The first day of cancer radiation therapy begins inside a simulator. The patient remains immobilized for up to 45 minutes while lasers and imaging scanners identify the areas to be treated.
From his desk next to the simulator, Israeli radiation oncologist Dr. Ben Corn feels the anxiety attacks brewing in the waiting room. And he understands.
He understands that patients are afraid to enter the simulator. He understands that people associate radiation with the cause of cancer (think Hiroshima and Chernobyl) rather than the cure.
Corn knows that the radiation oncology unit can cause stress and anxiety for patients, their families, and even medical staff. And he is determined to tackle this problem.
“I am extremely interested in the emotional and psychological dimensions of cancer, both in terms of the consequences for patients and their caregivers and in terms of improving the potential of the therapies available to me as an oncologist,” he said. he told ISRAEL21c.
That’s why Corn is partnering with pioneering neuroscientist Amir Amedi, director of the Baruch Ivcher Institute for Brain, Cognition, and Technology at Reichman University. (Read more about our recent lab visit here.)
The place where no one wants to be
Amedi and his lab are inventing multi-sensory devices to instill a sense of emotional well-being in the waiting, treatment and staff areas of the radiation therapy center that Corn will lead at Shaare Zedek Medical Center in Jerusalem.
New discoveries from the lab about the mind-body connection, and how this is mapped in the brain, form the scientific basis for relaxation-inducing inventions such as:
- Fancy-looking, MRI-safe 3D glasses that immerse the patient in an entertaining movie or relaxing virtual environment.
- Treatment chairs and tables incorporating tactile and auditory sensations that can relieve pain and distract attention from the stressful environment.
- Respiratory sensors with relaxing and soothing visual, audible and tactile feedback elements to encourage deeper, slower breaths that promote feelings of control and calm – and even improve the clinical effectiveness of imaging and radiation therapy.
- Relaxing auditory experiences created through in-ear recordings that bring together how different people hear the same sounds from different parts of the room.
“There are patients who can’t go through the simulation because they’re so scared, and I think that’s one way to mitigate that,” Corn says, noting that the procedure may never be pleasant but at least might be tolerable.
Although music or videos inside the simulator can reduce stress and anxiety, especially in children, Corn was looking for much more than that.
When he read an article about Amedi’s breakthrough multi-sensory technologies, he knew he had found it.
“I loved the disregard for boundaries that I saw in his work,” Corn says.
“Imagine that instead of relying on sight alone or music alone — or tactile sensations, which no one was even considering — we can start to combine all three,” says Corn.
“I contacted Amir and said, ‘This has to be imported where no one wants to be, which is cancer medicine.’ And it pleased him. So we’ve come up with all sorts of cool ways to do that.
The Shaare Zedek Cancer Center, slated to open this summer, will be the testing ground.
“Medicine without data is voodoo,” says Corn. “I want to do things that not only sound good but are proven to work, and part of the fun is proving those things in the context of clinical trials.”
“I feel like everything we’ve done is preparing us for this project,” Amedi told ISRAEL21c.
“During the pandemic, we started working on reprogramming the senses and combining them with the body’s sensory signals to reduce stress and anxiety. I built a sophisticated multi-sensory room for this.
His lab has created technologically enhanced versions of mindfulness meditation, body scan meditation, and the Attention Training Technique (ATT).
“If you do any of these techniques for a few minutes each day, it works well, but if people are already very stressed, it just makes their symptoms worse,” says Amedi. “They need ‘training wheels’ and that’s what we try to provide.”
Amber Maimon, head of the academic laboratory at Amedi, worked on these technologies for her postdoctoral studies on the bidirectional link between mental and physical health.
“We want to create a multi-sensory environment where the moment you walk in, you’re surrounded by relaxation,” Maimon told ISRAEL21c.
Pediatric patients are at the heart of the project. “These technologies can capture their attention and get them out of the ‘black bubble’ of treatment,” she says.
“Everything we do has certainly never been done before. Some of the experiences, like Body Scan Meditation and ATT, have been tested and validated, but our implementation and technology is totally new. Professor Amedi’s own neuroscience research is new.
Amedi, in turn, was intrigued by Corn’s research on the “hope theory” – developed by Professor Rick Snyder of the University of Kansas in 1989 – as a way to improve cure rates and longevity of cancer patients.
Hope is not the same as optimism or wishful thinking, Corn explains. Rather, it is a perception of what is possible.
“Hope is a very active concept, and no one needs it more than the cancer patient and the people around them,” says Corn.
“We have consistently pushed the concept of hope into the clinical arena,” he says.
Life’s Door, an Israeli organization he founded with his wife, family therapist Dvora Corn, teaches healthcare professionals and patients strategies for finding hope, meaning and well-being throughout illness.
“Three conditions allow hope to flourish: choosing a goal that is both meaningful and plausible; a path to achieve this goal, recognizing that there will be obstacles to overcome along the way; and the agency — the motivation — to go down this path,” says Corn.
“In the world of cancer medicine, someone may have the goal of curing their cancer. The route could be radiotherapy. But the obstacle is the anxiety of being exposed to radiation. We might find a workaround through Amir’s technology, and if we can temper the anxiety which, in turn, will trigger the third component, agency,” he says.
Amedi saw the potential to promote hope by stimulating the senses, especially from the perspective of children faced with this frightening simulator.
“We do imaging studies to understand why the body is so susceptible to anxiety,” Amedi says. “My philosophy is to look at the organization and plasticity of the brain to inspire new technologies, but it also goes the other way.”
He and Corn secured a research grant from Israeli venture capital firm Joy Ventures, as well as support from Siemens, one of the manufacturers of radiation therapy simulators.
The Helmsley Foundation is funding the purchase of the latest simulator model for the Radiotherapy Cancer Center. While older models used CT technology, the new generation model uses MRI technology.
“You can do all kinds of clever things with it, but you have the problem of RM-related claustrophobia,” says Corn.
“When you add the issue of claustrophobia to the stigma of radiation, it’s quite a challenge. I think with Amir we can solve both problems.
environment of hope
Multisensory technologies would be used not only in the simulator, “which is the most stressful place for the cancer patient”, but also in the treatment rooms.
“Someone who is very nervous about having radiation therapy can get nervous. We have immobilizers to make sure you don’t move, but even small movements can be a problem as we always want to target the tumor and not the surrounding tissue. If you move even a few millimeters, it can knock it down,” says Corn.
“By finding out who you are and asking you to tell me what makes you feel good – like walking on a beach, or smelling the forest after the rain, or baking bread – we can virtually create the desired environment for you. as part of your prescription,” he explains.
“I guess it will make patients less stressed, less nervous and more cooperative. They will feel empowered because they are helping us to help them and they will regain a sense of control.
Corn and Amedi want this “environment of hope” to extend to staff members.
“There is a lot of burnout and even suicidal ideation among oncology healthcare professionals. Amir’s idea is to help them cope with stress and actively think about hope and how to achieve it with the help of these technologies,” says Corn.
“No one does that, not even close. We want to document our findings in the medical literature for review by our colleagues, as we believe this may be a game-changer. »
Two research centers in the United Arab Emirates have expressed interest in developing a similar project, and Corn and Amedi have applied for a US government grant to facilitate this.
“If we can use Amir’s technology to optimize cancer medicine,” Corn says, “it will expand our toolbox with things they don’t teach you in med school.”