A Pilot Study Investigating the Benefits of Nature-Based Virtual Reality Interventions in Metastatic Breast Cancer Patients

Abstract

Living with metastatic breast cancer (MBC) can be difficult and is associated with many physical and psychological challenges. People who have MBC commonly report aversive consequences like pain, fatigue, stress and depression but patients are typically underserved by psychosocial support. One strategy that has shown good promise in the extant literature is connecting with nature. Benefits include stress recovery and improvements to mood and health-related quality of life. However, there are many barriers for MBC patients in accessing the outdoors. Virtual reality (VR) provides an alternative means to connect with nature. Previous work has shown nature VR interventions offer a feasible, non-invasive approach that is safe, easy to learn and use, and that they can lead to improvements in mood, fatigue and depression. Notably, there have been no studies that has investigated the acceptability and benefit to MBC patients of using VR interventions in their homes or specifically compared the benefits of nature presented in animation to real-world footage. This study aimed to compare the effects for people with MBC of two VR nature interventions; one presented 360-degree real-world nature footage (Ripple) and the other presented an animated nature experience (Happy Place). This small scale pilot study utilised a cross-over randomised controlled design. Forty participants with MBC were randomly allocated to either an A:B or B:A condition where they used one of the VR interventions for seven days, followed by a washout period of no VR usage for seven days and then used the other VR intervention for a final seven days. Participants completed six questionnaires, responded to daily text messages and completed logs recording their VR experience. Participants’ health-related quality of life (HRQoL), fatigue, pain, anxiety, depression, stress, spiritual wellbeing, connectedness to nature and relaxation levels were assessed throughout the study. Expectations were assessed prior to study commencement and feedback about their experience was collected post-intervention. Analyses revealed no differences between the VR interventions but participants’ relaxation levels improved following usage of both VR experiences and both were associated with improvements over time in HRQoL, fatigue, depression, stress, spiritual wellbeing and connectedness to nature. There was low attrition in the study, participants were highly adherent and feedback about using the interventions was primarily positive. This study is the first to assess the acceptability of MBC patients using VR interventions in their own homes and to compare the benefits of a real-world and an animated nature VR intervention on physical and psychological wellbeing. The findings of this work suggest that VR nature interventions offer promise as a way for MBC patients to access nature and gain its many benefits. However, further research to investigate causality and specific mechanisms is required.