Virtual reality in chemotherapy support for the treatment of physical functions, fear, and quality of life in pediatric cancer patients: A systematic review and meta-analysis

A synthesis of meta-analyses of immersive virtual reality interventions in pain

The severity and impact of pain can vary greatly, even in individuals with the same physical injury. This variation underscores the need for a variety of treatment strategies in effective pain management. Virtual reality (VR) is an emerging technology that has been used as a treatment in diverse pain populations and for diverse indications. In recent decades, many trials, systematic reviews, and meta-analyses have examined the impact of VR for pain management. While there is some evidence for efficacy in terms of distraction, pre-exposure, and physical therapy; populations, comparators and interventions differ significantly between existing meta-analyses. Thus, the present umbrella review was conducted to determine the overall strength of evidence for all identified populations, comparators, and interventions by synthesising available meta-analyses. Fifty-four meta-analyses reporting on the effect of immersive VR interventions in pain management were identified. Overall, VR interventions appeared efficacious for procedural pain conditions, where used for distraction, and when compared to standard care. While there was some evidence for efficacy in chronic pain populations, this only indicated short-term improvement in pain intensity. We also identified numerous areas for future research wherein the available results were inconclusive, such as examining long term interventions and outcomes for chronic pain populations, reporting of adverse events, and examining the efficacy of VR interventions designed for physical therapy, augmented cognitive therapies, or pre-exposure.

Moderating effects of screen time on the relationship between family functioning and negative emotions in Chinese children with cancer

PURPOSE

To explore whether screen time moderates the relationship between family functioning and negative emotions in Chinese children with cancer.

METHODS

Between November 2023 and May 2024, 206 children with cancer were recruited from a pediatric oncology ward at a tertiary hospital. Negative emotions, family functioning, and screen time were assessed using the Depression Anxiety Stress Scale-21, Family Adaptability and Cohesion Evaluation Scales, Second Edition, Chinese Version, and Screen Time Questionnaire, respectively. The moderating effect of screen time was analyzed using the Johnson-Neyman method and SPSS Process Macro.

RESULTS

Screen time had a significant moderating effect (B = -0.052, P < 0.05). Screen time could possibly moderate the relationship between family functioning and negative emotions, and the moderating effect may be diminished as screen time exceeded 3.13 h per day.

CONCLUSIONS

Family functioning and screen time likely have a vital impact on negative emotions in children with cancer. Increasing screen time probably decrease the adverse effects of poor family functioning on negative emotions, which, in turn, may reduce negative emotions.

PRACTICE IMPLICATIONS

These preliminary findings highlight the importance of monitoring and managing screen time in pediatric oncology settings may have in supporting the emotional well-being of children with cancer. This study provides a new theoretical perspective on care programs aimed at alleviating negative emotions in children with cancer.

The Challenge of Managing Neuropathic Pain in Children and Adolescents with Cancer

Neuropathic pain (NP) is a common complication associated with some types of childhood cancer, mainly due to nerve compression, chronic post-surgical pain, chemotherapy, and radiotherapy. NP is usually less responsive to traditional analgesics, and there is generally a lack of evidence on its management in cancer patients, leading to recommendations often based on clinical trials conducted on other forms of non-malignant NP. In pediatric oncology, managing NP is still very challenging for physicians. Different factors contribute to increasing the risk of undertreatment: (a) children may be unable to describe the quality of pain; therefore, the risk for NP to be underestimated or remain unrecognized; (b) specific tools to diagnose NP have not been validated in children; (c) there is a lack of randomized clinical trials involving children, with most evidence being based on case series and case reports; (d) most drugs used for adult patients are not approved for childhood cancers, and drug regulation varies among different countries; (e) recommendations for pediatric pain treatment are still not available. In this paper, a multidisciplinary team will review the current literature regarding children with cancer-related NP to define the best possible diagnostic strategies (e.g., clinical and instrumental tests) and propose a therapeutic care pathway, including both non-pharmacological and pharmacological approaches, which could help pediatricians, oncologists, neurologists, and pain therapists in designing the most effective multidisciplinary approach.

Extended Reality Interventions for Health and Procedural Anxiety: Panoramic Meta-Analysis Based on Overviews of Reviews

BACKGROUND

Extended reality (XR) technologies are increasingly being used to reduce health and procedural anxieties. The global effectiveness of these interventions is uncertain, and there is a lack of understanding of how patient outcomes might vary between different contexts and modalities.

OBJECTIVE

This research used panoramic meta-analysis to synthesize evidence across the diverse clinical contexts in which XR is used to address common outcomes of health and procedural anxiety.

METHODS

Review-level evidence was obtained from 4 databases (MEDLINE, Embase, APA PsycINFO, and Epistemonikos) from the beginning of 2013 until May 30, 2023. Reviews that performed meta-analysis of randomized controlled trials relating to patient-directed XR interventions for health and procedural anxiety were included. Studies that analyzed physiological measures, or focused on technologies that did not include meaningful immersive components, were excluded. Furthermore, data were only included from studies that compared intervention outcomes against no-treatment or treatment-as-usual controls. Analyses followed a preregistered, publicly available protocol. Trial effect sizes were extracted from reviews and expressed as standardized mean differences, which were entered into a 3-level generalized linear model. Here, outcomes were estimated for patients (level 1), studies (level 2), and anxiety indications (level 3), while meta-regressions explored possible influences of age, immersion, and different mechanisms of action. Where relevant, the quality of reviews was appraised using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, Revised Instrument) tool.

