The Efficacy of Virtual Reality-Based Interventions in Breast Cancer-Related Symptom Management: A Systematic Review and Meta-analysis

Using Integrative Therapies to Improve Patient-Reported Outcomes in Breast Cancer Survivors: A Living Evidence-Based Clinical Practice Guideline

AIM

Breast cancer imposes a serious disease and economic burden on patients. This guideline aims to develop a living evidence-based clinical practice recommendations to guide the use of integrative therapies for the improvement of patient-reported outcomes (PROs) in breast cancer survivors.

METHODS

We searched systematic reviews and meta-analyses or conducted de nova systematic reviews and meta-analyses to support the recommendations. The grading of recommendations, assessment, development, and evaluation approach was used to rate the certainty of evidence and the strength of recommendations.

RESULTS

The guideline panel issued 17 recommendations: for alleviating anxiety, strong recommendations in favor of muscle relaxation training, yoga, acceptance and commitment therapy, cognitive behavioral therapy, psychological education, and Tai Chi in general breast cancer survivors; for alleviating depression, strong recommendations in favor of mindfulness therapy, cognitive behavioral therapy, group psychotherapy, muscle relaxation training, acceptanceand commitment therapy in general breast cancer survivors, and exercise intervention for patients received radiotherapy; for sleep quality, conditional recommendations for all therapies; for pain, strong recommendations in favor of exercise intervention for postoperative breast cancer survivors; for alleviating fatigue, strong recommendations in favor of mindfulness therapy and group psychotherapy in general breast cancer survivors; for improving the quality of life, strong recommendations in favor of mindfulness therapy in general breast cancer survivors, Baduanjin and exercise intervention for patients undergoing anticancer treatment.

CONCLUSION

This proposed guideline provides recommendations for improving the PROs of breast cancer survivors. We hope these recommendations can help support practicing physicians and other healthcare providers for breast cancer survivors.

Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review

BACKGROUND

Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs.

OBJECTIVE

This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer.

METHODS

Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool.

RESULTS

In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer.

CONCLUSIONS

Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice.

TRIAL REGISTRATION

PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9.

Non-pharmacological Therapies for Depression in Women With Breast Cancer at Different Treatment Phases: A Systematic Review and Network Meta-Analysis

CONTEXT

Various non-pharmacological therapies (NPTs) have been found to be helpful for depression in women with breast cancer (BC). However, the relative efficacy of different NPTs in women with BC during different treatment phases is unclear.

OBJECTIVES

To conduct a systematic review and network meta-analysis (NMA) to compare the relative efficacy of various NPTs for improving depression in women with BC during the inter-/post-treatment periods.

METHODS

We searched eight databases (Embase, PubMed, PsycINFO, The Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and WanFang Database) to identify relevant randomized controlled trials published in English and Chinese from their inception to 31 January 2024. We assessed the methodological quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. NMA was conducted using a frequentist approach. The surface under the cumulative ranking (SUCRA) probabilities were used to rank the NPTs.

RESULTS

A total of 41 articles involving 5408 participants studied 18 NPTs. Based on NMA, in the intertreatment phase, mindfulness-based cognitive therapy (MBCT), psychological education, virtual reality (VR) and yoga significantly improved depression in women with BC. MBCT, psychological education, and VR were the three most effective NPTs in this period. In the post-treatment phase, mindfulness-based stress reduction significantly improved depression in women with BC, which was the most effective NPTs in this period. Based on the GRADE framework, most results were rated as "high" to "very low" for the confidence of evidence.

CONCLUSIONS

Our study confirmed the efficacy of several NPTs for depression in women with BC during inter-/post-treatment phases. These results should inform future clinical decisions and guidelines for depression in women with BC.

Effectiveness of Digital-Based Interventions on Physical and Psychological Outcomes Among Cancer Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

Evolving digital technology has paved the way for endless potentiality. Leveraging on digital technology for healthcare purposes can target cancer patients, thus improving physical and psychological symptoms. Nevertheless, there is limited consolidated evidence on the effectiveness of virtual reality (VR) and mobile applications. This review aimed to synthesize evidence concerning the effectiveness of VR and mobile-based interventions on physical (pain, fatigue, and sleep) and psychological (anxiety and depression) outcomes among cancer patients.

