Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy

Impact of Virtual Reality on Pain, ROM, Muscle Strength and Quality of Life among Breast Cancer Patients: An Integrative Review of Literature

BACKGROUND

Breast cancer is the most commonly diagnosed cancer among women globally, with significant impacts on physical, emotional, and functional well-being. Traditional rehabilitation methods may not fully address the multifaceted challenges faced by breast cancer survivors (BCSs), prompting exploration into innovative approaches such as Virtual Reality (VR) technology.

OBJECTIVE

The present review aims to assess the effectiveness of VR in alleviating pain, improving Range of Motion (ROM), enhancing muscle strength, and augmenting the overall quality of life in patients undergoing breast cancer rehabilitation.

METHODS

A comprehensive review of existing literature was conducted, focusing on studies investigating the use of VR in breast cancer rehabilitation. PubMed, Scopus, PEDro and Google scholar were searched for articles addressing VR interventions targeting pain management, ROM improvement, muscle strength enhancement, and quality of life enhancement in breast cancer patients.

RESULTS

Findings yielded total 12 articles matching the selection criteria. VR technology has shown promising results in addressing the multifaceted needs of breast cancer patients. VR also serves as a distraction tool, positively impacting psychological well-being and mitigating negative psychological symptoms associated with the disease.

CONCLUSION

VR represents a non-pharmacological approach to pain management and rehabilitation in breast cancer patients. Its ability to engage emotional, cognitive, and attention processes contributes to its effectiveness in enhancing overall quality of life. Further research is warranted to elucidate the long-term benefits and optimal utilization of VR technology in breast cancer rehabilitation programs.

Virtual Reality to Reduce Pain, Fatigue, and Emotional Distress in People With Cancer: A Scoping Review

BACKGROUND

Cancer and its treatments cause symptoms such as pain, fatigue, and emotional distress, which affect the quality of life of patients at different stages of cancer. Virtual reality (VR) has emerged as a promising alternative for addressing these symptoms by immersing patients in a virtual environment that isolates them from reality.

OBJECTIVE

To describe the existing evidence on the use of VR to improve pain, fatigue, and emotional distress in people with cancer at different stages of the cancer trajectory.

METHODS

A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Search was conducted in PubMed and CINAHL until October 2023.

RESULTS

Twenty-three primary studies related to the study topic were identified, and the following information was collected: type of VR (immersive vs nonimmersive) used in oncology services, purpose (distraction, training, or relaxation), devices used (head-mounted display, headset, or virtual controller), and the environment simulated (natural environment, skill games, or educational environment). The effects of VR on pain, fatigue, and emotional distress are described, highlighting its ability to mitigate these symptoms in the short term.

CONCLUSIONS

Virtual reality has been shown to be an effective technique for reducing pain, fatigue, and emotional distress in people with cancer in the short term.

IMPLICATIONS FOR PRACTICE

Nurses can use VR as a complementary tool to promote virtual environments that improve the care for and therefore the quality of life of people with cancer.

Evaluating Mixed Reality as a Tool for Patient Education of Facial Fractures

Background: Patients may be educated about facial fractures using two-dimensional computed tomography (2DCT); however, three-dimensional mixed reality (3DMR) goggles may improve patient education by delivering content in an immersive environment. Objective: To compare the effectiveness of 2DCT and 3DMR formats used for patient education on facial fractures, as measured by surveys. Methods: In this prospective, randomized, crossover study, video tutorials intended for facial fracture informed consent were created in 2DCT and 3DMR formats from a single CT data set of a zygomaticomaxillary complex (ZMC) fracture. Subjects were randomly assigned into two groups. Group 1 (n = 25) viewed the 2DCT tutorial, answered self-assessment and information recall surveys, viewed the 3DMR tutorial, repeated the prior surveys as well as a comparison survey. Group 2 (n = 25) followed the same sequence but viewed the 3DMR tutorial and then the 2DCT tutorial. Results: Participants (n = 50) had no differences in age (group 1-51.9 years/standard deviation [SD] 20.9; group 2-44.7 years/SD 17.6 years; p = 0.223), gender (group 1-10 male/15 female; group 2-11 male/14 female; p = 0.999), college education level (group 1-25 yes; group 2-25 yes; p = 0.844), or prior 2DCT or 3DMR experience (group 1-9 yes/16 no; group 2-13 yes/12 no; p = 0.393). The 3DMR format was preferred over 2DCT (p < 0.05), and it was reported to enhance understanding as compared to 2DCT (p < 0.05). No differences for information recall were noted (p = 0.753). Conclusion: In this study, participants preferred 3DMR goggles over 2DCT for a simulated ZMC fracture-informed consent.

Knowledge and attitude toward proton radiotherapy among oncology patients: a multi-center, cross-sectional study

Aim: To explore the knowledge and attitude among oncology patients toward proton radiotherapy. Materials & methods: This cross-sectional study was performed using self-designed questionnaire. Results: Based on 546 valid questionnaires, mean knowledge and attitude scores of 3.4 ± 3.6 (range: 0-12) and 31.1 ± 3.5 (range: 10-50) were observed. Multivariate analysis demonstrated that higher education (p = 0.021), higher monthly income (p = 0.005), and proton radiotherapy history (p < 0.001) were independently associated with higher knowledge scores. Higher knowledge (p = 0.020), older age (p = 0.030), not smoking (p = 0.032) and medication use (p = 0.035) were independently associated with higher attitude scores. Conclusion: Oncology patients have insufficient knowledge and negative attitude toward proton radiotherapy, which might be affected by their age, education, income, proton radiotherapy history, employment, smoking and medication use.

Application of virtual reality for supportive care in cancer patients: a systematic review

BACKGROUND

In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients.

METHOD

This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively.

RESULTS

A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported.

CONCLUSION

VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.

Effectiveness of Virtual Reality in the Management of Anxiety and Pain Peri-Treatment for Breast Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Breast cancer is the second most common cancer in humans. Its therapy procedures such as breast biopsy can cause anxiety and persistent pain in patients. Virtual reality (VR) has been applied to promote comfort in various populations. However, the effectiveness of VR in relieving pain and anxiety in patients undergoing breast cancer treatment is unclear.

PURPOSE

This study was designed to examine the effect of VR on anxiety and pain in people undergoing treatment for breast cancer.

METHODS

PubMed, Cochrane, Embase, Scopus, Web of Science, and MEDLINE databases were searched for studies involving VR, pain, and anxiety in patients with breast cancer published up to March 2022. The Cochrane Handbook for Systems quality evaluation standard 6.3.0 was followed to assess risk of bias in the identified studies, with the results reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Subsequently, a meta-analysis of the included data was conducted using RevMan 5.3 software.

RESULTS

Six randomized controlled trials and one quasi-experimental study were included. The strength of the evidence ranged from moderate to high. Although VR was found to ameliorate anxiety in patients with breast cancer, only three studies showed statistically significant changes. All of the included studies reported statistically significant improvement in pain levels. In addition, two of the studies reported cybersickness symptoms as a common side effect of VR.

CONCLUSIONS

VR has an important role to play in alleviating pain in patients with breast cancer. However, evidence demonstrating VR's importance in alleviating anxiety symptoms in this population is insufficient. Studies conducted with larger sample sizes and high-quality research methodologies will be necessary to clarify this issue. Clinical nurses should address the potential side effects of VR.

