A Radiation Oncologist’s Journey toward Virtual Reality for his Patients

Dr William Levin

A conversation between Dr William Levin, Penn Medicine and Denise Silber, VRforHealth

Dr. Levin is a Clinical Associate Professor in the Department of Radiation Oncology at the University of Pennsylvania Cancer Center. His post-graduate medical training includes a medical internship at Yale, a residency in radiation oncology at the University of Pennsylvania, and a fellowship in proton therapy at the Massachusetts General Hospital. His clinical focus is on the management of lung cancer and soft tissue sarcomas. Dr. Levin serves as the Medical Director of Global Network Operations. His research interests include investigation of integrative oncology modalities, and mind-body medicine. He is engaged in the development of virtual reality applications for healthcare.

DS Your interest in therapeutic Virtual Reality has two pillars, your holistic approach to your patients, and your personal appreciation of the value of mindfulness meditation. Can you tell us more?

WL As a radiation oncologist, it’s hard not to notice that the patient’s journey exposes them to stress and anxiety. We don’t just treat the patient’s biology. We treat the whole person, and that whole person is what interests me. In fact, had I not become an oncologist, I would have chosen psychiatry.

And finally, when we healthcare professionals are exposed to the stress and anxiety of our clinical environment and our patients, we suffer as well. Who hasn’t heard of professional burn-out? For my own well-being and the well-being of my patients, I started doing mindfulness meditations myself and went on to teach the practice to the patients. I saw and they saw the therapeutic value of proper breathing, and I was very gratified that I could help them. However, there was a group of people who could not do it. Their brain was so stressed that the learning curve was too high.

So you were a physician in search of a solution…?

Yes, and three years ago, I found one. I’m an avid photographer and a techie, and I got an invitation to a Virtual Reality open house on the other side of Philadelphia. It was snowing. It was rush hour. The drive took forever, and I couldn’t find a place to park. I was late. I walked in with my heart racing, chest pounding, head throbbing.

One of the staff handed me an Oculus headset. In the next second, I was looking down from the windy crows’ nest of an old, tall ship sailing on a rough ocean. And suddenly, there was a calm. The clouds parted. The water turned crystal blue and I saw the palm trees on a distant beach. The person who had given me the headset told me to look over my right shoulder, and there I could see the sun and feel the heat on my right cheek. I whipped off the headset to look for the source of the heat and realized that my brain had generated that heat. Only a few minutes had passed. I had never experienced anything like this with mindful meditation, and thought, we must offer this to the patients.

But there was very little information out there about Virtual Reality meditation for cancer patients in the US?

Exactly. And about six months later, we contracted with that VR agency to create an eight-minute mindfulness experience. In this scenario, the point of view of the observer is a dock, from where you watch gentle waves rolling in, as the sun rises. A narrator provides a mindfulness practice. We put a clunky, tethered headset in the waiting room, and the feedback from the patients and families was excellent. We had enough proof to bring to our chairman and initiate a pilot program.

Your Department is very innovative and open.

Yes, our Chairman, Jim Metz, is entrepreneurial and tech savvy. Under his leadership, we love to push the envelope, and the other departments appreciate our work. We all tried the VR headset out first ourselves. How can you embrace the technique and propose it, if you don’t have a first-hand experience?

And then we measured the learnings with the patients. Over 85% had a positive experience. A very small per cent developed cybersickness; they felt dizzy and had vestibular issues. But this was still a big success. 85% is a huge score. However, we do know that one size treatment does not fit all, whether in conventional medicine or an immersive experience. So we will need to offer a choice of scenarios.

We are now looking to bring the headset into the Proton Therapy room. There are only 40 Proton Therapy centers around the world. These are enormous, vaulted rooms with huge machinery and jolting sounds. And if that were not enough, many of the patients are children. Unfortunately, the metal in the VR headset creates an interaction with the equipment. So we are working with the physics team to find a way to circumvent that.

To conclude, you think that the time has come for VR?

Yes, with the pandemic, more people than ever need solutions for stress and anxiety. Dr Spiegel’s book which you reviewed, has come out at the right time. The movement is growing.

And we at VRforHealth are trying to help!

Yes indeed! We appreciate that greatly.

Thank you, Dr Levin for all that you and your team do!