Feb. 10, 2020 — Linda Larrimore has been getting chemotherapy every other week for 6 years to treat and manage colon cancer.

The chemotherapy is keeping her health stable, so it’s well worth it to the mother and grandmother to regularly get the treatment. Usually, she spends the 4½ hours every other week reading, watching TV, or chatting.

But sometimes, during her infusions, she chooses to go to the beach. “It’s so relaxing,” says Larrimore, 64, of Newark, DE. “I just love the beach.”

She isn’t actually getting away, but it certainly feels like it. Once her chemotherapy IV session begins, she and other patients at ChristianaCare Helen F. Graham Cancer Center & Research Institute can use a virtual reality (VR) headset to help pass the time.

Virtual reality is computer technology that uses headsets that let wearers see, hear, and interact with a 360-degree simulation. At the Graham Center, volunteers go around with carts containing the equipment, show patients how to use it, and introduce them to the various scenes. Larrimore says she always opts for the beach, calling it “peaceful.”

“I see sand and seagulls, and I hear the water. It is very soothing,” she says. “It’s also great for me because I can’t be out in the sun in real life,” because chemotherapy makes her skin too sensitive. “But when I sit down in that chair, I don’t have to worry about that. I feel like I’m there — and I don’t have to cover up from the sun.”

Larrimore isn’t alone in her fondness for using VR in a health care setting. The use of virtual reality is exploding and is expected to continue to grow. It’s now being employed in a variety of settings — from the clinic to medical classrooms — and one recent report estimates the market for VR in health care will reach $7 billion by 2026.

It’s still the early days of this technology, so the health care field is just beginning to realize how it can be used, when it’s helpful, and what challenges it brings. Here are some ways it’s now being used.

Helping Mothers in Labor

A few hospitals in the U.S. are now offering VR to women going through labor and delivery to reduce their pain. Melissa Wong, MD, a maternal fetal medicine doctor at Cedars-Sinai in Los Angeles, says she wanted to make sure the use was driven by data — not just following a trend.

She did a yearlong, randomized, placebo-control study at her hospital, which they believe to be the most comprehensive data ever gathered on the subject. A smaller study published in 2019 found 57% believed VR eased their pain, 100% felt it eased their anxiety, and 100% would recommend it for other women in labor.

“Going in as a skeptic, I didn’t think it would be that effective, but I was impressed,” Wong says. “One minute you would see women grabbing the side of bedrails in pain, and then when we put the VR headsets on, by the time the next contraction rolled around, they were relaxed — or sometimes even asleep. I was shocked. It was pretty impressiv

Wong did her study on 40 first-time mothers who used VR for up to 30 minutes or as many as 10 contractions during labor. Previous studies have tested VR for only 10 minutes on women in labor or about two contractions. While women had the headsets on, Wong stayed in the room with them collecting data, including pain scores and vitals on the mother and heart rates on the unborn baby.

Wong used a pregnancy-specific product created by a VR company working with a doula. Images included calming scenes like a beach, crackling fire, and, the most popular, a tree with leaves that bowed in and out with the wind to help women breathing through contractions. Those images were coupled with reassuring, pregnancy-specific narration.

“Labor pain is different than chronic and procedural pain because it’s moving towards something positive in the end, so there is a reason the auditory guidance should be different,” Wong says. “We wanted to make sure women were hearing things about connecting and getting closer to meeting their baby rather than strictly trying to distract or escape from what was going on. One woman described it as if she had a virtual doula supporting her.”

Wong says she’s not looking to eliminate using drugs for pain relief, but she does believe it’s important to understand the impacts of this kind of technology. She says there were some complaints about it. Some women said using the VR headset separated them from their partner, who was there to support them. Others wanted their partners to be able to experience the calming effects with them — which wasn’t possible with only one headset. Wong says there is still a lot to learn about how to best use this technology in her field and plans more studies on how it affects labor and perhaps even postpartum depression.

“We know next to nothing about what the right content is. This is the first study to even think about what the content should be in pregnant women. The fact that we even acknowledge that makes us different, but the reality is, VR is just a syringe and we really need to think about the actual medicine we are delivering in the syringe. We need to think about the VR experience coming through.”

Pain Reduction

Children’s National Hospital in Washington, D.C., piloted a program in the summer of 2019 that involved a VR headset for children who needed procedures in the emergency room — like removing sutures, stitches, and foreign bodies.

The program enrolled nearly 40 children between the ages of 7 and 23. Each was given a VR headset that was covered in protective gear to cut down on germs. They then chose between several scenarios, including riding a roller coaster, and walking through a jungle and talking with a friendly snake. The headsets were connected to another screen so that parents could see the images their children were interacting with.

“Since we deal with children, we picked age-appropriate videos. But you can be 9 and scared by something, so it was very nice that parents could watch too,” says Deena Berkowitz, MD, director of national emergency medicine at Children’s National. She says the technology got rave reviews from patients, parents, and providers.

“The kids were transfixed and didn’t notice their pain. We already have TVs and iPads, but there is something special and different about the 3D experience that immerses them in a totally different place. It is really powerful,” she says. “Parents were thrilled because they felt their child was less anxious and tolerated the procedure well, and staff loved it because it made the procedures much quicker. They said kids even needed less pain medication than usual. It was very popular.”

