A new study at Lawson Health Research Institute and Children’s Hospital at London Health Sciences Center (LHSC) is using virtual reality (VR) in hopes of minimizing fear and anxiety in pediatric patients during painful medical procedures, often used in cancer treatments.
The study looks at cancer patients between the ages of five to 17 who require port access, a reservoir that sits under the skin in which a needle must be inserted to administer blood work or give daily medication. A procedure which can be quite painful for patients.
“I see a lot of kids undergoing painful procedures and even though we provide them with anesthetic in some capacity, they still experience a significant amount of discomfort and it’s probably related to anticipatory anxiety and stress,” said LHSC’s emergency pediatric physician, Dr. Naveen Poonai.
In the study, 90 patients will be randomly divided into three groups. One will have access to VR technology during the procedure, the second group will view programs or games on tablets and iPads, and the third will have no technology at all. Researchers will then record their responses and give them a questionnaire afterwards to assess which was better.
Poonai hopes to “nip the anxiety in the bud” and not only create a better experience for kids during treatment, but also help them cope with painful procedures as they get older.
“VR is cool,” he said. “In the 60s we could distract them with a game of snakes and ladders, but now, we’re in the 21st century and virtual reality is what a lot of kids are doing right now.”
Patients can enjoy a 3-D experience spanning 180 degrees with various games and a virtual aquarium in which they can interact with wild life without imagining anything resembling a needle, Poonai said.
A tool in the toolbox
Pediatric oncologist, Dr. Alexandra Zorzi says that port access is a routine part of patient care and it is important for it to be a positive experience because it sets the tone for the interaction between patients and health care staff.
“Children are often nervous and have anxiety especially if they’ve had a poor experience in the past where it didn’t go so well or required multiple attempts,” she said. “They might need to be helped to stay in a certain position and all of that can be very overwhelming to a child.”
Zorzi believes VR can be very powerful for both children and their parents in pain management and can reduce the detrimental effects of anxiety on their physical and mental health.
“I really hope it can become a tool in the toolbox of ways that we can tailor our approach to an individual patient, it may not be suited for all patients, but it’s just one more tool that I can have to offer a patient,” she said.
Poonai often hears lots of crying and pleas from his patients to postpone port access.
“These children already have a chronic medical condition so you’re already heightened to their sensitivities right away and then they’re upset because they know what’s going to happen so they’re difficult to manage,” he said.
Poonai believes VR technology is going to make a big impact because it’s a drug-free approach. It’s also something that doesn’t cost the healthcare system much and doesn’t require to be restocked or any specialized training to deliver it, he said.
“Sometimes when we want to relieve children’s anxiety, one of the first things we do is reach for a drug,” Poonai said. “Whenever you have a drug-free approach combined with technology that’s current and topical, you get a lot of traction from parents.”
Zorzi recalls one of her younger patients, a hobbyist gamer, who used the technology VR during his port access. The patient’s mother was “flabbergasted” that he didn’t even react to having his port accessed because he was so immersed in the VR, she said.
Poonai and Zorzi’s teams are a third of the way in recruiting 90 participants. They plan to have early results by the spring, and hope to expand the use of VR technology to other painful medical procedures like suturing.