METHODS

A comprehensive literature search was conducted on ten electronic databases, ongoing trials, and grey literature, reported between 2013 to 2023. All randomized controlled trials (RCTs) examining VR and mobile-based interventions on the physical or psychological outcomes among people with cancer were included. Two independent reviewers screened records for eligibility, appraised methodological quality, and extracted data from included studies. The Cochrane Risk of Bias tool was used for data appraisal, and a modified Cochrane data extraction form was used for data extraction. Meta-analysis and subgroup analysis were used to analyze data.

RESULTS

In total, 43 studies were included. VR relaxation videos and game-based activities were efficacious in improving cancer-related pain. Mobile applications with educational content, symptom monitoring, relaxation videos, teleconsultation, and regular reminders contributed to positive effects on all outcomes. Mindfulness practice appeared to improve sleep quality, anxiety, and depression. Intervention effects sustained at least 6 months for all outcomes, except sleep.

CONCLUSIONS

VR and mobile-based interventions had the potential to improve pain, fatigue, sleep, anxiety, and depression at post-intervention. Future RCTs are required to further test both digital interventions on specific types of cancer on multiple research settings.

IMPLICATIONS TO NURSING PRACTICE

VR and mobile-based interventions can be offered in clinical settings to help cancer manage their pain, fatigue, sleep, anxiety, and depression. VR relaxation videos, game-based activities, teleconferences, mindfulness, education, and system reminders can be included.

Using Virtual Reality Pablo Gaming in the Post-Operative Rehabilitation of Breast Cancer Patients: Randomized Controlled Trial

Background/Objectives: Surgical treatment of breast cancer may lead to physical and psychological side effects. Exercises, especially those aided by virtual reality (VR), can improve both physical and psychological dysfunctions. To explore the effects of exercises using VR through Pablo games Technology on the function, grip strength, wrist ROM, fatigue, pain, activities of daily living (ADLs), and anxiety among post-operative breast cancer females. Methods: Forty post-operative breast cancer females participated in the current study: nineteen in the control group (CG), who received a standard treatment consisting of upper limb exercises plus intermittent compression therapy, and twenty-one participants assigned to the Pablo group (PG), who received the standard treatment plus additional training using the Pablo game training system. The intervention period was eight weeks long. The outcome measures were function, grip strength, wrist ROM, fatigue, pain, activities of daily living, and anxiety. Data were obtained at the baseline, after eight weeks, and at two months follow-up. Results: There were statistically significant declines in pain and fatigue, while there were statistically significant improvements in ADLs, grip strength, function, and ROM post-intervention and at two months follow-up in both groups (p < 0.001). Between-group comparisons demonstrated a statistically significant decrease in pain, anxiety, and fatigue and statistically significant improvements in function, ADLs, grip strength, and ROM in favor of the PG post-treatment and at the follow-up (p < 0.001). Conclusions: Adding VR using the Pablo game training system to the standard rehabilitation of post-surgical breast cancer patients can further improve their function, hand grip, wrist ROM, fatigue, pain, and ADLs.

The Efficacy of Virtual Reality-Based Interventions on Pain, Anxiety, Depression, and Quality of Life Among Patients With Cancer: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Although cancer patients are living longer, the numerous physical and psychological outcomes of cancer can still be burdensome. Pain, anxiety, depression, and decreased quality of life are symptoms that are highly impacted by cancer. The availability of modalities to cope with these symptoms is critical. Virtual reality-based interventions have been used among patients with cancer, but their effects on pain, anxiety, depression, and quality of life remain unclear.

OBJECTIVE

To determine the efficacy of virtual reality-based interventions on pain, anxiety, depression, and quality of life among cancer patients and to assess the efficacy of different contents and duration.

