According to Cancer Research UK, 28% of cancer patients receive chemotherapy treatment, which is around 102,760 people per year in the UK [1,2]. The most common type of chemotherapy is administration of the drugs directly into the patient’s vein (intravenous chemotherapy) and this is usually carried out in a hospital by a chemotherapy nurse [3,4]. While chemotherapy can be a life-saving treatment, the drugs are cytotoxic and so need to be administered correctly. Virtual Reality (VR) has been shown to be a useful tool to provide comprehensive training on safe chemotherapy drug delivery [5].
The drugs delivered in chemotherapy target cells as they divide, and as cancerous cells divide much more often than normal body cells, chemotherapy drugs can target tumours to kill these rapidly dividing cells [6]. Although the aim of chemotherapy is to only target cancer cells, healthy body cells can still be damaged or killed by the treatment, especially those that divide rapidly. These include cells in bone marrow, hair follicles, skin, and the lining of your digestive tract, so the side effects of chemotherapy are common and quite severe [6]. As the drugs used are cytotoxic, they can be extremely dangerous if they are administered incorrectly and can prolong the duration of the patient’s hospital stay, cause irreversible serious injury, or even death [5,7]. However, it has been shown that correct guidelines adherence in combination with effective communication between healthcare professionals can prevent most medication errors [8]. Nonetheless, improper chemotherapy administration doesn’t just affect the patient, it can also harm the medical staff member administering the drug [9]. Several United States and European studies indicate that oncology nurses administering chemotherapy drugs experience symptoms, such as hair loss and an unusually high rate of miscarriage, which is likely to be the result of exposure to these cytotoxic drugs [10].
In order to improve the standard of protection of medical staff carrying out chemotherapy administration, in 2013 the World Health Organization and the Pan Health Organization released an operating guideline entitled ‘Safe Handling of Hazardous Chemotherapy Drugs in Limited‐Resource Settings’ [11]. However, a 2015 study showed that these guidelines were often not followed. For example, only 85% of respondents reported that they always wore single chemotherapy gloves, and double gloves were reportedly always worn by less than 20% of respondents, even though double gloves are recommended [13].
Due to the risk of harm to patients and nurses from improper chemotherapy drug administration, it is extremely important that medical staff are properly trained on safe application of this medication. Many innovative teaching methods such as videos and animations could provide nursing students with more thorough training on safe drug delivery and make chemotherapy administration less dangerous [5]. VR could be a useful tool to provide appropriate training of the risks and allow staff to gain virtual experience before carrying out drug administration to people with cancer. In support of this, in a recent randomised controlled trial the effectiveness of VR teaching of chemotherapy was compared to standard chemotherapy training. The authors of the study designed VR activities that were delivered to nursing students in a one-week practice session, with the aim of providing virtual training and improving their confidence in the handling and delivery of chemotherapeutic drugs. The knowledge of the students who were taught using the VR programme, who had experienced real‐world simulations, was significantly increased compared with those who only read the standard education documents [5]. This study has therefore demonstrated that clinical nursing information in combination with VR experiences, can optimise chemotherapy treatment training.
Overall, VR has been shown to be an effective training tool in multiple clinical studies, including in correct chemotherapy administration education [5,13,14,15]. It is clear that there is a role for VR software in addition to the usual teaching methods and, importantly, it gives nursing students virtual clinical experience. By teaching medical staff how to administer chemotherapy drugs using VR, it provides safer, more well-rounded teaching experiences that can improve care, and it can even save lives.
Ella White
Bibliography:
[1] Cancer Research UK. 2021. Cancer treatment statistics. [online] Available at: <https://www.cancerresearchuk.org/health-professional/cancer-statistics/treatment>
[2] Cancer Research UK. 2021. Cancer Statistics for the UK. [online] Available at: <https://www.cancerresearchuk.org/health-professional/cancer-statistics-for-the-uk>
[3] nhs.uk. 2021. Chemotherapy. [online] Available at: <https://www.nhs.uk/conditions/chemotherapy/>
[4] Macmillan.org.uk. 2021. How is chemotherapy administered? Day units, hospital, home. [online] Available at: <https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/how-chemotherapy-is-given>
[5] Chan, H., Chang, H. and Huang, T., 2021. Virtual reality teaching in chemotherapy administration: Randomised controlled trial. Journal of Clinical Nursing, [online] Available at: <https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15701?saml_referrer>
[6] Cancerresearchuk.org. 2021. How chemotherapy works | Cancer in general | Cancer Research UK. [online] Available at: <https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/how-chemotherapy-works>
[7] Chotsampancharoen, T., Sripornsawan, P. and Wongchanchailert, M., 2015. Two Fatal Cases of Accidental Intrathecal Vincristine Administration: Learning from Death Events. Chemotherapy, [online] 61(2), pp.108-110. Available at: <https://pubmed.ncbi.nlm.nih.gov/26636546/>
[8] Coyne, E., Northfield, S., Ash, K. and Brown-West, L., 2019. Current evidence of education and safety requirements for the nursing administration of chemotherapy: An integrative review. European Journal of Oncology Nursing, [online] 41, pp.24-32. Available at: <https://www.sciencedirect.com/science/article/pii/S1462388919300493>
[9] Bnf.nice.org.uk. 2021. Cytotoxic drugs | Treatment summary | BNF content published by NICE. [online] Available at: <https://bnf.nice.org.uk/treatment-summary/cytotoxic-drugs.html>
[10] Mindmetreresearch.com. 2017. MindMetre Oncology Nurse Protection Report. [online] Available at: <http://www.mindmetreresearch.com/wp-content/uploads/2017/06/MindMetre-Oncology-Nurse-Protection-Report-February-2017.pdf>
[11] Iris.paho.org. 2013. Safe Handling of Hazardous Chemotherapy Drugs in Limited-Resource Settings. [online] Available at: <https://iris.paho.org/bitstream/handle/10665.2/28554/9789275118016-eng.pdf>
[12] Boiano, J., Steege, A. and Sweeney, M., 2014. Adherence to Safe Handling Guidelines by Health Care Workers Who Administer Antineoplastic Drugs. Journal of Occupational and Environmental Hygiene, [online] 11(11), pp.728-740. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568815/>
[13] Gunn, T., Jones, L., Bridge, P., Rowntree, P. and Nissen, L., 2017. The use of virtual reality simulation to improve technical skill in the undergraduate medical imaging student. Interactive Learning Environments, [online] 26(5), pp.613-620. Available at: <https://www.tandfonline.com/doi/abs/10.1080/10494820.2017.1374981>
[14] Dascal, J., Reid, M., IsHak, W. W., Spiegel, B., Recacho, J., Rosen, B., & Danovitch, I., 2017. Virtual Reality and Medical Inpatients: A Systematic Review of Randomized, Controlled Trials. Innovations in clinical neuroscience, [online] 14(1-2), 14–21. Available at: <https://pubmed.ncbi.nlm.nih.gov/28386517/>
[15] Hanson, J., Andersen, P. and Dunn, P., 2019. Effectiveness of three-dimensional visualisation on undergraduate nursing and midwifery students’ knowledge and achievement in pharmacology: A mixed methods study. Nurse Education Today, [online] 81, pp.19-25. Available at: <https://pubmed.ncbi.nlm.nih.gov/31306850/>
