Virtual reality can be used to improve functioning in patients with cancer, according to David Rhew, MD, Chief Medical Officer, Vice President and General Manager of Enterprise Healthcare, Samsung Electronics America. Research has shown that this technology can decrease pain and improve vision, as well as improve memory and functioning in older adults with dementia and Alzheimer disease.

David Rhew, MD

At the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) 2019 Annual Meeting in San Francisco,¹ Dr. Rhew described the potentially limitless applications of these technologic advancements in health care.

Extended reality operates on a spectrum, from completely digital—with virtual reality, a person puts on a headset and the entire outside world disappears—to completely real. Popular smartphone apps like Pokémon Go use augmented reality to superimpose digital images onto real ones. In the middle is mixed reality, wherein individuals have the ability to interact with some images; this technology is not as immersive as virtual reality nor as simple as augmented reality.

In health care, augmented and mixed reality provide numerous applications for training. For instance, surgeons can practice techniques on simulated images, and nurses can use a mechanism that superimposes an image on top of an extremity, allowing a vein to be easily spotted. “These are really remarkable opportunities,” he noted. However, according to Dr. Rhew, the uses for virtual reality in health care are even more boundless.

Pain Reduction

Traditionally, virtual reality has been used in medical settings for entertainment, training/education, and distraction therapy, but he maintains that this technology should not be constrained to traditional-use cases.

“Now [virtual reality] can be used to address areas we have struggled with as clinicians: to be able to solve pain management, restore vision, and improve functionality,” he said.

In the wake of the opioid crisis in the United States, non-narcotic alternatives are desperately needed for effective pain management, not only for patients with cancer, but for individuals with a variety of illnesses. Dr. Rhew and his colleagues have been conducting research on the effects of virtual reality on pain reduction, and the results have been promising.

One recently published study evaluated the effects of virtual reality in 120 patients hospitalized with moderate to severe pain, some due to cancer.² Half of the patients received a virtual-reality intervention once a day, whereas the other half watched the same content on a television screen. The investigators observed a 52% reduction in pain and a 60% reduction in anxiety in the virtual-reality group.

“What was interesting is that when we took the headset off, for about 2 to 3 hours afterward, people had sustained pain relief. We also saw a trend toward lower levels of narcotic usage, and a significant number of patients reporting generally feeling better,” he said. “We’re recognizing that this is an opportunity to help us address this pain crisis.”

According to Dr. Rhew, one of the questions that comes up often in response to this research is whether individuals are simply being distracted from their pain. He maintains that the reality is more complex than that. Multiple studies have conducted functional magnetic resonance imaging (MRI) scans on individuals with pain and have demonstrated that the areas of the brain affected by pain actually shrink when the patient is immersed in a virtual-reality world.³

“In conjunction with the clinical decrease in pain, you’re also seeing physiologic neurochemical changes as evidenced in functional MRI,” he noted. “This sometimes lasts for as long as 24 to 48 hours in individuals who are able to better control it.”

Improvements in Vision

Virtual reality has also shown promise in improving low vision—ie, visual impairment not correctable by medical or surgical treatment or conventional eyeglasses—a condition often seen in those with advanced age, macular degeneration, diabetic retinopathy, glaucoma, cataracts, and even as a side effect of some cancer drugs.

A study done at Johns Hopkins University looked at the effects of virtual reality on patients with macular degeneration.⁴ In addition to a large percentage of patients achieving their functional goals, their vision improved, on average, from 20/400 to 20/30. In addition to macular degeneration, other vision conditions can be improved simply by reconfiguring the virtual reality software, he noted.

According to Dr. Rhew, virtual reality has now been used by over 100 ophthalmology and optometry centers across the country. “We can address multiple ophthalmologic conditions with the use of these technologies,” he said. “But there is still a lack of awareness that they exist, even in academic medical centers.”

Mental Clarity in Seniors With Dementia

Cancer is commonly known as a disease of the elderly. The use of virtual reality in seniors in now widely accepted and has been implemented in many large senior care centers, but misperceptions abound when it comes to seniors being able to effectively use and take advantage of this technology, he said.

Among individuals with Alzheimer disease or dementia, reminiscence therapy is a common tool used for brain exercise. “We’ve seen [virtual reality] used for entertainment, but from a clinical perspective, we’re seeing that it can help with dementia,” Dr. Rhew explained. “When you keep showing someone the same picture book, they stop responding. But by using [virtual reality], and teleporting them back to their old home, it gives them a renewed sense of things they want to talk about, and it allows them to engage.”

Virtual reality can also be used prophylactically in these individuals to prevent agitation and “sundowning”—the state of confusion that may occur from late afternoon to evening in people with dementia.

Dr. Rhew and his colleagues are collaborating with the American Hospital Association and hospitals around the country. For certain conditions, they’re exploring the option for nonnarcotic pathways that allow for a virtual-reality alternative before an opiate is prescribed.

“What we’re really talking about is the opportunity to use these technologies in ways we’ve never thought of. They can help us provide better supportive care and can improve functional, mental, and spiritual quality of life,” he said. “These are validated solutions.… We need to start learning how we can better apply them in the real world.” ■

DISCLOSURE: Dr. Rhew is an employee of Samsung Electronics America, maker of some types of virtual-reality equipment.

REFERENCES

1. Rhew D: Digital health: Science fact, not science fiction: Overview of virtual reality, augmented reality and wearables. 2019 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology International Symposium on Supportive Care in Cancer. Presented June 21, 2019.

2. Tashjian VC, Mosadeghi S, Howard AR, et al: Virtual reality for management of pain in hospitalized patients. JMIR Ment Health 4:e9, 2017.

3. Hoffman HG, Richards TL, Coda B, et al: Modulation of thermal pain-related brain activity with virtual reality. Neuroreport 15:1245-1248, 2004.

4. Deemer AD, Swenor BK, Fujiwara K, et al: Preliminary evaluation of two digital image processing strategies for head-mounted magnification for low vision patients. Transl Vis Sci Technol 8:23, 2019.