Navigating the Metaverse: A New Virtual Tool with Promising Real Benefits for Breast Cancer Patients

BC, affecting both women and men, is a complex disease where early diagnosis plays a crucial role in successful treatment and enhances patient survival rates. The Metaverse, a virtual world, may offer new, personalized approaches to diagnosing and treating BC. Although Artificial Intelligence (AI) is still in its early stages, its rapid advancement indicates potential applications within the healthcare sector, including consolidating patient information in one accessible location. This could provide physicians with more comprehensive insights into disease details. Leveraging the Metaverse could facilitate clinical data analysis and improve the precision of diagnosis, potentially allowing for more tailored treatments for BC patients. However, while this article highlights the possible transformative impacts of virtual technologies on BC treatment, it is important to approach these developments with cautious optimism, recognizing the need for further research and validation to ensure enhanced patient care with greater accuracy and efficiency.

Prehabilitation Consultation on Self-Care and Physical Exercise in Patients Diagnosed with Abdominopelvic Cancer: Protocol of the Study

BACKGROUND

Introduction: Prehabilitation in the field of oncology has been defined as "the process in the continuum of care that occurs between diagnosis and the start of treatment involving physical and psychological measures that determine the patient's baseline functional status."

AIM

To determine the effectiveness of a Prehabilitation consultation on self-care and targeted physical exercise for patients diagnosed with abdominopelvic cancer.

DESIGN

An observational study that will evaluate the pre-post efficacy of an ad-hoc designed Prehabilitation intervention. The study population consists of patients diagnosed with colon or gynecological cancer with a surgical indication as part of their therapeutic plan from the General Surgery Services. It is configured around four key interventions: (a) health education and self-care, (b) specific nutritional counseling, (c) initial psychological assessment, and (d) directed physical exercise intervention. Health education, self-care interventions, and physical exercise will be carried out weekly from diagnosis to the scheduled surgery day.

RESULTS

Aspects such as self-care capacity or agency, perioperative anxiety, aerobic capacity, strength and flexibility, postoperative complications, and recovery time to adjuvant treatment will be measured using tools such as Appraisal of self-care agency scale (ASA), State Trait Anxiety Inventory (STAI), walking test, sit and Reach, Hand Grip or Squad Jump.

CONCLUSION

Utilizing validated tools for analyzing selected variables will contribute to refining and expanding care guidelines, ultimately enhancing support for both patients and their caregivers.

3D Reconstruction and Virtual Reality Is an Acceptable and Feasible Method for Addressing Body Image in Bariatric Metabolic Surgery

BACKGROUND

Patients living with obesity continue to experience body image dissatisfaction following bariatric metabolic surgery. The underlying reasons are poorly understood but may be due to unmet expectations. Negative body image perception following metabolic surgery leads to poorer psychological and clinical outcomes. This study aims to establish the acceptability and feasibility of three-dimensional (3D) reconstruction and virtual reality (VR) as a method of providing psychological support to bariatric patients to improve body image satisfaction and interventional outcomes.

METHODS

Seven participants were recruited from the Imperial Weight Centre. 3D photographs were captured and processed to produce two 3D reconstructed images with 15% and 25% total weight loss. Participants were shown their images using VR and participated in peer group workshops.

RESULTS

Six participants were retained until the end of the study. Five out of six participants agreed the images provided them with a more accurate representation of their body changes and overall appearance following bariatric metabolic surgery. All participants strongly agreed with the group setting and felt VR facilitated discussions on body image. Overall, all participants felt that the use of VR and 3D reconstruction is beneficial in supporting patients to adjust to changes in their body image after bariatric metabolic surgery.

CONCLUSIONS

This is the first study to explore and demonstrate that 3D reconstruction and VR is an acceptable and feasible method providing patients with a realistic expectation of how their body will change following significant weight loss, potentially improving body image satisfaction after surgery, as well as psychological and interventional outcomes.

Identifying oncology caregivers' pretreatment educational and emotional needs to inform future virtual reality educational interventions

PURPOSE

To identify oncology caregivers' unmet educational needs for the development of a virtual reality experience.

METHODS

A qualitative descriptive methodology was used; data were collected via online surveys.

RESULTS

Eighteen participants said their educational experiences were overwhelming and emotionally exhausting. They suggested a need to deliver educational information through different modalities and provide more clinician-based resources and support.

CONCLUSION

This study identified opportunities to complement traditional pretreatment education tailored to the caregivers' needs and experiences, such as specific procedural information and emotional management while being a caregiver. Creating virtual reality experiences exclusively for oncology caregivers is a novel nurse-led approach that is currently not in existence.

The application of virtual environment radiotherapy for RTT training: A scoping review

BACKGROUND

Virtual Environment Radiotherapy Training (VERT) is a virtual tool used in radiotherapy with a dual purpose: patient education and student training. This scoping review aims to identify the applications of VERT to acquire new skills in specific activities of Radiation Therapists (RTTs) clinical practice and education as reported in the literature. This scoping review will identify any gaps in this field and provide suggestions for future research.

METHODS

In accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) extension for scoping reviews and Arskey and O'Malley framework, an electronic search was conducted to retrieve complete original studies, reporting the use and implementation of VERT for teaching skills to RTTs. Studies were searched in PubMed, EMBASE, and SCOPUS databases and included retrieved articles if they investigated the use of VERT for RTTs training.

RESULTS

Of 251 titles, 16 articles fulfilled the selection criteria and most of the studies were qualitative evaluation studies (n=5) and pilot studies (n=4). The specific use of VERT for RTTs training was grouped into four categories (Planning CT, Set-up, IGRT, and TPS).

CONCLUSION

The use of VERT was described for each category by examining the interaction of the students or trainee RTTs in performing each phase within the virtual environment and describing their perceptions. This system Virtual Reality (VR) enables the development of specific motor skills without interfering and pressurising clinical resources by using clinical equipment in a risk-free offline environment, improving the clinical confidence of students or trainee RTTs. However, even if VR can be integrated into the RTTs training with a great advantage, VERT has still not been embraced. This mainly due to the presence of significant issues and limitations, such as inadequate coverage within the current literature, software and hardware costs.

Impact of patient information format on the experience of cancer patients treated with radiotherapy

Introduction

Radiotherapy (RT) stands as one of the main cancer treatments. The impact of RT and cancer treatment can have a physical and psychological impact on patients and their carers. To gain patient's trust, and ensure they feel valued, information should be provided before, during, and after RT. Patient and public involvement (PPI) has been lacking, and increased engagement with PPI groups could improve this. This rapid review aims to analyse the literature, and describe and report patient perception, experience, and satisfaction regarding the information received concerning their course of RT.

Methods

To allow the synthesis of results, a pragmatic decision was made to use a rapid review approach to analyse the literature, providing more timely information to inform future work. This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42023415916).Electronic databases CINAHL, AMED, Pubmed/MEDLINE, EMBASE, and PsycINFO were searched using a comprehensive search for published studies from January 2012 to November 2023. Two independent reviewers applied the eligibility criteria. Evidence from literature was extracted and transcribed into qualitative data and Braun and Clarke's six-step thematic analysis (TA) was employed to determine themes by one reviewer and checked by a second [26]. Due to the heterogeneity of the included literature, the analysis of this review is presented primarily through narrative synthesis.

Results

Sixty eight articles met the inclusion criteria for this review. Emerging themes included; a desire for information based on patient characteristics, information format, patient preparedness, timing e.g. timing of information and changing priorities over time, health care professional (HCP) involvement, barriers to information, and motivators for better information delivery.

Conclusions

Several factors can influence a patient's desire for information, from whom and when they receive it, to what format they would prefer to receive it. There is benefit to be gained in employing PPI and patient advocacy to inform future studies that aim to further understand the themes that emerged from this review. Such studies can therefore inform HCPs in providing patient-specific information and support by utilising multiple teaching strategies available to them.

