Effectiveness of Virtual Reality in Symptom Management of Cancer Patients: A Systematic Review and Meta-Analysis

Context. Although the survival rate of cancer patients has been increasing, such patients often experience severe physical and psychological burdens due to the effects of the disease and therapy. Multiple virtual reality (VR)-based interventions have been used to help improve physical and psychological symptoms and quality of life in cancer patients. Objective. This study aimed to assess the effects of VR-based interventions on anxiety, pain, depression, fear, distress, and quality of life in cancer patients. Methods. We conducted systematic searches in the PubMed, Web of Science, CINAHL, EMBASE, Cochrane Library, Scopus and APA PsycINFO databases from their inception to August 16, 2022. Two reviewers independently selected studies and extracted articles that met strict inclusion and exclusion criteria. Quality assessments of the included studies were performed according to the Cochrane risk assessment tool, and data analysis was performed using RevMan 5.4 software. Results. A total of 12 studies including 425 participants in the intervention group and 400 participants in the control group were selected for the final analysis. The results showed a significant difference between the VR and control groups for anxiety (standard mean difference [SMD] =-0.83, 95% CI-1.25 to-0.42, P< 0.001), SMD = pain (SMD =-0.86, 95% CI-1.36 to-0.35, P< 0.001), depression (SMD =-0.46, 95% CI-0.74 to-0.18, P = 0.001), fear (MD =-0.82, 95% CI-1.60 to-0.03, P = 0.04), and distress (SMD =-1.16, 95% CI-1.96 to-0.37, P = 0.004). However, no significant difference was observed in quality of life (SMD = 1.01, 95% CI-0.67 to 2.70, P = 0.24). Conclusions. VR interventions were effective in improving physical and psychological symptoms in cancer patients. Due to the limited number of studies, small sample sizes, and moderate to high heterogeneity, these results should be interpreted with caution. More rigorous, comprehensive and high-quality randomized controlled trials (RCTs) are needed to validate the results of this study. Trial Registration. PROSPERO International Prospective Register of Systematic Reviews CRD42022304931;https://www.crd. york.ac.uk/PROSPERO/display_record.php?RecordID=304931 J Pain Symptom Manage 2023;65:e467-e482. (c) 2023 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).