METHODS

Nine databases were retrieved from inception to July 31, 2024. The methodological quality was evaluated via the Cochrane Risk of Bias 2.0 tool. Data synthesis was conducted with Stata version 16.0, and sensitivity analysis and subgroup analysis were also performed.

RESULTS

Virtual reality-based interventions can soothe pain and anxiety. Subgroup analysis revealed that interventions focused on playing games and watching videos were effective at reducing pain. In addition, enjoying landscapes, receiving treatment-related health education, and watching videos were effective at decreasing anxiety; moreover, short-term (≤6 weeks) interventions were effective at relieving pain.

CONCLUSIONS

Virtual reality-based interventions are effective at decreasing pain and anxiety. The contents and duration of the intervention had an impact on their effectiveness.

IMPLICATIONS FOR NURSING PRACTICE

Symptom management is a paramount aspect of clinical cancer care. In daily oncology nursing, we encourage nurses to utilize the benefits of virtual reality-based interventions to improve cancer patients' experience with medical treatment.

Immersive Virtual Reality as a Tool to Reduce Anxiety and Distress in Patients With Breast Cancer During Radiotherapy

BACKGROUND

Virtual reality (VR) can be an innovative method to reduce patients' anxiety and support their psychological health.

OBJECTIVE

To evaluate the anxiety and distress-reducing effects of using immersive VR (IVR) intervention in breast cancer patients undergoing radiotherapy (RT).

METHODS

Sixty breast cancer patients undergoing RT were recruited for the quasi-experimental study. The participants were divided into the intervention group and the control group. Anxiety and distress, the primary outcome measures, were assessed before the first and after the last radiation session using reliable scales. Patients in the intervention group watched a tranquil forest view with birdsong and meditation music during each RT session using IVR goggles.

RESULTS

Both group patients had similar levels of anxiety and distress before the start of RT. After the intervention, the anxiety and distress of the patients in the intervention group decreased significantly compared with the control group. In addition, treatment-related comfort was higher in the intervention group. Overall, the majority of patients in the intervention group expressed a high level of satisfaction with this IVR experience.

CONCLUSION

Patients who experienced an IVR intervention showed less anxiety and distress, greater comfort, and higher satisfaction. This innovative technique can be used as a practical solution to alleviate anxiety and distress in various healthcare settings.

IMPLICATIONS FOR PRACTICE

Immersive VR can be used in treatment and care interventions that cause anxiety and distress in oncology patients.

Virtual Reality to Improve the Psychological and Physical Well-Being in Cancer Patients: An Umbrella Review

BACKGROUND/OBJECTIVES

Cancer patients often experience psychological and physical symptoms that can significantly impact their quality of life and treatment outcomes. Virtual reality (VR) has emerged as a promising complementary approach to standard cancer care. Due to the rapidly evolving nature of VR research in oncology, it seems essential to provide an overview of the current state of knowledge in this field. Therefore, this umbrella review aimed to synthesize evidence from all relevant systematic reviews and meta-analyses on VR-based interventions for improving psychological and physical well-being among cancer patients.

METHODS

A comprehensive search was conducted in four databases (Cochrane Database of Systematic Reviews, Medline, Web of Science, PsycInfo) from inception to August 2023. We included systematic reviews with or without meta-analyses that evaluated the effects of VR-based interventions on any health-related outcomes in cancer patients. The methodological quality of included reviews was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) tool.

RESULTS

Eighteen individual systematic reviews including ten performed meta-analyses were included, with sample sizes ranging from 225 to 842 participants. VR-based interventions were categorized into three main types: distraction, rehabilitation, and education. The interventions varied significantly in terms of content, equipment, setting, and duration. The most frequent use of VR is one-off exposure in hospital settings to distract patients from anticancer treatment and painful procedures, with natural or game-based content. The mechanism most commonly proposed to explain the effectiveness of VR involves attentional redirection.

