The effects of virtual reality on cancer-related pain and anxiety: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Cancer-related pain and anxiety are highly prevalent and inadequately managed. Virtual reality (VR) has emerged as a promising nonpharmacological intervention. However, its effectiveness remains unclear.
Objective: To assess the effects of VR on cancer-related pain and anxiety.
Study design: Systematic review and meta-analysis of randomized controlled trials (RCTs).
Methods: Nine databases were searched until November 30, 2024, to identify RCTs evaluating VR for cancer-related pain and anxiety. The risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2), and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A random-effects meta-analysis was performed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted to explore heterogeneity.
Results: Thirteen RCTs (n = 969) were included, VR was associated with reductions in pain (SMD = - 0.76, 95% CI: −1.42 - −0.09, P = 0.03) and anxiety (SMD = - 1.53, 95% CI: −2.75 - −0.31, P = 0.01). Subgroup analyses suggested that the effects may vary according to the clinical setting and population characteristics. More consistent findings have been observed in procedural settings and pediatric populations, whereas some studies in ward- or home-based settings reported comparable effects between VR and active distraction interventions. The certainty of the evidence was low due to the risk of bias and heterogeneity. Adverse events were infrequently reported.
Conclusion: VR may contribute to short-term reductions in pain and anxiety in patients with cancer. However, substantial heterogeneity and low-certainty evidence warrant cautious interpretation of these findings. Further high-quality RCTs are needed to confirm the current evidence and inform optimal implementation of VR in oncology care.

Keywords

Virtual reality / Anxiety / Pain / Systematic review / Meta-analysis / Randomized controlled trials

CRediT authorship contribution statement

Jiaojiao Zhang: Writing - review & editing, Writing - original draft, Visualization, Validation, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Yi Chen: Writing - review & editing, Writing - original draft, Visualization, Validation, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Yiwen Duan: Writing - review & editing, Visualization, Validation, Resources. Qi Sun: Writing - review & editing, Validation, Formal analysis. Tingting Cai: Writing - review & editing, Validation, Supervision, Methodology, Funding acquisition. Changrong Yuan: Writing - review & editing, Funding acquisition. All the authors have read and approved the final version of this manuscript.

Ethics approval

As this study was a systematic review and meta-analysis of previously published studies, ethical approval and informed consent were not required. All included RCTs reported approval from the relevant institutional ethics committee or review board. Informed consent was obtained from all participants, and parental or guardian consent was reported in studies involving children or adolescents where applicable.

Funding

This study was supported by the National Natural Science Foundation of China (grant number 72504060) and the Ministry of Education of Humanities and Social Science Project of China (grant number 23YJC630002).

Declaration of Generative AI and AI-assisted technologies in the writing process

The authors declare that no Generative AI or AI-assisted technologies were used in the writing process.

Declaration of Competing Interest

Changrong Yuan is an editorial board member of Healthcare and Rehabilitation but has not been involved in the journal’s review or decisions related to this manuscript. The authors declare that there are no conflicts of interest.

Acknowledgments

None.

Appendix A. Supplementary material

Supplementary material

Data availability

The data presented in this paper are available from the corresponding author upon request.

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