JMIR Publications

ABSTRACT

Background:

Connection with nature has well-established physical and psychological benefits. However, people with metastatic breast cancer (MBC) are often unable to access nature due to physical limitations, psychological barriers, and treatment demands. Virtual reality (VR) nature experiences offer an alternative means of connecting with nature and may be of particular benefit to cancer patients who are house or hospital-bound.

Objective:

This study aimed to explore whether VR nature experiences might be associated with physical and psychological benefits for people with MBC who are disconnected from nature.

Methods:

This secondary analysis of a previous randomised controlled cross-over trial recruited participants from the emailing lists of breast cancer support organisations. Participants were provided VR headsets to use daily in their own homes over three weeks. In the first week, participants used one of two VR nature experiences (‘Ripple’ or ‘Happy Place') daily, followed by a one week washout period, before using the other VR experience every day for the final week. Outcomes assessed changes between baseline and post-intervention in quality of life (EQ-5D-5L), pain (BPI-SF), fatigue (FACIT-fatigue), depression (DASS depression), anxiety (DASS anxiety), and spiritual well-being (FACIT-Sp-12), and investigated whether benefits were greater in participants who were not strongly connected with nature at baseline.

Results:

Thirty-eight women with MBC completed the VR interventions and were included in analyses. Participants reported significantly less fatigue (P=.001), less depression (P<.001), and greater quality of life (P=.019) following the interventions compared to baseline. People with a weaker connection with nature reported greater fatigue (P=.03), depression (P=.006), anxiety (P=.001), and poorer spirituality (P=.004) than their strongly connected counterparts. Only those with a weaker baseline connection with nature had improvements in depression following the intervention (P=.03) with similar trends observed in fatigue (P=.07) and quality of life (P=.10).

Conclusions:

The current report provides preliminary evidence that feeling connected with nature is associated with better physical and psychological status in MBC patients and that VR nature interventions might be of benefit for this clinical population. Future studies should focus on activities that encourage connection with nature (rather simply exposure to nature) and investigate the aspects of VR nature interventions that have the greatest therapeutic potential. Clinical Trial: Prospectively registered on 25th October 2019 with Australian New Zealand Clinical Trials Registry (ref: ACTRN12619001480178)