In this interview from the 48th Annual Oncology Nursing Society (ONS) Congress, Oncology Data Advisor talks with Amanda King, PhD, APNP-BC, a Nurse Scientist at the National Institutes of Health, about her innovative approach to address distress and anxiety experienced by patients with brain cancer through the use of virtual reality.
Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here at ONS Congress, and I'm joined by Dr. Amanda King. Thanks so much for coming on today.
Amanda King, PhD, APNP-BC: Of course, happy to be here.
Oncology Data Advisor: Would you like to introduce yourself and share what your work focuses on?
Dr. King: Sure, my name is Dr. Amanda King, and I'm a Nurse Scientist at the National Institutes of Health (NIH). I work in the Neuro-Oncology Branch and the Office of Patient-Centered Outcomes Research, where we're really focused on how patients feel and function throughout their illness trajectory. We study symptoms, and my work is focused on targeting psychological symptoms and developing innovative interventions to treat them.
Oncology Data Advisor: That's great. So, you had a poster here on a virtual reality intervention targeting distress and anxiety in primary brain tumor patients. For a little bit of background, what is "scanxiety," and why did you decide to focus on this?
Dr. King: So, "scanxiety" is typically for patients who have solid tumors, and it's the distress and anxiety that patients experience in that time leading up to when they have their surveillance imaging to evaluate whether or not their disease is back or has progressed. It can be very traumatic for patients during that period, especially when they have their scans and they don't have their clinical appointments to find out the results for a long period of time. A lot of patients either aren't treated for it or they end up on medications for it. Really, our passion is to try and find non-pharmacologic approaches that can be helpful for patients and to teach them their own coping skills, so they can use these things at home on their own.
Oncology Data Advisor: Right. Why did you decide to use virtual reality to help address this?
Dr. King: It's an interesting story actually. I came to the NIH about four and a half years ago as a Post-Doctoral Fellow, and it was actually a younger trainee that brought the idea to our branch to use virtual reality. I think she did a systematic review where she was looking at using virtual reality for sleep and other psychological symptoms in different kinds of patients. She and her mentor, who is also my mentor, Dr. Terri Armstrong, thought it would be a great idea. They reached out to the company, and the collaboration formed from there.
Oncology Data Advisor: How do the patients like using the virtual reality?
Dr. King: They love it. It's a lot of fun. What's really cool, I think, about this trial is it launched during the height of COVID. It's entirely remote, so patients can use it in the comfort of their own home. The caregivers can also use it, and the kids in the house can use it. I think what's really nice about it is that there are multiple different kinds of scenarios on the headset, because we don't really know what kinds are going to work best, since no one's really done this before. The ones that I think are going to be the most beneficial are really breath-based—teaching you the slow deep breathing, which is called cardiac coherence breathing. There are a lot of scenarios like that. The headset itself has something called a breath shield on the front of it, so it can detect your breathing pattern and the environment will actually change based on how you're breathing.
Oncology Data Advisor: That's very cool.
Dr. King: So, that's one type of scenario. Then another type was really helpful, I think, during COVID because it was just exploring beautiful, distant places—cities and the mountains and the Alps. When people couldn't go anywhere, I think they found that really calming.
Oncology Data Advisor: Sounds really fun.
Dr. King: Then there are also more guided meditative-type scenarios, too. What's really neat is that I don't think one thing's going to work best for everyone. They really do have a choice, and they can choose their own adventure. I love this trial. I think it's so much fun to lead and to hear how patients like using it.
Oncology Data Advisor: That's awesome. That's great they have so many options, too.
Dr. King: For sure, definitely.
Oncology Data Advisor: So, how did you go about recruiting and enrolling patients for it?
Dr. King: We recruited from the Neuro-Oncology Branch's natural history study. These are established patients with us. We just screen to see if they reported distress in the past on their symptom questionnaires. Really, the only patients that we are excluding at this time are patients who have had recent surgery or seizures. Currently, we're excluding preexisting anxiety conditions. I think in the beginning, we were just a little worried that if it was a more pervasive anxiety disorder, it might not benefit from this approach. But it was interesting. We just did an interim analysis, and we actually found that a lot of our patients have those disorders. We thought about it and it's like, "Well, it's not going to hurt them." I think moving forward, we're actually going to allow those patients and just see if it works.
Oncology Data Advisor: What were the differences after the study in terms of reducing anxiety?
Dr. King: We haven't looked at the symptom data yet; the first step is really just looking at the feasibility. That was our primary aim. So far, it's feasible, patients love it, we're able to recruit, and they're doing everything that we ask of them. The next step is to finish recruitment, and we'll look at the symptom data and go from there.
Oncology Data Advisor: Awesome. Do you have any other future directions for it?
Dr. King: We've actually already started talking to the company about a larger randomized controlled trial. I think that'll be the next step, so long as the efficacy data looks good. We're hopeful to do that and expand out to other types of cancer.
Oncology Data Advisor: Awesome, this is really great to hear about. Thank you so much for talking to me about it.
Dr. King: You're so welcome. Thanks for having me.
About Dr. King
Amanda King, PhD, APNP-BC, is a Nurse Scientist and a Research Fellow at the National Cancer Institute of the National Institutes of Health. Her research focuses on distress and anxiety symptoms in patients with cancer and targeted interventions to help improve psychological symptoms and quality of life.
For More Information
King A (2023). Feasibility of a virtual reality intervention targeting distress and anxiety in primary brain tumor patients at the time of clinical evaluation: interim analysis of a phase 2 clinical trial. Presented at: 48th Annual Oncology Nursing Society Congress. Available at: https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/13548
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.
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