Background: Radiation therapy (XRT) for head and neck cancer (HNC) can significantly impact a person’s ability to swallow. Dysphagia exercises completed during XRT are known to benefit long term swallowing outcomes. However, adherence to therapy during XRT is low often because of pain from the oncological treatment. Complementary and integrative pain management techniques have been investigated with various cancer populations, including some focus on patients with head and neck cancer. Virtual reality (VR) is one such method, but it has not yet been studied with HNC patients as a pain mitigation approach to increase dysphagia therapy adherence. The goals of this dissertation are to: (1) determine the perceptions and experiences of speech-language pathologists (SLPs) on pain and pain management because they would principally be the ones doing such work, (2) assess the user experience (UX) in VR of adults without HNC, and (3) assess the feasibility and user experience of VR with HNC patients who are completing XRT. This foundational information is needed to inform future work assessing the efficacy of using VR for pain mitigation to optimize dysphagia therapy adherence. The feasibility and UX studies are vital because HNC patients in XRT often already experience negative side effects from their cancer treatment that might be exacerbated by effects from VR. Methods: The first study surveyed clinically practicing SLPs (N=207) regarding pain and pain management education, training, and implementation. Study two assessed adults without HNC (N=30) to establish a UX data set for adults without HNC. Following a single session VR, participants completed UX survey tools regarding usability, acceptability, and negative side effects. Study three assessed the UX of HNC patients (N=10) who participated in three sessions of VR (Pre-, Mid-, and Post-XRT). As part of this protocol, within session changes from pre- to post-VR in self-rated swallowing and general pain was tracked. In Studies 2 and 3, groups were block randomized into one of two VR conditions (active or passive VR) to allow exploration of the type of VR on UX. Results: SLPs reported limited education and training in pain and pain management despite caseloads frequently having individuals with pain that impacted evaluation and treatment, including therapeutic progress. There was strong support for the use of novel techniques for pain management. In study two, there were no differences in UX between active and passive VR experiences for adults without HNC. Patients with HNC in study three also showed no differences between active and passive virtual reality experiences. Negative side effects were minimal and remained consistent throughout the course of XRT. There were no differences in UX between individuals with and those without HNC in terms of usability and acceptability of VR, or presence of negative side effects. There were clinically meaningful reductions in both general and swallowing-related pain with use of virtual reality in the HNC patients. Conclusions: SLPs would benefit from increased opportunities in education and training on pain and pain management. They expressed willingness to use novel techniques, like VR, for this purpose. The user experience of VR in active and passive environments was positive for adults with and without HNC and both groups expressed a high level of willingness to adopt VR use. There were minimal negative side effects in both groups. Of importance was that clinically meaningful decreases in perceived pain (swallowing and general) occurred following VR sessions in the HNC patients. These results are promising and justify further studies beginning to look at the efficacy of VR as a pain mitigation tool for patients with HNC undergoing XRT.
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