Enhancing Cancer Care Through Virtual Reality

Podcast Transcript

Dale Shepard, MD, PhD: Cancer Advances, a Cleveland Clinic podcast for medical professionals, exploring the latest innovative research and clinical advances in the field of oncology. Today I am happy to be joined by Dr. Rafael Arteta, a Genitourinary Medical Oncologist at the Maroone Cancer Center in Weston, Florida. He's here today to discuss the use of virtual reality and the care of patients with cancer. Welcome.

Rafael Arteta-Bulos, MD: Thank you. Thank you for the opportunity to discuss virtual reality in oncologic care.

Dale Shepard, MD, PhD: Absolutely. So give us a little bit of an idea what you do at our Cleveland Clinic Center down in Weston.

Rafael Arteta-Bulos, MD: Yeah. I'm the main genitourinary medical oncologist at Cleveland Clinic here in Florida. I mainly focus my practice on prostate cancer, bladder cancer, testicular cancer, and kidney cancer. And we do research. In this case, we have been focusing for the last several months doing this research on virtual reality on cancer care.

Dale Shepard, MD, PhD: Excellent. So just as a backdrop, there's a lot of different people that might be listening in, what are some of the psychological or physical burdens of people who are getting chemotherapy?

Rafael Arteta-Bulos, MD: During chemotherapy, cancer patients experience a range of physical and psychological burdens. On the physical side, one of the most common are fatigue, nausea, vomiting, diarrhea, lack of appetite. On the psychological part, patients struggle with anxiety, depression, pain, body imaging concerns, sometimes fear of recurrence or feeling of isolation. So those are the things that we try to improve is psychologically to try to improve the well-being and the experience of cancer patient receiving treatment.

Dale Shepard, MD, PhD: So we're going to talk about how virtual reality has been incorporated in this. So what was the impetus to think about virtual reality and how that might be helpful?

Rafael Arteta-Bulos, MD: Over the last 20 years, the interest in virtual reality has been growing. It often has been associated with gaming, but we start seeing potential beyond entertainment. In healthcare, especially in oncology, patient undergoing chemotherapy spends long hours receiving treatment, that long hours sitting on treatment carries on physical and emotional challenging for patients. So virtual reality is trying to divert the attention of the patient to try to reduce the anxiety in these stressful situations.

Dale Shepard, MD, PhD: How exactly, as the patient's getting treated, how does this virtual reality experience, what does that look like as the patient's getting infusions?

Rafael Arteta-Bulos, MD: During infusions, patient wore a virtual reality headset, which immerse the patient on a 360 degree environment during chemotherapy. A research coordinator is always close to them to assist and to set up the experience, but basically they are immersed on a 360 degree environment that really move them out from the chemotherapy suite environment. And I believe that type of experience is the main benefit on these patients.

Dale Shepard, MD, PhD: So clearly different than just watching something on a screen?

Rafael Arteta-Bulos, MD: Right. The standard of care, we allow patient to read a book, to watch TV or to surf the web, but this is more like an immersed reality that the patient really enjoys. We have a very good feedback from patient after they receive the intervention.

Dale Shepard, MD, PhD: So they have the sensation that they're not really in the chair getting chemo?

Rafael Arteta-Bulos, MD: They move their head around and they can see all the way around and have a very good experience.

Dale Shepard, MD, PhD: Great. So when you think about how to test that, of course it would be with a trial and how did you guys go about setting up a trial to see if there's a benefit to virtual reality?

Rafael Arteta-Bulos, MD: There have been some previous studies suggesting benefit on psychological benefit for patient receiving cancer care. So we designed a trial that included mainly patient over the age of 18 regarding the type of cancer of staging, and we use a national comprehensive cancer network distress thermometer that give us a score that determine how much stress the patient is having on that visit. This stress score goes from 0 to 10, and we tried to start on patients that have a score higher than 5, which basically limited the exposure of the patient that has at least moderate distress.

Dale Shepard, MD, PhD: When you went about picking patients, you said any kind of cancer, did you focus on whether they were starting treatment or further along in treatment? New patients? How did you pick the patients?