The Development and Evaluation of an Educational Video for Breast Cancer Patients Requiring Adjuvant Radiation Therapy

Patient education and informed consent are required prior to adjuvant radiation therapy (RT) for early breast cancer (EBC), and include the role, rationale, potential toxicities and practicalities of the treatment process. Current education of patients about RT is verbal, in the form of a consultation by a radiation oncologist, often supplemented with print or online materials. This approach is limited by its doctor-dependency and non-standardised nature. Video education is being recognised increasingly as an opportunity to remediate this and appeal to patients' preference for visual learning. The purpose of this study was to design and produce a video as an educational adjunct for EBC patients' viewing prior to adjuvant RT, and to evaluate its acceptability through content analysis of three online focus group discussions, among ten participants with EBC requiring RT. After qualitative content analysis of the focus group transcripts, data were summarised into three main categories: (1) understanding of RT, (2) ease of engagement with the video and (3) anxiety and preparedness for RT. The 18-min video was positively received by all participants, and discussion feedback was used to inform improvements to the video. This focus group study demonstrated that the video was well understood, informative and acceptable to EBC patients in preparing them for RT. The effectiveness of the video in improving knowledge and alleviating distress in preparation for therapy will be further evaluated in an ethics-approved biphasic quasi-experimental study.

Utilising interactive technology for stroke patient education: a systematic review

PURPOSE

As a leading cause of death and disability worldwide, how to effectively manage and prevent stroke is a key consideration for health care systems. Throughout the world stroke management recommendations include education; however, not all patients receive this intervention. Advances in technology have provided health professionals with a range of innovative, effective, and modern tools that may be useful in delivering stroke education. This study aimed to systematically review the current evidence for the use of interactive technology in stroke patient education, and whether this was effective for increasing patients' stroke knowledge and behaviours that lower stroke risk.

METHODS AND MATERIALS

The protocol was registered with PROSPERO (#225223) and a literature search undertaken in Embase (including MEDLINE and PubMed), PsycInfo and CINAHL from inception until August 2022. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the included articles.

RESULTS

From an initial yield of 760 articles, 10 articles met the study inclusion criteria. The articles explored a range of interactive technologies, with none of them includes articles using the same technology. All of the articles reported at least one positive effect from the technology. Two articles reported on stroke incidence post-intervention. The methodological quality of the articles varied, but was largely medium to high.

CONCLUSION

The paucity of evidence highlights a need for future studies to provide insights into the benefits of quality interactive technology-based stroke education and to identify options for optimal delivery modes in stroke education.

Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study

Background

Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application.

Objective

This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers.

Methods

A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness.

Results

Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home.

Conclusions

The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation.

Use of virtual reality in patient education program to reduce anxiety in upper gastrointestinal endoscopy: A randomized controlled trial

Background and Aim

Virtual reality (VR) provides an immersive image-viewing experience that has recently been expanding its use in clinical medicine. We aimed to examine a patient education program by VR to reduce anxiety in patients undergoing esophagogastroduodenoscopy (EGD).

Methods

We conducted a randomized controlled trial and consecutively enrolled patients who had an indication for unsedated EGD with topical anesthesia. Patients were randomly assigned to use Oculus GO with three-dimensionally specific software content (a stand-alone VR headset) for patient education or standard patient education using oral information (the control group) before EGD. The primary outcome was the variation in anxiety scores before and after patient education programs.

Results

A total of 107 patients underwent EGD and received a VR (n = 58) and control (n = 49) patient education program. The mean anxiety score before starting the patient education program was 41.4 9.6 in the VR group and 41.9 7.7 in the control group. The mean anxiety score after the patient education program was 37.1 10.8 in the VR group and 38.9 8.07 in the control group (P-value = 0.354). The anxiety score in the VR group decreased more than in the control group but was not significant. The recall questionnaire scores were higher in the VR group (4.70.4) than the control group (3.91, P-value 0.001).

Conclusion

A virtual reality-assisted patient education program before EGD did not significantly reduce anxiety but may provide more memory and understanding about the procedure to patients who underwent unsedated EGD.

Smartphone-based augmented reality patient education in radiation oncology

We built an augmented reality (AR) patient education application for portable iOS and Android devices that allows patients to view a virtual simulation of themselves receiving radiation treatment. We created software that reads data from the clinical treatment planning system and renders the patient's actual radiotherapy plan in AR on a tablet or smartphone. The patient's CT simulation data are converted into a 3D translucent virtual human shown being treated with visible radiation beams from a virtual linear accelerator. We conducted a patient study to determine if showing patients this AR simulation improves patient understanding of radiotherapy and/or reduces anxiety about treatment. A total of 75 patients completed this study. The most common plans were 3D breast tangents and intensity modulated radiotherapy lung plans. Patients were administered questionnaires both before and after their AR viewing experience. After their AR viewing, 95% of patients indicated that they had a better understanding of how radiotherapy will be used to treat their cancer. Of the 35 patients who expressed anxiety about radiotherapy beforehand, 21 (60%) indicated that they had decreased anxiety after the AR session. In our single-arm prospective patient study, we found that this simplified low-cost tablet-based personalized AR simulation can be a helpful educational tool for cancer patients undergoing radiotherapy.

Gait patterns during overground and virtual omnidirectional treadmill walking

BACKGROUND

Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults.

METHODS

Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture.

RESULTS

Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail.

CONCLUSION

Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.

Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis

BACKGROUND

Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients' and families' psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families.

OBJECTIVE

A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members.

METHODS

Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute's critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach.

RESULTS

A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients' quality of life with a small effect size (Hedges g=0.05, 95% CI -0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=-0.72, 95% CI -1.89 to 0.46; I2=97.6%; P<.001).

CONCLUSIONS

This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice.

TRIAL REGISTRATION

PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698.

An Investigation of the Effect of Virtual Reality on Alleviating Anxiety in Patients With Breast Cancer Undergoing Radiation Therapy: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the anxiety-reducing effects of virtual reality (VR) on patients with breast cancer undergoing adjuvant radiation therapy (RT).

METHODS AND MATERIALS

This randomized controlled trial was conducted among patients with breast cancer receiving RT at a single institution. Of 196 enrolled and randomized patients, 97 were assigned to a VR explanation group (intervention) and 99 were assigned to the standard-of-care group (control). Anxiety levels were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) as the primary endpoint and the State-Trait Anxiety Inventory (STAI) and Linear Analogue Scale Assessment (LASA) as secondary endpoints. Knowledge of the RT procedure, patient satisfaction, and time spent for counseling were also assessed.

RESULTS

Intervention significantly reduced patient anxiety immediately, not only on the primary endpoint, APAIS, but also on the STAI and LASA anxiety scales. Specifically, in the intervention group, there were immediate reductions of 26.0%, 16.1%, and 55.8% for APAIS, STAI, and LASA, respectively, whereas in the control group, the respective reductions were 8.1%, 8.5%, and 13.7%. Among the 3 anxiety scales, long-term anxiety reduction was observed only when anxiety was measured by LASA. Subgroup analyses showed that the effect on anxiety did not differ based on the physician, baseline anxiety level, use of hormone therapy, or health literacy. The intervention also significantly improved knowledge of the RT procedure (81.9/100 vs 76.8/100; P = .006) and patient satisfaction with the explanation manner (6.56 vs 5.72; P < .001) compared with the control group.

CONCLUSIONS

Immersive VR applied to the current procedure reduces anxiety during RT planning for patients with breast cancer. Further research is necessary to investigate the long-term effects of VR on anxiety.

The Multidomain Metaverse Cancer Care Digital Platform: Development and Usability Study

BACKGROUND

As cancer treatment methods have diversified and the importance of self-management, which lowers the dependence rate on direct hospital visits, has increased, effective cancer care education and management for health professionals and patients have become necessary. The metaverse is in the spotlight as a means of digital health that allows users to engage in cancer care education and management beyond physical constraints. However, it is difficult to find a multipurpose medical metaverse that can not only be used in the field but also complements current cancer care.

