Effect of virtual reality on time perception in patients receiving chemotherapy

Abstract

Purpose: Virtual reality (VR) during chemotherapy has resulted in an elapsed time compression effect, validating the attention diversion capabilities of VR. Using the framework of the pacemaker-accumulator cognitive model of time perception, this study explored the influence of age, gender, state anxiety, fatigue, and cancer diagnosis in predicting the difference between actual time elapsed during receipt of intravenous chemotherapy while immersed in a VR environment versus patient's retrospective estimates of time elapsed during this treatment.

Materials and methods: This secondary analysis from three studies yielded a pooled sample of N = 137 participants with breast, lung, or colon cancer. Each study employed a crossover design requiring two matched intravenous chemotherapy treatments, with participants randomly assigned to receive VR during one treatment. Regressions modeled the effect of demographic variables, diagnosis, and Piper Fatigue Scale and State Anxiety Inventory scores on the difference between actual and estimated time elapsed during chemotherapy with VR.

Results: In a forward regression model, three predictors (diagnosis, gender, and anxiety) explained a significant portion of the variability for altered time perception (F=5.06, p = 0.0008). Diagnosis was the strongest predictor; individuals with breast and colon cancer perceived time passed more quickly.

Conclusions: VR is a noninvasive intervention that can make chemotherapy treatments more tolerable. Women with breast cancer are more likely and lung cancer patients less likely to experience altered time perception during VR (a possible indicator of effectiveness for this distraction intervention). Understanding factors that predict responses to interventions can help clinicians tailor coping strategies to meet each patient's needs.

Fig. 1

The pacemaker– accumulator (PA ) cognitive model of time perception. a PA model in a neutral environment: Rate of pulse generation in pacemaker is constant and all pulses are collected in the accumulator, resulting in accurate perceptions of experienced duration and estimates of time elapsed. b PA model in a stressful treatment environment: Negative arousal increases rate of pulse generation in the pacemaker and full attention is focused on the passage of time during treatment, resulting in higher values of experienced duration and overestimates of time elapsed. c PA model showing effects of distraction intervention on time perception in a stressful treatment environment: Intervention increases the patient’s sense of control (reducing rate of pulse generation in the pacemaker) and substitutes positive arousal for most of the treatment-associated negative arousal shown in b, resulting in lower values of experienced duration and underestimates of time elapsed. Figures are derived from Wittman and Paulus [43] (p. 8) and Droit-Volet and Gil [12] (p. 1944) and incorporate concepts from Chaston and Kingstone [6], Humphreys and Buehner [20], and Wearden [41]

Fig. 2

Actual time elapsed during chemotherapy treatment with VR immersion versus patient estimates of time elapsed during the treatment: mean values for patients with cancer of the breast (N=91), colon (N=18), and lung (N=28)