Words by Cale Wilkinson

Illustrations by Beci Orpin

This article has been edited. The full article can be read in issue 1

With research showing that Virtual Reality headsets are helping chronically ill children experience less anxiety and less pain during their hospital procedures, we immerse ourselves into the world of VR at the Murdoch Children’s Research Institute and take a look at what they’re doing to help those fighting cancer.

It’s hard to think of childhood cancer as anything other than traumatic. The speed of diagnosis, the ferocity of treatment and the terror of an unknown future make it a daunting journey for even the most resilient children and their families.

As head of the Psycho-oncology Program for the Children’s Cancer Centre within Melbourne’s Royal Children’s Hospital, Dr Maria McCarthy has dedicated her career to seeking out innovative ways to lessen this impact.

When Dr McCarthy was first approached by Murdoch Children’s Research Institute’s (MCRI) Bytes4health Program to consider looking into the effectiveness of virtual reality experiences on the wellbeing of these kids, she was incredibly open to the idea. “Like most people I was very aware of VR and its use in gaming and entertainment, but unaware of its utility in a clinical setting,” McCarthy said. “A lot of our inpatients can experience isolation, loneliness and boredom at times, so I could see a place for an immersive experience like VR.”

MCRI’s Bytes4health is an innovative incubator program where selected digital health and medtech start-ups can access cutting edge medical research, clinical expertise and digital health product development experience. “The Bytes4Health Program addressed an unmet need in the health technology sector” explains Dr James Dromey, Chief Operating Officer at MCRI. “While we have seen a growing number of start-up incubators and accelerators in Australia, there are very limited opportunities for health-tech companies to access medical research and clinical expertise.”

Healthcare and its surrounding research has traditionally been expensive and highly regulated, however, there’s now a growing awareness of the potential of low-cost disruptive technology, which is where Bytes4health offers support. The program produced an incredible range of applicants and some outstanding finalists, however, in the end there were two winners. One of them being Melbourne-based immersive technology company Phoria, with its product DREAM3D – a VR platform that was looking to test and validate the clinical benefits of using VR to improve the wellbeing of chronically ill children who were spending a lot of time in hospital.

At the point of applying to Bytes4health, Phoria had the idea and the product but needed credible partners to help with testing and, most importantly, a patient population willing to give it a go.

Phoria developed the entire content offering on their own (3x10-minute VR experiences), and despite the $25,000 prizemoney from Bytes4health, to say that it was bootstrapped would be a serious understatement. Trent Clews-de Castella, CEO of Phoria, estimates that VR content usually costs around $10,000 a minute to produce. “We were committed to the project from day one, so we really moved mountains to make it happen,” he says. It helped that Phoria were able to strike innovative agreements with Zoos Victoria and Parks Victoria to get the content they needed. “Both of these organisations were generous enough to allow us to repurpose some commercial content we had produced for them. When people understood the project, they were very generous.”

To avoid any potential conflict, Phoria provided their DREAM3D VR products to Dr McCarthy and her research team, but were not involved in the study in any way. “We felt this was a logical step to maintain the integrity of our results,” says McCarthy. The study has been conducted in two parts, with the first seeking feedback on the staff’s attitude to technology and VR in particular. “We wanted to see if our team of nurses, allied health professionals and others could accept the idea of VR as a therapeutic tool and understand any gaps,” she says. In the second part of the study a group of children were given access to VR and another control group had access to iPads. It is expected that the trial will be complete in mid-2018.

The immersive nature of VR experiences lend themselves perfectly as a tool for distraction therapy.

“Children ‘feel’ the water while a nurse or doctor prepares and cleans their hand, and fish gently bite at their hand while a needle is inserted.”

All children participating in the study are long-stay inpatients who are actively receiving treatment for their cancer. Aside from the child’s self-reported experience, the researchers are testing a range of physical measures including nausea and markers of anxiety and mood to get a genuine sense of whether it can impact quality of life. “These kids are quite isolated,” explains McCarthy. “They’re at their most intense phase of treatment so it’s important we don’t just measure if they liked it or not. We’d like to know if immersive experiences like VR can help kids maintain a semblance of quality of life during treatment and whether this continues on after treatment has finished.”

While the DREAM3D study continues, there are several other local and international VR studies now underway. At the Monash Medical Centre they have begun the world’s largest study of virtual reality headsets to improve the experience of children undergoing needle procedures. Needle procedures, including intravenous cannulas and blood tests, can be extremely distressing for many children and can lead to life-long anxiety. In contrast to the DREAM3D trial, the VR animations have been created to perfectly coincide with the procedures being carried out. “Children ‘feel’ the water while a nurse or doctor prepares and cleans their hand, and fish gently bite at their hand while a needle is inserted,” says Dr Evelyn Chan, Monash University Research Fellow.

The Monash study points towards a broader application of VR to manage children’s pain during medical procedures. For years clinicians have used all sorts of tools such as controlled breathing, books or puzzles to deploy what is known as ‘distraction therapy’. The immersive nature of VR experiences lend themselves perfectly as a tool for distraction therapy. Overseas in Paolo Alto, California, the new Lucile Packard Children’s Hospital, Stanford, is one of the first hospitals in the world to begin implementing VR therapy in every patient unit. “Preliminary results have shown that kids are more cooperative when they are engaged in VR, with less movement, less fear and sometimes even lower pain scores, which can make the experience more positive for the provider and the child,” says Dr Sam Rodriguez, co-founder of the Childhood Anxiety Reduction through Innovation and Technology (CHARIOT) Program.

Back at the Children’s Cancer Centre in Melbourne, Dr McCarthy remains excited about the DREAM3D trial and is optimistic that VR might just be another small incremental step in maintaining quality of life for kids with cancer.

Cale Wilkinson is a Melbourne based contributor, who currently works in medical research philanthropy.