OBJECTIVE

This study aimed to develop an integrated metaverse cancer care platform, Dr. Meta, and examine its usability.

METHODS

We conducted a multicenter, cross-sectional survey between November and December 2021. A descriptive analysis was performed to examine users' experiences with Dr. Meta. In addition, a supplementary open-ended question was used to ask users for their suggestions and improvements regarding the platform.

RESULTS

Responses from 70 Korean participants (male: n=19, 27% and female: n=51, 73%) were analyzed. More than half (n=37, 54%) of the participants were satisfied with Dr. Meta; they responded that it was an interesting and immersive platform (n=50, 72%). Less than half perceived no discomfort when using Dr. Meta (n=34, 49%) and no difficulty in wearing and operating the device (n=30, 43%). Furthermore, more than half (n=50, 72%) of the participants reported that Dr. Meta would help provide non-face-to-face and noncontact services. More than half also wanted to continue using this platform in the future (n=41, 59%) and recommended it to others (n=42, 60%).

CONCLUSIONS

We developed a multidomain metaverse cancer care platform that can support both health professionals and patients in non-face-to-face cancer care. The platform was uniquely disseminated and implemented in multiple regional hospitals and showed the potential to perform successful cancer care.

Interdisciplinary interventions that improve patient-reported outcomes in perioperative cancer care: A systematic review of randomized control trials

INTRODUCTION

Interdisciplinary teams are often leveraged to improve quality of cancer care in the perioperative period. We aimed to identify the team structures and processes in interdisciplinary interventions that improve perioperative patient-reported outcomes for patients with cancer.

METHODS

We searched PubMed, EMBASE, and CINAHL for randomized control trials published at any time and screened 7,195 articles. To be included in our review, studies needed to report patient-reported outcomes, have interventions that occur in the perioperative period, include surgical cancer treatment, and include at least one non physician intervention clinical team member: advanced practice providers, including nurse practitioners and physician assistants, clinical nurse specialists, and registered nurses. We narratively synthesized intervention components, specifically roles assumed by intervention clinical team members and interdisciplinary team processes, to compare interventions that improved patient-reported outcomes, based on minimal clinically important difference and statistical significance.

RESULTS

We included 34 studies with a total of 4,722 participants, of which 31 reported a clinically meaningful improvement in at least one patient-reported outcome. No included studies had an overall high risk of bias. The common clinical team member roles featured patient education regarding diagnosis, treatment, coping, and pain/symptom management as well as postoperative follow up regarding problems after surgery, resource dissemination, and care planning. Other intervention components included six or more months of continuous clinical team member contact with the patient and involvement of the patient's caregiver.

CONCLUSIONS

Future interventions might prioritize supporting clinical team members roles to include patient education, caregiver engagement, and clinical follow-up.

Automatic patient positioning based on robot rotational workspace for extended reality

PURPOSE

Understanding the properties and aspects of the robotic system is essential to a successful medical intervention, as different capabilities and limits characterize each. Robot positioning is a crucial step in the surgical setup that ensures proper reachability to the desired port locations and facilitates docking procedures. This very demanding task requires much experience to master, especially with multiple trocars, increasing the barrier of entry for surgeons in training.

METHODS

Previously, we demonstrated an Augmented Reality-based system to visualize the rotational workspace of the robotic system and proved it helps the surgical staff to optimize patient positioning for single-port interventions. In this work, we implemented a new algorithm to allow for an automatic, real-time robotic arm positioning for multiple ports.

RESULTS

Our system, based on the rotational workspace data of the robotic arm and the set of trocar locations, can calculate the optimal position of the robotic arm in milliseconds for the positional and in seconds for the rotational workspace in virtual and augmented reality setups.

CONCLUSIONS

Following the previous work, we extended our system to support multiple ports to cover a broader range of surgical procedures and introduced the automatic positioning component. Our solution can decrease the surgical setup time and eliminate the need to repositioning the robot mid-procedure and is suitable both for the preoperative planning step using VR and in the operating room-running on an AR headset.

Association of Patient Experience of Care and Radiation Therapy Initiation Among Women With Early-Stage Breast Cancer

PURPOSE

For women diagnosed with early-stage breast cancer, lumpectomy followed by radiation therapy (RT) has been a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment for certain women. It is unclear what patient-driven factors are related to decisions to receive RT. This study examined relationships between patient-reported experience of care, an important dimension of health care quality, and receipt of RT after lumpectomy.

METHODS AND MATERIALS

We used National Cancer Institute Surveillance, Epidemiology, and End Results data linked to the CMS Medicare Consumer Assessment of Healthcare Providers and Systems patient surveys (SEER-CAHPS) to examine experiences of care among women diagnosed with local/regional stage breast cancer 2000 to 2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey ≤18 months after diagnosis, and survived for this study period. Experience of care was assessed by patient-provided scores for physicians, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of external beam RT with care experience and patient sociodemographic and clinical characteristics.

RESULTS

The study population included 824 women; 655 (79%) received RT. Women with higher experience of care scores for their personal doctor were significantly more likely to have received any RT (odds ratio [OR], 1.18; P = .033). Nonsignificant trends were observed for associations of increased RT with higher CAHPS measures of doctor communications (OR, 1.15; P = .055) and care coordination (OR, 1.24; P = .051). In contrast, women reporting higher scores for Part D prescription drug plans were significantly less likely to have received RT (OR, 0.78; P = .030).

CONCLUSIONS

Patient experience of care was significantly associated with receipt of RT after lumpectomy among women with breast cancer. Health care organization leaders may want to consider incorporating experience of care into quality improvement initiatives and other activities that aim to improve patient decision-making, care, and outcomes.

The Efficacy of Virtual Reality-Based Interventions in Breast Cancer-Related Symptom Management: A Systematic Review and Meta-analysis

BACKGROUND

Breast cancer patients experience a range of disease- and treatment-related symptoms that seriously threaten their quality of life. Virtual reality (VR), an emerging complementary and integrative therapy, has been increasingly applied in clinical practice. However, there is insufficient evidence to support the effectiveness of VR-based interventions on symptom management in breast cancer patients.

OBJECTIVE

This article aimed to systematically examine the effects of VR on breast cancer-related symptom management.

METHODS

The PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wan Fang, and VIP databases were comprehensively searched for randomized controlled trials (RCTs) and quasi-RCTs published up to April 10, 2021. Studies using VR-based interventions to manage breast cancer-related symptoms were included. Two investigators independently reviewed and extracted data and evaluated methodological quality. RevMan 5.3 was used for meta-analysis, and heterogeneity was evaluated using Higgins' I2 (%) statistic.

RESULTS

Eight RCTs and 6 quasi-RCTs with 797 participants were included. Virtual reality-based interventions significantly improved symptoms of anxiety, depression, pain, cognitive function, and shoulder range of motion in breast cancer patients, but no significant improvements in grip and upper extremity function were observed.

CONCLUSION

Virtual reality-based interventions had a positive effect on symptom management for breast cancer patients.

IMPLICATIONS FOR PRACTICE

Health professionals, especially nurses, can apply VR in clinical practice to reduce symptoms and improve the quality of life of breast cancer patients. More studies are needed to draw higher quality conclusions and explore the best interventions and cost-effectiveness of VR.

Women's experience of the health information process involving a digital information tool before commencing radiation therapy for breast cancer: a deductive interview study

BACKGROUND

Individuals undergoing radiation therapy for breast cancer frequently request information before, throughout and after the treatment as a means to reduce distress. Nevertheless, the provision of information to meet individuals needs from their level of health literacy is often overlooked. Thus, individuals information needs are often unmet, leading to reports of discontent. Internet and digital information technology has significantly augmented the available information and changed the way in which persons accesses and comprehends information. As health information is no longer explicitly obtained from healthcare professionals, it is essential to examine the sequences of the health information process in general, and in relation to health literacy. This paper reports on qualitative interviews, targeting women diagnosed with breast cancer who were given access to a health information technology tool, Digi-Do, before commencing radiation therapy, during, and after treatment.

