Background & Aims
Cancer patients experience a high frequency and intensity of breakthrough cancer pain (BTcP), with prevalence rates of 40-60%. BTcP is insufficiently treated in 77% of patients. Research supports the use of nonpharmacologic interventions to improve BTcP management. Virtual reality (VR) distraction therapy has been shown to reduce perceived pain in various populations, with preliminary evidence for breakthrough pain. This pilot study investigates the feasibility and preliminary effectiveness of a VR distraction therapy for breakthrough cancer pain in hospitalized cancer patients. The aims are: 1) Describe the feasibility of a VR distraction therapy for BTcP in hospitalized cancer patients; 2) Evaluate the preliminary efficacy of a VR distraction therapy and usual care versus usual care alone on BTcP intensity in cancer patients experiencing an episode of BTcP; 3) Evaluate if the degree of presence and/or cybersickness moderates the degree of BTcP intensity during VR distraction therapy.
Methods
This study uses a within-participant, non-blinded experimental design with two treatments groups of randomized order: A) pharmacologic analgesia alone (usual care); and B) pharmacologic analgesia alone (usual care) and VR distraction therapy. Hospitalized adult cancer patients with BTcP will be recruited from a midwestern hospital. Participants will undergo treatments over two separate BTcP episodes. For both episodes, participants will rate their pain intensity at the end of the episode and the maximum, or worse, pain intensity experienced during the episode on a Numeric Rating Scale. Participants will complete self-report questionnaires to measure presence and cybersickness at the end of the VR session. Data on analgesic medication doses will be collected from medical records. The VR therapy involves an Oculus Quest 2 headset with a choice of three virtual experiences, each lasting up to 20 minutes. Participants will self-report treatment acceptability and usability using measures.
Results
Data collection and analysis is ongoing, with a current sample size of 15. Descriptive statistics will be calculated for all variables. For aim 1, demand will be assess using recruitment and retention data. Content analysis on researcher memos and observations to identify barriers to evaluating and delivering the intervention. Scores of treatment acceptability items and a usability scale will be computed. Quality and adverse events of the intervention will be assessed using presence and cybersickness scores. For aim 2, change scores for BTcP pain intensity scores before a treatment and the worst pain experienced during the BTcP episode for both treatment groups will be computed. Based on distribution of data, a paired analysis to compare independent groups will be conducted. For aim 3, moderation effects of presence and cybersickness will be tested with multiple regression analysis. A model will be estimated with relevant variables.
Conclusions
This research investigates a novel complimentary pain management intervention for cancer patients with BTcP. The findings of this pilot study will help inform future research on the use of VR distraction therapy for BTcP in hospitalized cancer patients.
References
1. Herrero, C. C., Torres, A. A., Cruz-Hernández, J. J., Carrato, A., Constenla, M., Díaz-Rubio, E., … & Guillem, V. (2019). Working towards a consensus on the oncological approach of breakthrough pain: a Delphi survey of Spanish experts. Journal of Pain Research, 12, 2349.
2. Zeppetella, G., & Davies, A. N. (2013). Opioids for the management of breakthrough pain in cancer patients. Cochrane Database of Systematic Reviews, (10).
3. Camps Herrero, C., Batista, N., Díaz Fernández, N., Escobar Álvarez, Y., Gonzalo Gómez, A., Isla Casado, D., … & Guillem Porta, V. (2020). Breakthrough cancer pain: review and calls to action to improve its management. Clinical and Translational Oncology, 22, 1216-1226.
4. Mallari, B., Spaeth, E. K., Goh, H., & Boyd, B. S. (2019). Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. Journal of pain research, 2053-2085.
5. Wittkopf, P. G., Lloyd, D. M., Coe, O., Yacoobali, S., & Billington, J. (2020). The effect of interactive virtual reality on pain perception: a systematic review of clinical studies. Disability and rehabilitation, 42(26), 3722-3733.
Presenting Author
Lynn Nakad
Poster Authors
Lynn Nakad
MSN, RN
University of Iowa College of Nursing
Lead Author
Topics
- Treatment/Management: Complementary and Alternative therapies