October 26, 2021
Few experiences in life can compare to the stress, fear and anxiety that come with a cancer diagnosis. Young or old, it is an avalanche of uncertainty that requires patients to summon immense reserves of courage in the face of their own mortality, one day and one treatment at a time.
The field of integrative medicine has become an increasingly important facet of modern medicine. Programs, such as pet therapy, yoga and meditation, have been wrapped into the treatment experience in order to help patients cope with the emotional extremes of their compulsive worries. The health and well-being of patients is viewed through an integrative lens that hopes to equip them with effective coping skills that they can rely on during difficult times.
Virtual reality (VR) is a cutting-edge tool on the frontier of digital therapeutics, a branch of technology innovation that aims to turn distraction into a more immersive, accessible arm of clinical treatment.
At Penn Medicine’s Department of Radiation Oncology — home to the world’s largest, most integrated proton center, The Roberts Proton Therapy Center — the development of VR is seen as a critical mission in the advancement of patient-centered cancer treatment.
“Our vision is to incorporate VR into the comprehensive care of our cancer patients and their caregivers. This treatment modality may offer solutions to medical problems not addressed by conventional medicine,” said William Levin, MD, Associate Professor of Radiation Oncology and Medical Director for Global Network Operations.
Penn Radiation Oncology is renowned for developing the most state of the art radiation treatment technology and offering patients the most cutting edge treatment options. But for patients undergoing radiation, or any other cancer treatment, the treatment process is often daunting.
"It can be very scary coming into a Center like ours and having these huge machines,” said Fern Nibauer-Cohen, Senior Director of Patient Engagement at Penn Medicine’s Department of Radiation Oncology.
Levin, Nibauer-Cohen and their colleagues in the Department of Radiation Oncology first took an interest in virtual reality several years ago as a novel method to assist cancer patients in navigating the ups and downs of treatment.
Before the coronavirus pandemic, the department had implemented a relaxation VR program in its waiting room. The program included a headset with an eight-minute module that virtually transported patients and their caregivers onto the dock of a bay, where they watched a sunrise and heard crickets chirping together with narration from a mindfulness coach.
But when COVID-19 hit, the initial rollout of VR was largely suspended due to concerns about sanitizing headsets and keeping the number of people in the waiting room to a minimum.
At that time, patients had to arrive to their treatments without the support of family and friends, a setback necessitated by pandemic safety protocols.
"With the times we're in, we're all under so much stress and pressure,” Nibauer-Cohen said. “For patients who are diagnosed with cancer, it just adds another layer. Our primary goal for our patients is really focusing on stress and anxiety reduction through mindfulness and distraction therapy. We want them to have the opportunity to access mindfulness in a VR environment.”
Nibauer-Cohen and Levin give credit to James Metz, MD, Chair of Penn Radiation Oncology, for his leadership and vision in the deployment of virtual reality at Penn Medicine. Metz has positioned the department as global leaders in the development of health care applications for virtual reality.
“We are in a period of rapid growth with applying VR to the healthcare setting. Over the past three years, Penn Radiation Oncology has piloted several VR programs to enhance the patient experience, provide patient education and add to our comprehensive global training and education portfolio," Metz said. "As we are pivoting to our next phase of VR development, I am really excited that our department is the hub of this very exciting and immersive technology that will help to redefine the patient experience and professional education."
With conditions improving in the pandemic recovery, Penn Medicine is wasting no time in resuming its VR program.
A small clinical trial will begin shortly evaluating a virtual reality program to reduce stress and anxiety in Levin’s lung cancer patients. This activity will occur before and after daily radiation treatments.
"We now know that chronic stress and anxiety can weaken the immune system. That can have negative consequences on well-being and may actually affect cancer treatment outcomes,” Levin said. “With the use of this technology, our hope is that not only will the patient feel better but it will actually have a positive impact on their cancer treatment on a molecular level.” The trial marks an important step toward a future of virtual reality that the team believes will soon transform cancer care by addressing the needs of the whole cancer patient.
In the near future, Dr. Levin hopes to see even more integrated patient VR experiences that will alleviate the immediate sense of fear and anxiety felt during treatments.
Ultimately, the idea is to make VR an integral part of both clinical cancer treatment and follow-up care.
"It's not that I want my patients to lug a headset around everywhere. What will happen naturally is they will develop that muscle memory for calmness and relaxation," Levin said. "That's the ultimate goal.”
As the virtual reality program at Penn Radiation Oncology ramps up, Levin feels the promise of VR will always come back to addressing the devastating impact of cancer — physical and mental — that he sees firsthand every day.