Berkowitz stresses her staff didn’t measure if there was a reduction in pain medicine. The biggest challenge for her hospital now is figuring out how to continue using the technology.

“We thought it worked wonderfully, but this was just a pilot study. The next step for us is completely operational. Our challenge is figuring out who will operate the cart every day. It’s hard for our nurses and Child Life staff to find time for that, so we are still sorting that out.”

Complex Surgery

Neurosurgeons at Stanford Children’s Health in Palo Alto, CA, recently used virtual reality and 3D printed models to help them prepare to remove a life-threatening brain tumor from the youngest and smallest patient to ever have such a procedure. This surgical technique involved using a tube called an endoscope to remove the brain tumor through the nose of a 2-year-old boy. Before his surgery, it had only been done a handful of times on children, and all were over the age of 5.

“This patient is so small, so it became a question of, technically, can we actually do this surgery safely? There were very narrow corridors to get to the tumor through an approach that is generally only considered applicable for older patients,” says Gerald Grant, MD, chief of pediatric neurosurgery at Stanford Children’s Health.

VR allowed doctors to load an MRI and CT scan of the boy’s brain into a 3D reality tool so his team could map out and rehearse their surgical approach to remove as much of the tumor as possible and protect critical structures. They were able completely remove his tumor.

“Through our rehearsals, we could look at how the procedure might go and what to look out for, and it was an amazing way to basically do the whole surgery in VR before actually doing it,” Grant says. “Virtual reality has really opened up a dimension we couldn’t access before. We can rehearse procedures and navigate through the brain and look around the tumor 3-dimensionally and see views of the anatomy that we’ve never seen before.”

Patient Education and Experience

Doctors at Stanford Children’s Health use virtual reality in a variety of ways. Distraction-based therapy helps ease pain and anxiety during medical procedures. Some therapy inspires physical therapy and occupational therapy patients to move more. A pediatric cardiologist at the hospital created a VR experience to help explain more than 20 complex congenital heart defects to patients, families, and medical trainees. Grant says there is a specialized VR lab at Stanford where doctors can sit and sync up to the same VR 3D views to plan and discuss procedures together.

“Virtual reality is creating experiences in the clinic that we’ve never seen before,” Grant says. “When you give a child a headset and they can play around with seeing their own brain — all of a sudden they light up. They treat the tumor like they’re an Avenger or a superhero going after the enemy.”

Medical Education

Walter Jean, MD, a neurosurgeon at George Washington University Hospital in Washington, D.C., says VR images are transforming care in a variety of other ways too — from assuring patients after procedures that the tumor or aneurysm is really gone, to changing surgical preparation and doctor education.

“When you are doing surgery, you only have one shot as a doctor to get it right. But with virtual reality, you can practice and rehearse as many times as you want, using different approaches. If you make a mistake, all you have to do is reset and try again. It really helps with learning,” Jean says.

He says the use of VR has quintupled at his hospital in just 2½ years and continues to grow by the day. He says while the equipment is expensive now, he thinks that much like smartphones, it has the power to eventually become a great equalizer.

“Maybe there are ways to simplify it and make it cheaper, but it does allow us to go to places we’ve never gone before,” Jean explains. “I think at some point, we are going to improve connectivity to the point that I can be in my office using virtual reality and be in a shared virtual space with surgeons in India, for example.”

Easing Patient Anxiety

Larrimore, the chemotherapy patient, found VR to be so useful that she jumped at the chance to help create a new VR experience for patients before their first treatment. During the video, watchers can observe Larrimore as she portrays a patient in a behind-the-scenes tour and is taken through the IV room. Viewers can see what nurses do when they treat patients and where they sit during an IV drip. The video shows what happens in the pharmacy so patients understand why it takes the time it does to prepare medication. And Larrimore even shows how you have to take your IV pole with you when you go the bathroom.

“It walks you through what to expect, far beyond what a doctor or nurse can tell you, and I hope it clears up concerns and fears. I think it’s such an important tool to help ease the unknown for new cancer patients,” she says.

Larrimore is optimistic that this new tool is making a difference. “A lot of people are scared coming in, and it gives them an idea of what to expect. It’s different than reading it or hearing about it,” she says. “If you can see what will happen, I think it makes everything easier when you actually have to experience it in real life.”



Sources

Deena Berkowitz, MD, Children’s National Medical Center, Washington, D.C.

Gerald Grant, MD, Stanford Children’s Health, Palo Alto, CA.

Walter Jean, MD, George Washington University Hospital, Washington, D.C.

Linda Larrimore, Newark, DE.

Cynthia D. Waddington, registered nurse, ChristianaCare Helen F. Graham Cancer Center & Research Institute, Newark, DE.

Melissa Wong, MD, Cedars-Sinai Medical Center, Los Angeles.

Obstetrics & Gynecology: “Patient Reported Outcomes on the Use of Virtual Reality for Pain Management in Labor [17E].”

Reports & Data: “AR/VR in Healthcare Market to Reach USD 7.05 Billion by 2026,” May 15, 2019.

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