CONCLUSIONS

This umbrella review suggests that VR-based interventions may be effective in improving psychological outcomes in cancer patients, particularly anxiety, pain, and depression. However, high heterogeneity across studies and mixed results for some outcomes indicate a need for further high-quality research. Moreover, a more refined analysis of VR-based interventions is essential to explore the specific mechanisms of action associated with each type. This approach would enable us to establish the optimal characteristics of each intervention and their long-term effects.

Impact of Virtual Reality on Pain, ROM, Muscle Strength and Quality of Life among Breast Cancer Patients: An Integrative Review of Literature

BACKGROUND

Breast cancer is the most commonly diagnosed cancer among women globally, with significant impacts on physical, emotional, and functional well-being. Traditional rehabilitation methods may not fully address the multifaceted challenges faced by breast cancer survivors (BCSs), prompting exploration into innovative approaches such as Virtual Reality (VR) technology.

OBJECTIVE

The present review aims to assess the effectiveness of VR in alleviating pain, improving Range of Motion (ROM), enhancing muscle strength, and augmenting the overall quality of life in patients undergoing breast cancer rehabilitation.

METHODS

A comprehensive review of existing literature was conducted, focusing on studies investigating the use of VR in breast cancer rehabilitation. PubMed, Scopus, PEDro and Google scholar were searched for articles addressing VR interventions targeting pain management, ROM improvement, muscle strength enhancement, and quality of life enhancement in breast cancer patients.

RESULTS

Findings yielded total 12 articles matching the selection criteria. VR technology has shown promising results in addressing the multifaceted needs of breast cancer patients. VR also serves as a distraction tool, positively impacting psychological well-being and mitigating negative psychological symptoms associated with the disease.

CONCLUSION

VR represents a non-pharmacological approach to pain management and rehabilitation in breast cancer patients. Its ability to engage emotional, cognitive, and attention processes contributes to its effectiveness in enhancing overall quality of life. Further research is warranted to elucidate the long-term benefits and optimal utilization of VR technology in breast cancer rehabilitation programs.

Virtual Reality to Reduce Pain, Fatigue, and Emotional Distress in People With Cancer: A Scoping Review

BACKGROUND

Cancer and its treatments cause symptoms such as pain, fatigue, and emotional distress, which affect the quality of life of patients at different stages of cancer. Virtual reality (VR) has emerged as a promising alternative for addressing these symptoms by immersing patients in a virtual environment that isolates them from reality.

OBJECTIVE

To describe the existing evidence on the use of VR to improve pain, fatigue, and emotional distress in people with cancer at different stages of the cancer trajectory.

METHODS

A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Search was conducted in PubMed and CINAHL until October 2023.

RESULTS

Twenty-three primary studies related to the study topic were identified, and the following information was collected: type of VR (immersive vs nonimmersive) used in oncology services, purpose (distraction, training, or relaxation), devices used (head-mounted display, headset, or virtual controller), and the environment simulated (natural environment, skill games, or educational environment). The effects of VR on pain, fatigue, and emotional distress are described, highlighting its ability to mitigate these symptoms in the short term.

CONCLUSIONS

Virtual reality has been shown to be an effective technique for reducing pain, fatigue, and emotional distress in people with cancer in the short term.

IMPLICATIONS FOR PRACTICE

Nurses can use VR as a complementary tool to promote virtual environments that improve the care for and therefore the quality of life of people with cancer.

Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers

Virtual reality (VR) technology has evolved from entertainment to significant applications in healthcare and education. Despite its potential, there is limited research on the role of VR in cancer care. This study investigates VR's ability to simulate the chemotherapy process, aiming to enhance patients' knowledge and mitigate anxiety associated with chemotherapy. Utilizing a two-arm, mixed-methods pre/post-survey design, the study measured changes in patients' anxiety and knowledge before and after exposure to a VR simulation. Participants (n = 267) engaged with VR simulations or interactive 360-degree videos depicting the chemotherapy process. Data analyses revealed a significant median increase in chemotherapy knowledge post-exposure to the VR content (z = 12.511, p < 0.001). Demographic factSors significantly influenced perceptions of VR realism and usefulness (p < 0.05). Additionally, VR exposure was correlated with reduced anxiety levels and improved treatment expectations (p < 0.05). Participants with higher post-understanding chemotherapy scores considered VR a useful tool for managing anxiety about chemotherapy and recommended VR for other medical procedures (p < 0.001). These findings underscore VR technology's potential as a valuable tool in cancer treatment, suggesting it can enhance patient education and reduce anxiety, thereby improving patient outcomes during cancer therapy.