METHODS

A qualitative research design, inspired by the integrated health literacy model, was chosen to enable critical reflection by the participating women. Semi-structured interviews were conducted with 15 women with access to a digital information tool, named Digi-Do, in addition to receiving standard information (oral and written) before commencing radiation therapy, during, and after treatment. A deductive thematic analysis process was conducted.

RESULTS

The results demonstrate how knowledge, competence, and motivation influence women's experience of the health information process. Three main themes were found: Meeting interactive and personal needs by engaging with health information; Critical recognition of sources of information; and Capability to communicate comprehended health information. The findings reflect the women's experience of the four competencies: to access, understand, appraise, and apply, essential elements of the health information process.

CONCLUSIONS

We can conclude that there is a need for tailored digital information tools, such as the Digi-Do, to enable iterative access and use of reliable health information before, during and after the radiation therapy process. The Digi-Do can be seen as a valuable complement to the interpersonal communication with health care professionals, facilitating a better understanding, and enabling iterative access and use of reliable health information before, during and after the radiotherapy treatment. This enhances a sense of preparedness before treatment starts.

The Patient's perspective: A review of the results from a radiotherapy patient experience survey in the North-West of England

INTRODUCTION

A patient experience survey was undertaken for patients completing radiotherapy at the three Northwest of England Radiotherapy Providers.

METHODS

A previously reported National Radiotherapy Patient Experience Survey was adapted and undertaken in the Northwest of England. Quantitative data was analysed to establish trends. Frequency distribution was applied to appraise the number of participants selecting each of the pre-determined responses. Thematic analysis of free text responses was conducted.

RESULTS

The questionnaire received 653 responses from the 3 providers across seven departments. Thematic analysis revealed 3 themes; logistics, information and operational.

CONCLUSION

The results indicate that the majority of patients are satisfied with their treatment and care. Patients' responses indicate areas for improvements. Expectancy theory states that an individual's satisfaction is related to the difference between expected service and the service received. Consequently, when reviewing services and developing improvement it is important to understand patients' expectations^. This regional survey starts to capture what people receiving radiotherapy expect from the service and the professionals delivering their treatment.

IMPLICATIONS FOR PRACTICE

This survey responses make a case for reviewing the information provision pre and post radiotherapy. This includes clarifying the understanding of consent for treatment including the intended benefits and potential late effects. There is an argument to offer information sessions prior to radiotherapy to achieve more relaxed and informed patients. A recommendation from this work is for the radiotherapy community undertake a national radiotherapy patient experience survey, facilitated via the 11 Radiotherapy ODNs. A national radiotherapy survey has multiple benefits to inform improvements in practice. This includes benchmarking services against national averages. This approach is aligned with the principles of the service specification in terms of reducing variation and increasing quality.

Development and validation of a cost-effective virtual reality educational tool to reduce anxiety and improve set-up accuracy in radiotherapy patients

PURPOSE

This study proposes a cost-effective method for educating radiotherapy patients through an immersive virtual reality (VR) system.

METHODS

The VR educational tool comprises VR glasses, a handheld controller, the scientific knowledge of radiotherapy, radiotherapy demonstration, and an audio introduction. To verify its efficacy, 120 radiotherapy patients with tumors were prospectively enrolled and divided into the control group or VR intervention group. After the first treatment, set-up errors, including three translation errors and three rotation errors, were recorded in six directions. In addition, participants were required to complete a questionnaire before radiotherapy to assess anxiety and understanding degrees. The questionnaire was scored using a five-point Likert Scale. Finally, Spearman's rank correlation test was used to evaluate set-up errors and questionnaire scores.

RESULTS

The set-up errors are significantly reduced in AP, SI, total translation, Roll and total rotation in the intervention group compared with the control group (p < 0.05). The scores are higher in the intervention group than in the control group in question 1 (2.1 ± 0.58 vs. 3.3 ± 0.55), question 2 (1.3 ± 0.44 vs. 2.5 ± 0.65), question 4 (2.2 ± 0.65 vs. 3.2 ± 0.82), question 5 (1.8 ± 0.59 vs. 3.1 ± 0.79), and all subscales (5.5 ± 1.2 vs. 8.9 ± 1.3 and 6.4 ± 1.3 vs. 9.2 ± 1.5). The scores of high, moderate, and low correlation are 47 (74%), 15 (23%), and 2 (3%) for the control group and 44 (69%), 17 (26%), and 3 (5%) for the intervention group, respectively.

CONCLUSION

The VR educational tool can significantly improve comprehension and reduce anxiety. There is a strong correlation between set-up errors and questionnaire scores. The VR educational tool may help reduce set-up errors for radiotherapy patients.

Using virtual reality to prepare patients for radiotherapy: A systematic review of interventional studies with educational sessions

Purpose

To understand the impact of radiotherapy educational sessions with virtual reality on oncologic adult patients' psychological and cognitive outcomes related to the treatment experience.

Methods

This review was performed according to the Preferred Reporting Items for Systematic Reviews guidelines. A systematic electronic search in three databases, MEDLINE, Scopus, and Web of Science, was conducted in December 2021 to find interventional studies with adult patients undergoing external radiotherapy who received an educational session with virtual reality before or during the treatment. The studies that provided qualitative or quantitative information about the impact of educational sessions on patients' psychological and cognitive dimensions related to RT experience were retained for analysis.

Results

Of the 25 records found, eight articles about seven studies were analysed that involved 376 patients with different oncological pathologies. Most studies evaluated knowledge and treatment-related anxiety, mainly through self-reported questionnaires. The analysis showed a significant improvement in patients' knowledge and comprehension of radiotherapy treatment. Anxiety levels also decreased with virtual reality educational sessions and throughout the treatment in almost all the studies, although with less homogeneous results.

Conclusion

Virtual reality methods in standard educational sessions can enhance cancer patients' preparation for radiation therapy by increasing their understanding of treatment and reducing anxiety.

Creating a Successful Virtual Reality-Based Medical Simulation Environment: Tutorial

Innovation in medical education is not only inevitable but a requirement. Manikin-based simulation is currently the gold standard for supplemental clinical training; however, this modality requires significant equipment and personnel to operate. Virtual reality (VR) is emerging as a new method of delivering medical simulation sessions that requires less infrastructure but also allows for greater accessibility and flexibility. VR has slowly been integrated into the medical curriculum in some hospitals; however, more widespread adoption would transform the delivery of medical education for future clinicians. This tutorial introduces educators to the BUILD REALITY (begin, use, identify, leverage, define, recreate, educate, adapt, look, identify, test, amplify) framework, a series of practical tips for designing and implementing a VR-based medical simulation environment in their curriculum. The suggestions are based on the relevant literature and the authors' personal experience in creating and implementing VR environments for medical trainees. Altogether, this paper provides guidance on conducting a needs assessment, setting objectives, designing a VR environment, and incorporating the session into the broader medical curriculum.

Effectiveness of Virtual Reality in Symptom Management of Cancer Patients: A Systematic Review and Meta-Analysis

CONTEXT

Although the survival rate of cancer patients has been increasing, such patients often experience severe physical and psychological burdens due to the effects of the disease and therapy. Multiple virtual reality (VR)-based interventions have been used to help improve physical and psychological symptoms and quality of life in cancer patients.

OBJECTIVE

This study aimed to assess the effects of VR-based interventions on anxiety, pain, depression, fear, distress, and quality of life in cancer patients.

