Pre-M = 3 [1]; Post-M = 1 [1]). Tension decreased by 74% (Pre-M = 30 [24]; Post-M = 8 [13]). Relaxation improved by 38% (Pre-M = 62 [21]); Post-M = 86 [17]). Stress decreased by 68% (Pre-M = 24 [24]; Post-M = 8 [14]). Anxiety decreased by 65% (Pre-M = 20 [23]; Post-M = 7 [13]). Mood improved by 70% (Pre-M = 13 [16]; Post-M = 4 [11]). Qualitative data suggested a positive response to the VR Blue protocol.Significance of results.This work supports the feasibility, acceptability, and safety of VR Blue for advanced colorectal cancer patients. Participants showed significant pre-post improvement in pain and pain-related symptoms hinting to the potential feasibility of VR interventions in this population. Larger, randomized trials with a control condition are needed to examine the efficacy of VR-based interventions for patients with advanced colorectal cancer and pain.

Highlights

Colorectal cancer is the fourth most commonly diagnosed malignancy in the USA (Siegel et al, 2018; Wolf et al, 2018)
There was 100% data collected for all participants at all assessment timepoints. These data meet all a priori feasibility benchmarks and suggest that patients with advanced colorectal cancer were attracted to the virtual reality (VR) protocol and willing to enroll in the pilot study
Non-pharmacological pain management options are needed for advanced colorectal cancer patients who suffer from high symptom burden

Summary

Introduction

Colorectal cancer is the fourth most commonly diagnosed malignancy in the USA (Siegel et al, 2018; Wolf et al, 2018). Stage 1 pilot work is an ideal opportunity to begin assessing mechanisms of change Due to their late-stage disease and persistent pain, advanced colorectal cancer patients report negative pain-related cognitions (e.g., pain catastrophizing) and low confidence that they can control pain without medical intervention (e.g., self-efficacy for pain management). VR may be useful for advanced colorectal cancer patients endorsing persistent pain because it can impact cognitive pathways by decreasing pain catastrophizing and increasing pain self-efficacy to improve pain control and moderate pain signaling (Loreto-Quijada et al, 2014) This pilot study extends preliminary research conducted by Colloca et al (2020) that found exposure to a 30-min virtual underwater/sea environment (VR Blue) produced significant increases in pain tolerance for thermal pain stimuli compared to control conditions, along with improved mood and reduced anxiety and pain unpleasantness. We collected qualitative data following the VR Blue session to better understand participants’ preferences, thoughts, and feelings about the VR experience

Participants

Procedure

Results

Discussion

Would you appreciate the option to use different types of scenery?

Conclusion