Which came first, the rooftop garden or the directional sign to the rooftop garden? In the case of a blossoming project to measure the impact of both a real garden and a virtual environment on Houston Methodist Cancer Center oncology patients, the sign came first. While pointing to a nonexistent garden, it planted the seed for a new clinical study and potentially an innovative patient therapy.

The misplaced sign appeared in the Outpatient Center, the work site of Renee Stubbins, PhD, RD, senior research oncology dietitian, and Ashley Verzwyvelt, RN, OCN, oncology infusion nurse liaison. After realizing the sign was a "mistake"—a preliminary notice for future plans—the two co-workers were inspired to make inquiries. After learning what was required, they submitted a proposal for a simple study to see what nature could do to improve patient health and wellbeing during infusion therapy.

To the researchers’ surprise and delight, the project grew exponentially. The Center for Health and Nature, the funding entity for the study, paired Stubbins and Verzwyvelt with Ann McNamara, PhD, associate professor and associate head of the Department of Visualization at Texas A&M University. McNamara added a virtual reality component, since not all study participants, such as those who are immunocompromised, can get outdoors.

“The Impact of Virtual Reality/Biophillic Environment on Distress and Pain in Oncology Patients” is designed to observe 36 solid tumor oncology patients who receive infusions every two weeks for at least six cycles. The participants will be randomly assigned to one of three rooms at each visit: control, virtual reality or garden view. Data collection will occur in patients with various stages and types of cancer and will measure both subjective and objective components, including pain, stress, heart rate, blood pressure and saliva cortisol levels before and after infusion.

As word of the endeavor spread, interest from community groups and charitable organizations continued to grow. The project now includes entities offering their work pro bono, including Skyline Art Services, landscape designers Asakura Robinson, the Trevino Group and others. It also attracted the attention of Houston muralist Mario Figueroa, Jr, better known as GONZO247, who has donated his talents to paint a gardenscape as part of the installation.

On October 11, 2019, a ribbon cutting ceremony celebrated the official opening of the garden and mural installation, located on the 21st floor of the Outpatient Center. Data collection for the project is already underway. The next phase of the project will explore how the garden may support clinician wellbeing, when used as a retreat for staff as well as patients.