METHODS

We conducted systematic searches in the PubMed, Web of Science, CINAHL, EMBASE, Cochrane Library, Scopus and APA PsycINFO databases from their inception to August 16, 2022. Two reviewers independently selected studies and extracted articles that met strict inclusion and exclusion criteria. Quality assessments of the included studies were performed according to the Cochrane risk assessment tool, and data analysis was performed using RevMan 5.4 software.

RESULTS

A total of 12 studies including 425 participants in the intervention group and 400 participants in the control group were selected for the final analysis. The results showed a significant difference between the VR and control groups for anxiety (standard mean difference [SMD] =-0.83, 95% CI -1.25 to -0.42, P < 0.001), SMD = pain (SMD =-0.86, 95% CI -1.36 to -0.35, P < 0.001), depression (SMD = -0.46, 95% CI -0.74 to -0.18, P = 0.001), fear (MD = -0.82, 95% CI -1.60 to -0.03, P = 0.04), and distress (SMD = -1.16, 95% CI -1.96 to -0.37, P = 0.004). However, no significant difference was observed in quality of life (SMD = 1.01, 95% CI -0.67 to 2.70, P = 0.24).

CONCLUSIONS

VR interventions were effective in improving physical and psychological symptoms in cancer patients. Due to the limited number of studies, small sample sizes, and moderate to high heterogeneity, these results should be interpreted with caution. More rigorous, comprehensive and high-quality randomized controlled trials (RCTs) are needed to validate the results of this study.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022304931;https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=304931.

Effect of involvement and motivation on self-learning: Evaluating a mobile e-learning program for nurses caring for women with gynecologic cancer

AIM

To evaluate a mobile e-learning program for nurses caring for women with gynecologic cancer and explore the effect of personal involvement and motivation on self-learning.

BACKGROUND

Cancer care has gradually come to be regarded as chronic disease management. In this context, nurses require health education skills to impart cancer-related knowledge and teach patients the relevant practices to enhance their adaptation to the illness. Thus, nurses would benefit from a mobile program to facilitate learning educational skills efficiently as it allows learners to learn at their own pace and convenience.

METHODS

A cross-sectional study design was used. A mobile e-learning program with interactive tasks was designed to function as supplementary education for nurses. The program comprised four topics including exercise, illness representations based on the Common Sense Model, caring principles associated with chemotherapy and radiation therapy in caring for women with gynecologic cancer. In total, 84 purposively sampled nurses completed the program successfully. Data were collected via structured questionnaire from March to August 2021. Partial least squares structural equation modeling was used to examine the proposed hypotheses regarding the effects of involvement and motivation on learning outcomes.

RESULTS

The results showed that cognitive involvement had significant effects on learning motivation. However, no significant effects were found for affective involvement. Furthermore, cognitive involvement was indirectly associated with learning effects via motivational components. The strongest associations between motivational factors and learning effects were found for perceived attention, followed by perceived relevance.

CONCLUSIONS

The results suggest that motivation is a proximal influencing factor for learning effects. However, the effects of perceived attention and relevance were stronger than those of perceived confidence and satisfaction. Furthermore, the authors identified the different aspects of involvement and found that cognitive involvement had significant effects on learning motivation, while no effects were observed for affective involvement.

Opportunities and challenges of virtual reality-based interventions for patients with breast cancer: a systematic review

BACKGROUND

Breast cancer is one of the most common cancers diagnosed worldwide and the second leading cause of death among women. Virtual reality (VR) has many opportunities and challenges for breast cancer patients' rehabilitation and symptom management. The purpose of this systematic review is to look into the benefits and drawbacks of VR interventions for breast cancer patients.

METHODS

A systematic search was conducted on PubMed, Web of Science, Scopus, IEEE, and the Cochrane Library, from inception until February 6, 2022. The inclusion criteria were: (1) original studies without restriction in study design; (2) a study population consisting of patients with breast cancer; (3) any type of VR-based interventions (immersive and non-immersive); and (5) studies published in English. To assess the risk of bias, the Effective Public Health Practice Project (EPHPP) Tool was used.

RESULTS

Eighteen articles were included in this systematic review. The result showed that VR could provide many opportunities for patients with breast cancer, including reducing anxiety, time perception, pain, fatigue, chemotherapy-related symptom distress levels, and depression severity, as well as improvement in the range of motion, strength, and function. Cybersickness symptoms, the weight of headsets and helmets, the quality of the visual image, and the cost of the equipment are some of the challenges in using this technology on these patients.

CONCLUSIONS

The systematic review showed that VR interventions have opportunities and challenges for patients with breast cancer. VR can be effective for rehabilitation and symptom management and is used in different stages of treatment to improve the condition of patients with breast cancer. However, before using it, the researcher should consider its challenges.

Virtual reality and surgical oncology

More than 80% of people diagnosed with cancer will require surgery. However, less than 5% have access to safe, affordable and timely surgery in low- and middle-income countries (LMICs) settings mostly due to the lack of trained workforce. Since its creation, virtual reality (VR) has been heralded as a viable adjunct to surgical training, but its adoption in surgical oncology to date is poorly understood. We undertook a systematic review to determine the application of VR across different surgical specialties, modalities and cancer pathway globally between January 2011 and 2021. We reviewed their characteristics and respective methods of validation of 24 articles. The results revealed gaps in application and accessibility of VR with a proclivity for high-income countries and high-risk, complex oncological surgeries. There is a lack of standardisation of clinical evaluation of VR, both in terms of clinical trials and implementation science. While all VR illustrated face and content validity, only around two-third exhibited construct validity and predictive validity was lacking overall. In conclusion, the asynchrony between VR development and actual global cancer surgery demand means the technology is not effectively, efficiently and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise cost-effective VR technologies with predictive validity for high demand, open cancer surgeries required in LMICs.

Health literacy and fatigue, anxiety, depression, and somatic symptoms in patients with differentiated thyroid carcinoma from West China: A cross-sectional study

Background and Aims

Differentiated thyroid carcinoma (DTC) patients are associated with excellent prognosis but impaired health-related quality of life (HRQOL) by initial and subsequent therapy. Health literacy plays a pivotal role in public health and medical settings, but data on its relationship with DTC patients' HRQOL are insufficient and equivocal. This study was designed to explore the relationship between health literacy and HRQOL in patients with DTC from West China areas.

Methods

A cross-sectional study with a descriptive correlational design was conducted. 126 patients with DTC were recruited between 2020 and 2021. Levels of health literacy and HRQOL (including fatigue level, anxiety/depression status, and somatoform symptoms) were assessed by questionnaires. Pearson product-moment correlation and Stepwise multiple regression were used to examined the adjusted association of health literacy with HRQOL.

Results

Health literacy and receiving DTC-related education together explained 16.2% of the variance in fatigue level. Patients who had higher health literacy, received more DTC-related education were currently employed and less fatigue. Health literacy, fatigue level and DTC-related education together explained 31.0% of the variance in anxiety and depression of DTC patients. Patients who had higher health literacy, received more DTC-related education and less fatigue level were less anxious and depressive. Age explained 8.3% of the variance in DTC patients' somatoform symptoms. Older patients complained more somatoform symptoms.

Conclusion

Health literacy was positively associated with HRQOL in DTC patients regarding to fatigue level and anxiety/depression status across the entire sample. Interventions to improve HRQOL should take the patients' health literacy into account.

Virtual integration of patient education in radiotherapy (VIPER)

•

Videoconferencing allows for face-to-face interactions and visual aids for patient education.

•

Patients were highly satisfied with videoconferencing for virtual patient education.

•

Radiation Therapists reported videoconferencing and in-person patient education were comparable.