Rafael Arteta-Bulos, MD: The baseline characteristics between the virtual reality group and the standard group, we tried to balance those with the number of chemotherapy sessions that the patient has been completed. We try to balance age, sex, race, ethnicity, and also the staging of the cancer.

Dale Shepard, MD, PhD: So when we think about the trial, one group was in a virtual reality group and the other group was the standard things they would do during treatment?

Rafael Arteta-Bulos, MD: Yeah, that is correct, yes.

Dale Shepard, MD, PhD: And from a patient standpoint, again, you mentioned virtual reality and we think about gaming, is this using those virtual reality devices and having them sit and have an alternate distraction, if you will?

Rafael Arteta-Bulos, MD: We have a fixed set of topics that they can choose, but there are different themes that we can use, for example, swimming with dolphins, sometime visiting a beach in Thailand or having guided meditation. They can choose what is their preference and they're exposed to this virtual reality session for 15 minutes.

Dale Shepard, MD, PhD: How many patients did you look at in each group?

Rafael Arteta-Bulos, MD: We select 70 patients, and we divide those 35 patients on the virtual reality arm and the other 35 on the standard arm.

Dale Shepard, MD, PhD: And I guess patients, when they got their chemotherapy, how many sessions did they have? Did you measure this over time or was it just during an initial session that they got their virtual reality?

Rafael Arteta-Bulos, MD: On this specific trial, we expose each patient to one session of 15 minutes, but on future research, we are planning to half the dose of repetitive intervention to see how that impacts, overall, quality of life. But in this specific trial, we expose patient only once to this virtual reality setting.

Dale Shepard, MD, PhD: Okay. And you mentioned further studies, which I guess suggests that you had good outcomes from this one. So what kind of findings did you come across?

Rafael Arteta-Bulos, MD: We use standardized ways to measure outcomes like distress during treatment, anxiety and well-being. We have noticed that with the exposure to virtual reality, there's a 63% decrease in distress, and this was statistically significant. We also noticed that the anxiety decreased by 61% on the patient exposed to virtual reality versus 27% on the patient exposed to standard of care. And also the p-value was significant. Same with a well-being improvement, does show an improvement of 50% on the group using virtual reality versus around 15% on the patient using a standard of care and also was statistically significant.

Dale Shepard, MD, PhD: And so even with just one treatment for a fairly short period of time, you got some pretty significant findings?

Rafael Arteta-Bulos, MD: Yeah, that was very encouraged and very impressive findings. Some previous studies show that in order for this improvement to be maintained over time, it requires repetition of exposure. So that is one thing to consider for future studies.

Dale Shepard, MD, PhD: And were there any sort of physical measures that you might incorporate later so at least some patients get anticipatory nausea or things like that? Are these things that maybe might be improved by things like virtual reality and maybe improving that experience?

Rafael Arteta-Bulos, MD: Yeah, on this specific trial, we have focus on psychological aspects of cancer, but we are planning to use, for example, blood pressure, heart rate, symptoms of nausea, vomiting to try to see if those improve after being exposed to virtual reality.

Dale Shepard, MD, PhD: So I guess one thing is we're talking about this trial that's important to point out. How did you guys get funding to do this?

Rafael Arteta-Bulos, MD: Basically, let me explain how ended up doing these trials. We applied for a VeloSano grant, so we want the grant to run this trial. And also, the son of one of my patients that survived his life after four years with metastatic bladder cancer represents a company that is called Magic Horizons. So that company is the one that provides all the equipment and the software to use this technology on cancer patients.

Dale Shepard, MD, PhD: That's great. So I was shamelessly just confirming that you used VeloSano funding. We have VeloSano coming up. So an important thing to point out that we're making good progress as a result of the money we raise. So thinking ahead, tell us a little bit about where we may go from here.

