VIRTUAL REALITY MEETS RADIATION: A NEW ERA IN PATIENT COACHING
Kathleene Dower is a 2025 clinical fellow with Breast Cancer Trials, and her project is looking to explore whether virtual reality (VR) coaching and education can help patients learn the Deep Inspiration Breath Hold technique more effectively.
Kathleene Dower is a radiation therapist and 2025 clinical fellow with breast cancer trials. Her project is about piloting virtual reality (VR) coaching and education for Deep Inspiration Breath Hold; a breathing technique used during radiation therapy to move the heart away from radiation and protect it from damage.
This study will explore whether VR coaching and education can help patients learn this technique more effectively. We spoke with Kathleene about the importance of this research and what it means for patients.
“When we had some new technology implemented within this department, basically what we saw with a lot of our breast cancer patients, who are left sided breast cancer patients, was that if deep inspiration breath hold is of benefit for their outcomes from treatment, our radiation oncologists will ask them to take a deep breath in and hold their breath for their treatment.”
“Now these are sustained breaths, so basically, they’ll take a deep breath for at least 20 seconds and then go into normal breathing, then a deep breath again, and then normal breathing after that.”
“And what we found with a lot of our patients is that they could not do a deep inspiration breath hold. Some of our patients became quite frustrated and upset that they couldn’t do it because they knew that there was a higher risk of them getting late cardiac events after their treatment.”
“So, we wanted them to have, a very robust education of what deep inspiration breath hold was. We also saw that the patients were quite anxious as well. They had a fear of the unknown, and they didn’t know what to expect. So, we invested in virtual reality education, and the reason why we invested in virtual reality education was because when people were immersed in the virtual reality experience, they’re completely focused in on whatever you were trying to educate them about.”
“We also have noise canceling headphones as well for them. So, they are completely immersed in that experience, and that’s the feedback that we have received from patients as well, that they were focused in, they knew exactly what they needed to do for their treatment and that it took away one unknown for them, which is exactly what we wanted to do.”
Listen to the Podcast
Kathleene Dower is a 2025 clinical fellow with Breast Cancer Trials, and her project is looking to explore whether virtual reality (VR) coaching and education can help patients learn the Deep Inspiration Breath Hold technique more effectively.
Why is the Deep Inspiration Breath Hold technique important and what challenges do patients typically face with this technique?
“So, it is particularly important for left breast cancer patients who are lying on their back for treatment. So, what happens when patients take a deep breath in and hold their heart moves away from their breast, so that means is that basically the topographical movement away or displacement away from their breasts, means that we are delivering a lower dose of radiation to the heart.”
“There are other ways that we can get the heart dose down, but that is just one extra added measure as well. And it means that we are giving patients the best treatment that we can offer them, so that’s particularly important.”
“It also means as well that their lungs are more inflated. So, as a volume, we’re treating less lung volume too, and because the patient is in a static position we are targeting their breast cancer a lot more than if they were to be free breathing. When they’re free breathing, their breast is moving in and out of the beam a little bit. That’s another reason why deep inspiration breath hold is important for left breast cancer patients.”
“The challenges that we’ve seen are that patients were afraid of the unknown. They had a fear of the unknown. They were anxious about whether they would be able to do deep inspiration, breath hold or not. When we gave them that education and the coaching, they were able to practice before they came in for their mapping or simulation session.”
“If patients couldn’t do a deep inspiration breath hold at their at their mapping session, they won’t be offered a deep inspiration breath hold for their free breathing treatment.”
“It’s important that we maximise the opportunities for patients to do it at their mapping session. We want to give them as best a chance as possible that they can do it. So, you put on the headset first and you’ll watch a 20 second animation of a patient’s chest free breathing, and then the patient taking a deep breath in and holding their breath, and a radiation beam coming on.”
“And it basically says, your radiation doctor has asked you to take a deep breath in and hold for your treatment. By taking a deep breath in, your heart moves away from the radiation beam. So that explains why we want them to do deep inspiration breath hold.”
“When I interviewed patients beforehand, a lot of them said that they wanted to know why they needed to do it. When you talk to patients about it, or you give them written information, they don’t really understand why. Now adults learn best with what we call the VARK acronym. So, its visual, audio, readability, and kinesiology.”
“With the virtual reality they had that visual component, they had the audio, and when they were doing the breath hold exercises as well, they had the kinesiology. So that touch and that feel through doing the movement, and with the readability component we would give them information as well so that they could read through it. So, we were maximising the education that they received, and we made it palatable for patients too.”
“It was really about health literacy too and making sure they could understand what do to from that education, especially receiving it in the form of virtual reality. And the feedback that we received back from patients was that they found it very easy to understand.”
What factors will you be measuring to determine whether it is effective?
“It’s the feedback that we receive from patients. Also in our pilot study, we ask them to do standardised anxiety questionnaires as well. And so, we’re looking at raised anxiety versus normal anxiety. We asked them to do these anxiety questionnaires at certain time points. Before the intervention, and then after the intervention, then a couple more times after that.”
“A lot of patients said that it just took away the factor of the unknown, and it reduced their anxiety. I can’t exactly give you the data now because it hasn’t been run through SPSS, but basically what I have looked at is pre intervention patients had raised anxiety and then post virtual reality education, they had lower anxiety levels after that.”
“So, as I said before, to maximise their ability to do deep inspiration breath hold and give them the best chance possible of them doing that for their treatment, which can affect them late term as well. Patients did feel a sense of accomplishment once they finished it, and some patients also said they liked being in control too.”
“You know, all the way through their pathway. Basically, they’ve been told that they have breast cancer, they get surgery, they might have chemotherapy and then radiation after that. And from some patients they felt like they weren’t in control at all, but doing the deep inspiration breath hold, because when they do the deep inspiration breath hold, they’re controlling the machine.”
“Our treatment machine only activates when they’re in that deep inspiration breath hold mode, and so they felt that they got a little bit of control back during their treatment, which was important too, and it was very empowering for some of our patients.”
“From a research perspective, I’m hoping to do a randomised control trial with other departments as well. So, we’re looking at filming with Tamworth Cancer Center and other rural hospitals, so we can hopefully open this up to other departments as well. And I think that virtual reality education, especially with radiation therapy, is so important, because in general patients only have radiation therapy once, so there’s nothing tangible that they can know or relate their experience to, so that’s why they have that fear of the unknown.”
“But with virtual reality education, they can get immersed in the experience, so they have something tangible to basically base their knowledge of. So, I think for radiation therapy, it will become very much part of our education piece for patients.”
“Unfortunately, some patients cannot do deep inspiration breath hold, but we will aim as much as possible to get their heart dose to as low as what we possibly can through other measures as well.”