Purpose

Pre-radiotherapy patient education led by Radiation Therapists (RTT) has been shown to improve patients’ distress and overall experiences. In an effort to offer a remote delivery method while allowing for visual learning and face-to-face communication, this pilot project evaluated the feasibility and acceptability of using virtual videoconferencing for patient education.

Methods

This prospective pilot study integrated virtual patient education into standard care. This workflow consisted of a one-on-one, 45-minute tele-education session with an RTT on the day prior to CT-simulation. For this study, patients were offered the option to complete the session using web-based videoconferencing if they had the capability for it. Feasibility was evaluated as the proportion of patients who agreed to and completed virtual education. To evaluate acceptability, patients and RTTs were then emailed post-intervention surveys evaluating their satisfaction with virtual patient education.

Results

Over three months 106 of 139 patients (76%) approached consented to virtual education. The median (range) age was 65 (27–93), 69% were male and most had genitourinary (38%) or head-and-neck (29%) cancers. Ninety patients (85%) completed virtual education as planned, with incompletions due to scheduling (8) or patient technical issues (7), or treatment cancellation (1). Sixty-eight patients completed surveys, with the vast majority agreeing virtual education was clear (94%) and helped them prepare (100%), they were comfortable with the technology (96%) and they were satisfied overall (99%). Twelve RTTs responded, suggesting overall that virtual education was higher quality though less feasible than tele-education, and comparable to in-person education.

Conclusion

Offering individual, RTT-led virtual education using videoconferencing to patients pre-radiotherapy was feasible and acceptable in this pilot study, and is therefore being recommended as an option for all our patients. Future work will directly compare the effectiveness of in-person versus virtual education, and incorporate individual patient needs and preferences.

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women's Quality of Life: A Systematic Review and Meta-Analysis

Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC.

METHODS

We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI).

RESULTS

Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: -1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, -0.72; 95%CI: -1.31, -0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, -0.8; 95%CI: -1.31, -0.26), anxiety (SMD, -1.02; 95%CI: -1.71, -0.34), and depression (SMD, -1.57; 95%CI: -3.1, -0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89).

CONCLUSIONS

Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.

Virtual reality in preoperative preparation of children undergoing general anesthesia: a randomized controlled study

BACKGROUND

Preoperative anxiety can cause hyperalgesia, postoperative delirium and other adverse events, and even long-term psychological disorders. The aim of this trial was to determine whether preoperative virtual reality (VR) preparation reduces anxiety prior to induction of anesthesia.

METHODS

Data were analyzed for 99 children undergoing elective surgery. Participants were randomly assigned to a VR exposure intervention group or a control group. In the VR group, children watched a VR video showing a realistic interactive immersive virtual version of the perioperative process. The control group received conventional preoperative preparation. Preoperative anxiety using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) during anesthesia induction was the main outcome. Secondary outcomes included induction compliance, emergence delirium, pain, and parental satisfaction.

RESULTS

The VR group had lower mYPAS-SF scores when leaving the waiting area (27.1, interquartile range, IQR 22.9-33.3 vs. 33.3, IQR 27.1-39.6; P = 0.006), and during anesthesia induction (29.2, IQR 22.9-33.3 vs. 39.6, IQR 33.3-55.2; P = 9×10^-6). The Induction Compliance Checklist (ICC) scores during anesthesia induction were lower in the VR group (0.0, IQR 0.0-0.0 vs. 1.0, IQR 0.0-1.0; P = 0.003) than the control group, while parental satisfaction in the VR group was higher.

CONCLUSION

Virtual reality exposure as a preparation tool has a beneficial effect on anxiety, induction compliance and parental satisfaction in children undergoing elective surgery.

CLINICAL TRIAL REGISTRATION

ChiCTR2000035417.

Rapid Adaptation of Cancer Education in Response to the COVID-19 Pandemic: Evaluation of a Live Virtual Statistics and Research Skills Workshop for Oncology Trainees

Due to COVID-19, an annual interactive statistics and research methodology workshop for radiation oncology trainees was adapted at short notice into a live virtual format. This study aimed to evaluate trainee opinions around the educational value of the workshop, logistical aspects and impact on interactivity. A post-course on-line survey was completed by 26/42 trainee attendees (response rate 62%). For five pre-specified learning outcomes (LO), 58 to 69% of trainees agreed that the LO was completely or largely met (Likert scores 6 and 7 on a scale 1 = not met at all; 7 = completely met). All trainees felt that logistical aspects of the workshop including organisation, accessibility to the platform and sound/image quality were good or excellent. With regard to opportunities for interaction and suitability for small-group 'break-out' sessions, the majority felt that interaction could be adequately maintained whilst just under a quarter felt the delivery method was not fit for the purpose. Networking/social engagement with peers and teachers was the factor most impaired using the live virtual delivery format. Over three-quarters of trainees replied they would favour the current event or other educational sessions being offered (at least as an option) in a virtual format in the future. Cost and convenience were given as the major non-COVID-19-related benefits of virtual on-line learning. These preliminary findings provide valuable feedback to help adapt or develop further on-line educational and training initiatives that will be necessary in the COVID-19 pandemic period and beyond.

What is the effect of a low literacy talking book on patient knowledge, anxiety and communication before radiation therapy starts? A pilot study

INTRODUCTION

Radiation therapy is a common cancer treatment, requiring timely information to help patients prepare for treatment. We pilot tested a low literacy, psycho-educational talking book (written booklet, with accompanying audio recording) to examine (i) the effect of the tool on knowledge, anxiety and communication; (ii) acceptability, and (iii) how it was used in appointments.

METHODS

A pre-post design was employed. Patients scheduled to receive radiation therapy for any cancer were recruited from two hospitals in Sydney, Australia. Participants were sent the talking book before treatment planning and completed baseline and follow-up surveys, before and after the intervention.

RESULTS

Forty participants were recruited, and 39 completed all study assessments. Overall, knowledge increased after receiving the talking book by 3.8 points from 13.9 to 17.7/20 (95% confidence interval (CI) 2.7, 4.8, P < 0.001). Anxiety and concerns were significantly lower after receiving the talking book (P = 0.015 and P = 0.004, respectively). Nearly half of participants (s = 17, 48%) reported using the book during appointments. Most reported finding it easier to communicate (n = 31, 89%) and to ask more questions (n = 21, 62%).

CONCLUSION

The talking book shows promise in improving knowledge, reducing anxiety and enhancing communication. Strategies to support the implementation of the talking book are required. Further studies to translate the book into different languages are also planned.

Virtual reality as a patient education tool in healthcare: A scoping review

OBJECTIVE

To explore what is currently known about the use of virtual reality (VR) as a patient education tool in healthcare.

METHODS

Arksey and O'Malley's scoping review method and the PRISMA-ScR Checklist were employed. Four peer-reviewed databases were searched (Medline, Embase, PsychINFO, the Cochrane library). Pre-defined selection criteria identified 18 studies for inclusion. Results were synthesized using a narrative approach.

RESULTS

VR as an educational tool in healthcare is feasible and acceptable, and may improve patient's knowledge about their illness and satisfaction with treatment. Most studies used the Oculus VR glasses or headset, educated patients though the use of 3D 360° VR anatomical models, and were conducted with people affected with cancer. Opportunities exist for exploring unintended consequences, and the role of VR in educating populations with lower health literacy.

CONCLUSION

VR could assist in communicating medical information and knowledge to patients, but more research is needed, particularly to identify for whom and in what situations this method is most useful and to improve understanding about the potential unintended consequences.

PRACTICE IMPLICATIONS

Health professionals should consider using VR to educate their patients, and researchers can use this as a road map on how to address knowledge gaps in this field.