Rafael Arteta-Bulos, MD: I believe that in the future we are expecting the VR technology, the virtual reality technology become more sophisticated with advances with artificial intelligence and machine learning that can personalize virtual reality to each individual patient. There are some preliminary trials using artificial intelligence to try to recognize emotions in the patient based on changes in their patient face and try to adjust the type of experience that they offer based on those findings. So I expect a more sophisticated virtual technology in the future. That will also impact the delivery of medical information to patients. A lot of patients feel really anxious about what is going to happen during chemotherapy, how the chemotherapy suite looks. So they're using virtual reality, informative way to engage patient on treatment and for them to be more familiar with what is coming during chemotherapy.

Dale Shepard, MD, PhD: I guess just back to the experience you gained from this trial, logistically patients end up with a headset and there was software, and so certainly if this were to be expanded, other than the equipment costs, was there very much that was disruptive in terms of their care or what did you guys learn from a logistics standpoint?

Rafael Arteta-Bulos, MD: That's a good question. I try to calculate how much will be the cost of each exposure based on information about the cost of the software and also the hardware. And the cost per exposure for the device and the technology, meaning the software, is around $3 per patient. To this, we need to add the cost of, in this case, our research coordinator that are with the patient during the exposure and assist, also, with cleaning and keeping the device. But we are very enthusiastic that this can be implemented in real life and patient can benefit from this type of supportive treatment.

Dale Shepard, MD, PhD: From a logistics standpoint, you said that there were some standardized visualization, this was a relatively small study. Any insight into what sort of imagery might've been more effective?

Rafael Arteta-Bulos, MD: Our patients are basically from South Florida and they are more interested or they choose more often topics that are related to nature. Miami is a big city and we don't have too much exposure to nature like in the north of the states. So most of them elected swimming with dolphins or walk in the forest or something related with nature.

Dale Shepard, MD, PhD: Yeah, that's great. As we think about moving forward, is the next trial already in the development phase?

Rafael Arteta-Bulos, MD: We are thinking about trying to put a trial together basically to try to determine how long this type of benefit lasts, how long this improvement or decreasing distress and anxiety lasts and if it's needed to re-expose the patient to the treatment and how often. So we want to determine what will be the real impact of this intervention in the long-term.

Dale Shepard, MD, PhD: It's great that you're working on this area. We think about how you actually give a treatment to shrink a tumor, but sometimes we don't give enough attention to the other impacts on patients.

Rafael Arteta-Bulos, MD: We realize that cancer care, we have very good treatments, chemotherapy, immunotherapy, targeted therapy, CAR T, very sophisticated treatment, but patient still suffers significant burden psychologically. So I believe that is a significant component of patient care basically for the well-being of the patient.

Dale Shepard, MD, PhD: So you're doing good work. It looks like you've put together some great data and this work was presented at ASCO, is that correct?

Rafael Arteta-Bulos, MD: Yeah. We present a poster in ASCO 2025 and we work on this trial with Dr. Nahleh, the head of the cancer center here in Florida. And we have a research fellow, Dr. Maria Jose Herran. She really worked hard on this organizing and putting the data together.

Dale Shepard, MD, PhD: Great. So congratulations on putting this all together and it looks like a good head start on improving care for patients.

Rafael Arteta-Bulos, MD: Yes. I want to maybe summarize what I believe how virtual reality will impact patient care. And basically, this is an emerging and promising tool in cancer care that offer benefit in supportive care, also education and rehabilitation and can help manage anxiety, pain and in general, well-being of the patients. So I believe this will be more common in cancer centers and we are waiting for further studies to really determine the impact in the overall wealth of the patient.

Dale Shepard, MD, PhD: It sounds like, again, you're doing great work and congratulations on helping lead the way in this area.

Rafael Arteta-Bulos, MD: Thank you. Thank you very much for the time and the interview.

Dale Shepard, MD, PhD: Absolutely. Thanks for being with us.

Rafael Arteta-Bulos, MD: Thank you.

Dale Shepard, MD, PhD: To make a direct online referral to our Cancer Institute, complete our online cancer patient referral form by visiting clevelandclinic.org/cancerpatientreferrals. You will receive confirmation once the appointment is scheduled.

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