Virtual reality-based supportive care interventions for patients with cancer: an umbrella review of systematic reviews and meta-analyses

PURPOSE

This umbrella review aimed to identify, critically appraise, and synthesize current evidence from systematic reviews and meta-analyses on the applications of virtual reality-based supportive care interventions in cancer.

METHODS

Three bibliographic databases were searched from inception to February 1, 2024. Two independent reviewers screened the titles and abstracts of 421 records and retrieved 26 full-text systematic reviews. Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) was used for quality assessment. Qualitative syntheses were performed to investigate the effects of virtual reality-based supportive care interventions on quality of life and physical, psychological, cognitive, and functional outcomes. Meta-analysis was performed based on data from the distinct primary studies that were extracted from the included reviews.

RESULTS

This umbrella review included 20 systematic reviews that were published between 2018 and 2023; nine of them conducted meta-analyses. A total of 86 distinct primary studies were identified. According to the AMSTAR-2 assessment, two reviews were evaluated as moderate quality, nine as low, and nine as critically low. Meta-analyses of primary studies revealed significant effects of virtual reality on anxiety (p < 0.001), depression (p < 0.001), and pain (p < 0.001), but not fatigue (p = 0.263). Qualitative syntheses revealed positive effects of virtual reality on physical function, cognitive function, and quality of life. Limited evidence was reported regarding outcomes of balance, gait, mobility, and activities of daily living.

CONCLUSION

Virtual reality has proven to be a safe and feasible approach to deliver supportive care in cancer. Virtual reality can be implemented in various stages and settings of the cancer care continuum to support patients undergoing painful procedures, during or after chemotherapy, and after surgical interventions. Virtual reality can serve as an effective supportive care intervention to manage anxiety, pain, and depression for patients with cancer.

Application of virtual reality for supportive care in cancer patients: a systematic review

BACKGROUND

In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients.

METHOD

This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively.

RESULTS

A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported.

CONCLUSION

VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.

A randomized controlled trial of a self-led, virtual reality-based cognitive behavioral therapy on sick role adaptation in colorectal cancer patients: study protocol

BACKGROUND

Significant concomitants of the sick role maladaptation in colorectal cancer (CRC) patients include inappropriate cognitions, emotional states, and overt conducts associated to disease. This protocol was developed to implement and evaluate the effects of a self-led, virtual reality-based cognitive behavioral therapy (VR-CBT) on the sick role adaptation among working-age CRC patients.

METHODS

This is an assessor-blinded, randomized controlled trail that adheres to the SPIRIT 2013 Statement guidelines. A total of 60 working-age CRC patients will be recruited from the colorectal wards of a cancer center and randomly assigned to the VR-CBT group or attention control (AC) group. The VR-CBT group will receive a 7-sessions VR-CBT targeted to sick role adaptation, while the AC group will receive weekly attention at the same time the VR-CBT group receives the intervention. The sick role adaptation, anxiety and depression, illness perceptions, and quality of life will be measured at baseline, 1, 2 and 3-month after completion of the intervention. Side-effects related to VR in the VR-CBT group will be measured at the end of each session. The participants will receive invitations to participate in semi-structured interviews to explore their experiences with the intervention.

DISCUSSION

The positive outcomes and user experience of VR-CBT will advance researches on the effectiveness of psychosocial interventions that aims to promote adaptation to the unexpected sick role on cancer populations. This protocol can be tested as an accessible and feasible alternative to traditional high-cost treatment in a randomized controlled study to improve the outcomes of younger cancer survivors.