The use of virtual reality in patient education related to medical somatic treatment: A scoping review

OBJECTIVE

To map the available evidence on the context, content and outcome of VR in patient education in situations related to preparation for medical somatic treatment.

METHODS

A Scoping review. In October 2020, the Embase, CINAHL, MEDLINE and PsycINFO databases were searched with the terms 'Virtual Reality' and 'Patient Education'. The literature was synthesised and mapped with a narrative approach.

RESULTS

17 studies published between 2015 and 2020 were included in the qualitative synthesis. VR was applied in (paediatric) surgery and radiation therapy treatment. VR interventions were heterogeneous regarding technical applications, context of implementation, guidance by healthcare professionals and integration in education sessions. Anxiety reduction was demonstrated significantly in some studies. Patients experienced VR education useful; it enhanced understanding, improved communication with healthcare professionals and encouraged treatment compliance.

CONCLUSIONS

The application of VR in patient education is a promising technology. Patients are highly satisfied and experience enhanced understanding. VR education was not effective in reducing all anxiety, pain and stress and improving preparedness for treatment. Practice implications It is important to develop VR interventions profoundly. The application of a methodological framework for VR development is recommended. Involve patients, educationalists and technology professionals in the development of technology interventions.

Pilot Study of a Virtual Reality Educational Intervention for Radiotherapy Patients Prior to Initiating Treatment

Virtual reality (VR) presents opportunities for innovative patient educational methods. This study used a combination of subjective questionnaires and objective physiological measures to investigate the impact of a VR radiotherapy (RT) educational system on patients' understanding and anxiety prior to commencing RT. Sixty patients were randomized to control (n = 30) and intervention (n = 30) groups prior to initiating RT. The control group received the standard nursing care process. The intervention group additionally participated in a detailed introduction to RT positioning, procedures, treatments, and other RT-related information via VR education. All patients completed a data collection from pre- and postintervention, which included questions on RT comprehension, anxiety-related scales, and objective physiological data reflecting the patient's psychological state, such as blood pressure, heart rate, and respiration. Both groups had high anxiety levels before the intervention, and there was no significant difference between the questionnaire and physiological data of the two groups. Following the intervention, anxiety scores (state-trait anxiety scale and visual analog scale) of the intervention group decreased significantly compared with those of the control group, and there was a significant decrease in systolic blood pressure (p < 0.05) and increase in cognitive score (p < 0.05). This study reports the positive impact of a virtual reality radiotherapy (VRRT) patient educational system on increasing patient RT comprehension and reducing anxiety. Further work is needed to improve the acceptability of the system to patients and to explore further the impact of VR education on patients' psychological and physical needs.

Virtual Reality-Based Education for Patients Undergoing Radiation Therapy

We built a virtual reality (VR) application that runs on a commercially available standalone VR headset that allows patients to view a virtual simulation of themselves receiving radiotherapy. The purpose of this study was to determine if this experience can improve patient understanding of radiotherapy and/or reduce patient anxiety. We created software that reads data from our clinical treatment planning system and renders the plan on a life-size "virtual linear accelerator." The patient's CT simulation data is converted into a 3D translucent virtual human shown lying on the treatment table while visible yellow radiation beams are delivered to the target volumes in the patient. We conducted a prospective study to determine if showing patients their radiotherapy plan in VR improves patient education and/or reduces anxiety about treatment. A total of 43 patients were enrolled. The most common plans were 3D breast tangents and intensity-modulated radiotherapy prostate plans. Patients were administered pre- and post-experience questionnaires. Thirty-two patients (74%) indicated that they "strongly agree" that the VR session gave them a better understanding of how radiotherapy will be used to treat their cancer. Of the 21 patients who expressed any anxiety about radiotherapy beforehand, 12 (57%) said that the VR session helped decrease their anxiety about undergoing radiotherapy. In our single-institution, single-arm prospective patient study, we found that the majority of patients reported that the personalized VR experience was educational and can reduce anxiety. VR technology has potential to be a powerful adjunctive educational tool for cancer patients about to undergo radiotherapy.

Augmented Reality in Radiology for Education and Training—A Design Study

Education is an important component of every healthcare system. Patients need to be educated about their planned procedures; healthcare professionals need to be trained in their respective profession. Both patient education and the training of healthcare professionals are often completed in person, which requires resources and is bound to certain times and places. Virtual educational environments can potentially save human and monetary resources, increase learner engagement, and enable users to learn according to their own schedules. This design study describes proofs of concept for two augmented reality-enabled (AR) educational tools, utilizing a Microsoft HoloLens head-mounted display. In the first use case, we demonstrate an AR application which could be used to educate cancer patients about their radiotherapy treatment and potentially reduce patient anxiety. The second use case demonstrates an AR training environment, which could complement the practical training of undergraduate radiography students. Two prototypes—VIPER, for patient education, and ARTUR for the training of radiography students—were developed and tested for viability and usability, both based on individual user tests. Both patient and student education were evaluated as viable and usable additions to conventional educational methods, despite being limited in terms of accessibility, usability, and fidelity. Suitable hardware is becoming more accessible and capable, and higher-fidelity holograms, better utilization of real-world objects, and more intuitive input methods could increase user immersion and acceptance of the technology.

Efficacy of virtual reality-based interventions for patients with breast cancer symptom and rehabilitation management: a systematic review and meta-analysis

OBJECTIVES

To determine the effectiveness of virtual reality (VR)-based intervention on the symptoms and rehabilitation management in patients with breast cancer.

DESIGN

Systematic review and meta-analysis.

STUDY SELECTION

We included all eligible randomised controlled trials and quasi-experimental studies (published in English and Chinese).

PARTICIPANTS

Patients with breast cancer (≥18 years) undergoing cancer treatment.

INTERVENTIONS

Any intervention administered to improve the symptoms and rehabilitation of patients with breast cancer. The control group was given conventional care.

OUTCOMES

All outcomes were as follows: pain, fatigue, anxiety, depressive symptoms, cognitive function, and range of motion of upper limb in patients with breast cancer.

DATA SOURCES

We searched PubMed, Embase, CENTRAL and SinoMed, four electronic databases, covering the database establishment period to January 2022.

REVIEW METHODS

Two reviewers independently extracted content and data consistent with the prespecified framework and assessed risk bias. Random-effects meta-analysis was used to pool data across trials. Meta-analysis was performed using Review Manager V.5.4.

RESULTS

A total of eight studies met the eligibility criteria and were included in this study. The combined effect size showed that VR was positive for improving patients' anxiety(standard mean differenc (SMD)=-2.07, 95% CI= (-3.81 to -0.34), I²=95%) and abduction of upper limbs (MD=15.54, 95% CI= (12.79 to 18.29), I²=0%), but fatigue (SMD=-0.92, 95% CI= (-4.47 to 2.62), I²=99%) was not. Qualitative analysis showed VR improved patients' depressive symptoms, pain and cognitive function.

CONCLUSIONS

VR technology has a good effect on symptoms and rehabilitation management of patients with breast cancer, but the quality of evidence is low, and the sample size is small. To date, there are few intervention studies, therefore, giving precise recommendation or conclusion is difficult. We have a favourable view of this, and more clinical studies are needed in the future to improve the credibility of the results.

The Effectiveness of Virtual Reality-Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis

Background

Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs.

Objective

This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs.

Methods

A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95% CIs were used to calculate continuous variables.

Results

Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95% CI 0.62 to 1.29; P<.001), anxiety (MD −6.47; 95% CI −7.21 to −5.73; P<.001), depression (MD −4.27; 95% CI −4.64 to −3.91; P<.001), pain (MD −1.32; 95% CI −2.56 to −0.09; P=.04), and cognitive function (MD 8.80; 95% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95% CI –0.93 to 4.85; P=.18).

Conclusions

Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well‐designed, large, high‐quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk