Virtual Reality

The study was a randomized, controlled trial. The intervention was a “Bedside Wellness System” (BSW) that included:  a virtual world for 20 minutes, with three-dimensional sound, wide angle display screens, gentle breezes, aromatherapy, and synchronized foot movement devices. There were three scenes:  a lake, a forest, and a country town. The control group interviewed before chemotherapy and the end of the trial.

• The sample was comprised of 30 patients.
• Age ranged from 18 to 70 years. 
• Most patients were women.
• Patients had multiple types of cancer.

• Outpatient chemotherapy
• Tokyo, Japan

The study was a randomized, controlled trial with pre-/posttests and two trials; both groups were subdivided into depressed versus nondepressed.

• Cancer Fatigue Scale (developed by the institution) 
• Fatigue visual analog scale (VAS)

An insignificant effect on fatigue was found when comparing the pre-/posttests of the depressed and nondepressed subgroups in the control group, comparing between the trials, although the depressed control subgroup seemed to have greater fatigue after chemotherapy than the nondepressed subgroup. Statistical significance was found after the second test in the control group, and post second trial tests showed significance compared to the control; however, no significance was found when comparing the depressed versus nondepressed subgroups.

• Data/charts in the article do not support the conclusion of decreased fatigue, except for the control group.
• The study had a small sample size; it was limited to chemotherapy patients and was random but not diverse.
• The equipment was expensive and requires expertise in virtual reality distraction techniques.

The intervention consisted of a virtual reality immersion system and was a six- to seven-minute system trial that included:  a wide three-screen LCD with stereo sound, a walking system for bedridden patients, scent with gentle breeze, and a vital signs monitor. Three scenarios were used:  a typical park, a plateau, and a cherry blossom avenue in bloom.

• The sample was comprised of 22 female, bedridden patients.
• Age ranged from 33 to 75 years. 
• Patients had breast (n = 18) and ovarian (n = 4) cancers.
• Performance Status:  0–2. 

• Inpatient
• Japanese cancer center

This was a single-arm, pilot study.

The authors used their own fatigue scale (not described).

Of the patients, 16 were not fatigued, four were a little fatigued, one was fairly fatigued, and one had no answer.

Major

• Analyses were poorly described.

Minor

• How patients were chosen was not described.
• This was a pilot study.
• The equipment was very expensive.

In the virtual reality intervention (VRI), there were three scenarios from which to choose. Every patient was given a gift worth $10 at completion.

• The sample was comprised of 16 women.
• Mean age was 57.7 years (range 50–77). 
• Patients were included if they
  • Had breast cancer
  • Were 50 years or older
  • Had at least two matched intravenous chemotherapy cycles
  • Could read/write English
  • Had no primary or metastases to the brain
  • Had no history of seizures or motion sickness.

• Outpatient
• Comprehensive cancer center

This was a crossover study, with the intervention either occurring during the first or second treatment.

Piper Fatigue Scale (PFS)

When compared to the treatment cycles in which no VRI was given, there was a statistically significant decrease in fatigue immediately following chemotherapy treatments in which women received the VRI. Two days after treatment, there was a trend toward lower fatigue scores, although the differences did not reach statistical significance.

• The study had a small sample size.
• Time exposure of the intervention was not controlled or reported.
• Only patients with breast cancer were included. 
• Special equipment was required.

Nursing time is needed for follow-up telephone calls.

Virtual reality (VR) is a computer-simulated technique during which individuals wear a head-mounted device and become immersed in scenarios through visual and auditory stimuli that they manipulate. Patients wore a VR headset during an intravenous (IV) chemotherapy treatment and chose from the following scenarios:

1. Deep sea diving
2. Walking through an art museum
3. Exploring ancient worlds
4. Solving a mystery.

Each scenario was long enough to last the entire length of the chemotherapy infusion (45–90 minutes). Patients were free to change scenarios at any time. During the control and VR conditions, patients sat in a reclining treatment chair. In the control condition, patients were free to participate in any activities they chose during treatment, such as watching television, talking with others, or reading. Patients were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and to receive the control (no intervention) during an alternate matched chemotherapy treatment. Outcomes were assessed at baseline (T1), immediately after chemotherapy (T2), and 48 hours postchemotherapy (T3).

• The sample was comprised of 123 adults receiving initial chemotherapy treatments.
• Mean age was 53.97 years (range 32–78).
• The majority of the patients were female (77%) and Caucasian (91%), and about half had a diagnosis of breast cancer (52%).
• Patients were excluded if they were younger 18 years, non-English speaking, had evidence of primary or metastatic disease to the brain, or had a history of motion sickness or seizures.

Outpatient clinic at a comprehensive cancer center in southeastern United States

Patients were undergoing the active treatment phase of care.

The study used a randomized, crossover, within-subjects design with a:

1. VR distraction intervention
2. Control.

Revised Piper Fatigue Scale (PFS)

The VR intervention did not improve fatigue outcomes. Although the treatment group experienced a greater decline than the control from T1 to T2, the difference did not reach statistical significance.

• The intervention was only used once with each patient, and determining whether patients had enough exposure to VR to produce an effect on symptoms was not possible.
• In some cases, a stronger “dosage” of VR may be needed.
• The study was conducted at a single site, and the the study population was homogenous.
• The study lacked standardized measures to capture satisfaction with VR use during chemotherapy treatment.

The two-arm study included virtual reality, pre-/post second day tests, and three scenario choices for chemotherapy infusion. Patients were randomized to the first or second chemotherapy session to an approximately 45-minute intervention.

• The sample was comprised of 20 women with breast cancer.
• Age ranged from 27 to 55 years. 
• Patients had no brain metastases or primary and no history of motion sickness or seizures.

• Outpatient
• Comprehensive cancer center

The study was a randomized, crossover trial.

• Piper Fatigue Scale (PFS)
• Self-Directed Search (SDS)
• State Anxiety Inventory (SAI)
• Open-ended questionnaire “Eval VR Intervention\"

There was a trend toward lower scores after the intervention, although the difference was not statistically significant.

• The study had a small sample size.
• Only patients with breast cancer were included.
• The intervention was not useful for cognitive impairment.
• The equipment was expensive, and special training was required.