TRIAL REGISTRATION

The protocol was registered on 21 June, 2023 in Chinese Clinical Trial Registry (No.: ChiCTR2300072699) at https://www.chictr.org.cn/ .

Effectiveness of Virtual Reality-Based Interventions for Upper Limb Rehabilitation in Breast Cancer Patients: Systematic Review and Meta-Analysis

Purpose: To investigate the effectiveness of virtual reality (VR)-based interventions for functional rehabilitation of the upper limb in breast cancer patients through a systematic review and meta-analysis. Methods: The PubMed, Cochrane, Web of Science, CINAHL, Scopus, CNKI, Wanfang, and VIP databases were systematically searched for relevant literature published from the establishment of the database to June 2023. Differences in the effectiveness of VR-based interventions and other intervention therapies were compared using random effects model meta-analysis and standard deviation (SMD). Results: Seven eligible articles were identified and included in the meta-analysis. The combined analysis found that VR-based interventions had a positive impact on patients' upper limb mobility in terms of flexion (SMD = 1.33, 95% confidence interval; CI [0.48-2.19], P = 0.002), abduction (SMD = 1.22, 95% CI [0.58-1.86], P = 0.0002), and external rotation (SMD = 0.94, 95% CI [0.48-1.40], P < 0.0001). In addition, VR-based interventions could significantly improve the postoperative pain of patients with breast cancer. However, in grip strength (SMD = 0.43, 95% CI [-3.05 to 3.92], P = 0.81), shoulder muscle strength in flexion strength (SMD = 0.05, 95% CI [-2.07 to 2.18], P = 0.96), abduction strength (SMD = -0.10, 95% CI [-1.32 to 1.12], P = 0.88), external rotation strength (SMD = 0.46, 95% CI [-1.96 to 2.88], P = 0.71), and lymphedema, VR was as effective as other intervention treatments. A subgroup analysis showed that patients younger than 55 years had more benefit with VR-based rehabilitation than with other interventions and showed improvements with the intervention within 2 weeks. The intervention effect of using auxiliary equipment such as robotic arms is better than VR exercise based solely on games. Conclusion: The results of meta-analysis show that the intervention measures based on VR have positive effects on the improvement of upper limb mobility and pain relief in breast cancer patients. However, considering the low quality of evidence and small sample size, more clinical studies should be conducted to improve the credibility of the results.

Hematopoietic Stem-Cell Transplantation: Exploring the Latest Advances and Gaps in Disparities, Psychosocial and Symptom Management Interventions, and Chronic Graft-Versus-Host Disease Care

Although allogeneic hematopoietic cell transplantation (HCT) offers a potential for cure for many patients with advanced hematologic malignancies and bone marrow failure or immunodeficiency syndromes, it is an intensive treatment and accompanied by short- and long-term physical and psychological symptoms requiring specialized care. With substantial advances in therapeutic approaches for HCT and supportive care, HCT survivors experience less morbidity and mortality. However, disparities in both HCT access and outcomes persist, and HCT survivors and their caregivers often lack access to much-needed psychosocial care. Additionally, more medical and psychosocial resources are needed to holistically care for HCT survivors with chronic graft-versus-host disease (GVHD). Hence, this chapter focuses on three areas pertaining to advances and gaps in HCT care: disparities in access to and outcomes of HCT, psychosocial and physical symptom management with supportive care interventions, and GVHD prevention and management.

Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses

Background

Virtual reality (VR) has shown promising levels of effectiveness in nursing education, pain management, and rehabilitation. However, meta-analyses have discussed the effects of VR usage in nursing unilaterally and inconsistently, and the evidence base is diffuse and varied.

Objective

We aimed to synthesize the combined evidence from meta-analyses that assessed the effects of nurses using VR technology on nursing education or patient health outcomes.

Methods

We conducted an umbrella review by searching for meta-analyses about VR intervention in clinical nursing practice on Web of Science, Embase, Cochrane, and PubMed, and in reference lists. Eligible studies were published in English between December 1, 2012, and September 20, 2023. Meta-analyses of ≤2 intervention studies and meta-analyses without 95% CI or heterogeneity data were excluded. Characteristic indicators, population information, VR intervention information, and 95% CIs were extracted. A descriptive analysis of research results was conducted to discern relationships between VR interventions and outcomes. I2 and P values were used to evaluate publication bias. AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) checklist were used to appraise literature quality.

Results

In total, 768 records were identified; 74 meta-analyses were included for review. The most reported VR study conditions were neuronursing (25/74, 34%), pediatric nursing (13/74, 18%), surgical and wound care (11/74, 15%), oncological nursing (11/74, 15%), and older adult nursing (10/74, 14%). Further, 30% (22/74) of meta-analyses reported publication bias, and 15% (11/74) and 8% (6/74) were rated as "high" based on AMSTAR 2 and the GRADE checklist, respectively. The main outcome indicators among all included meta-analyses were pain (37/214, 17.3%), anxiety (36/214, 16.8%), cognitive function (17/214, 7.9%), balance (16/214, 7.5%), depression (16/214, 7.5%), motor function (12/214, 5.6%), and participation in life (12/214, 5.6%). VR treatment for cognition, pain, anxiety, and depression was effective (all P values were <.05), while the utility of VR for improving motor function, balance, memory, and attention was controversial. Adverse effects included nausea, vomiting, and dizziness (incidence: range 4.76%-50%). The most common VR platforms were Pico VR glasses, head-mounted displays, the Nintendo Wii, and the Xbox Kinect. VR intervention duration ranged from 2 weeks to 12 months (typically ≥4 wk). VR session length and frequency ranged from 5 to 100 minutes and from 1 to 10 times per week, respectively.

Conclusions

VR in nursing has positive effects-relieving patients' pain, anxiety, and depression and improving cognitive function-despite the included studies' limited quality. However, applying VR in nursing to improve patients' motor function, balance, memory, and attention remains controversial. Nursing researchers need to further explore the effects and standard operation protocols of VR in clinical practice, and more high-quality research on VR in nursing is needed.

Effectiveness of immersive virtual reality on anxiety, fatigue and pain in patients with cancer undergoing chemotherapy: A systematic review and meta-analysis

PURPOSE

This Systematic review and meta-analysis aimed to assess the effectiveness of Virtual Reality on anxiety, fatigue and pain in patients with cancer during chemotherapy and provide evidence for decision-making in clinical practice.

METHODS

A systematic literature search was performed in the databases PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature and the Cochrane Library. Risk of Bias was used to assess the quality of individual studies, and Grading of Recommendations Assessment, Development and Evaluation was used to assess confidence for each individual outcome. A random-effects model was used to examine the overall effect.

RESULTS

Four randomized controlled trials and four crossover studies were included, with an overall sample of 459 patients. Results showed that Virtual Reality compared with standard care had a significant reduction of anxiety only (MD = -6.57, 95% CI: -11.59 to -1.54, p = 0.01) but with considerable heterogeneity (I² = 92%), while Virtual Reality was not significantly different from integrative interventions. The trials included showed small sample sizes, lack of statistical power, low methodological quality, high heterogeneity, and different Virtual Reality technology types, lengths and frequencies.

CONCLUSION

The quality of evidence is very low and the strength of recommendation is weak. Further research has large potential for reducing uncertainty about the effects of Virtual Reality in patients with cancer receiving chemotherapy. This study was registered with PROSPERO as CRD42020223375.

Digital and Interactive Health Interventions Minimize the Physical and Psychological Impact of Breast Cancer, Increasing Women's Quality of Life: A Systematic Review and Meta-Analysis

Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC.

METHODS

We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI).

RESULTS

Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: -1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, -0.72; 95%CI: -1.31, -0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, -0.8; 95%CI: -1.31, -0.26), anxiety (SMD, -1.02; 95%CI: -1.71, -0.34), and depression (SMD, -1.57; 95%CI: -3.1, -0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89).

CONCLUSIONS

Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.