RESULTS

Data from 83 individual trials were extracted from 18 eligible meta-analyses. Most studies involved pediatric patient groups and focused on procedural, as opposed to general, health anxieties (eg, relating to needle insertion, dental operations, and acute surgery contexts). Interventions targeted distraction-, education-, and exposure-based mechanisms, and were provided via a range of immersive and nonimmersive systems. These interventions proved broadly effective in reducing patient anxiety, with models revealing significant but heterogeneous effects for both procedural (d=-0.75, 95% CI -0.95 to -0.54) and general health (d=-0.82, 95% CI -1.20 to -0.45) indications (when compared with nontreatment or usual-care control conditions). For procedural anxieties, effects may be influenced by publication bias and appear more pronounced for children (vs adults) and nonimmersive (vs immersive) technology interventions, but they were not different by indication.

CONCLUSIONS

Results demonstrate that XR interventions have successfully reduced patient anxiety across diverse clinical contexts. However, significant uncertainty remains about the generalizability of effects within various unexplored indications, and existing evidence is limited in methodological quality. Although current research is broadly positive in this area, it is premature to assert that XR interventions are effective for any given health or procedural anxiety indication.

The effect of calcium oxalate stones and uric acid stones on male sexual function

PURPOSE

This study compared the effects of calcium oxalate stones and uric acid stones on male sexual function.

METHODS

We enrolled 100 patients with ureteral stones. According to the composition of the stones, they were divided into the calcium oxalate stone group and the uric acid stone group. All patients underwent ureteroscopic holmium laser lithotripsy. General data such as age, body mass index, course of disease, stone diameter, and degree of renal hydronephrosis were compared. Sperm parameters, including sperm density, sperm viability, and sperm deformity rate, as well as International Index of Erectile Function-5 questionnaire (IIEF-5) scores, and Quality of Life (QOL) scores, were measured and compared before and 6 weeks after the surgery.

RESULTS

There were no statistically significant differences in general data and sperm parameters between the two groups before the surgery (P > 0.05). However, there were significantly lower IIEF scores but significantly higher QOL scores in the uric acid stone group. In the calcium oxalate stone group, there were no statistically significant differences in sperm parameters, IIEF score, and QOL score before and after the surgery (P > 0.05). In the uric acid stone group, there were no statistically significant differences in sperm parameters before and after surgery (P > 0.05), whereas there were significantly higher IIEF scores but significantly lower QOL scores after the surgery (P < 0.05). The prevalence of erectile dysfunction (ED) in the uric acid stone group was 38.18% (21/55), which was significantly higher compared to 20.00% (9/45) in the calcium oxalate stone group (P < 0.05). The multivariate binary logistic regression analysis showed that the independent risk factor related to ED was uric acid stones (odds ratio: 2.637, 95% confidence interval 1.040-6.689, P = 0.041). No statistically significant differences were found in sperm parameters between patients with and without ED.

CONCLUSION

Compared with the calcium oxalate stone group, patients with uric acid stones had a higher prevalence of ED and poorer sexual performance.

Extended Reality Analgesia Evidence Reviews Often Lack Sufficient Intervention Detail

Background

Evidence synthesis projects such as systematic reviews and meta-analyses are defined by the focal research question addressed through assemblage and analysis of all relevant literature. In complex intervention domains such as medical extended reality (MXR), there are a plethora of intervention factors that could be included in research questions, which define study inclusion criteria and, in turn, shape the generalizability of results. This article quantifies how recently published evidence syntheses of MXR interventions for pain management characterize the primary studies they assess.

Method

Inclusion criteria for analysis consisted of English-language scoping reviews, systematic reviews, and meta-analyses, published in 2021-2023, that evaluated MXR-based interventions for pain management in any setting. We employed quantitative content analysis to assess characterization of intervention features.

Results

Of the 61 synthesis publications that met inclusion criteria, 29 (48%) included only minimal description of MXR intervention content, 14 (23%) included substantial content descriptions, and the remainder did not describe intervention content within synthesized studies. Hardware details were reported for 15 (25%) of publications in a minimal way, 28 (46%) in a substantial way, and not reported in 18 (30%) of syntheses. Among the 39 papers that included a meta-analysis, 10 (25%) explicitly evaluated the role of intervention features in intervention efficacy.

Conclusion

Findings suggest considerable variability in the characterization of intervention elements (content and hardware), which can limit accurate conclusions about the generalizability of synthesis findings. Accordingly, we make recommendations to guide future evidence syntheses in the MXR domain.

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.

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.

Cyborg Children: A Systematic Literature Review on the Experience of Children Using Extended Reality

This literature review presents a comprehensive and systematic account of research on the experiences of children with extended reality (XR), including VR, AR, and other types of immersive technologies that enhance and augment children's activities. The search on Scopus and Web of Science produced 531 outputs. Content analysis with inter-rater reliability (Krippendorff's α) and Leximancer, a software for text mining, were used for analyzing the material. Four research strands were identified: (1) interventions, treatments, and medical procedures in clinical contexts; (2) teaching and learning enhanced by XR; (3) children's adoption and user experiences; (4) design and prototyping of XR hardware and software for children. The results showed the following findings: (a) studies on children's clinical interventions and treatments using HMD-supported immersive virtual reality comprise the most substantial strand of studies; (b) research in this area, and in teaching and learning studies, has grown dramatically since 2017, while the other areas have been stagnant over the years; (c) AR research is still limited and is mainly applied in educational contexts for design and prototyping; (d) few studies have considered children's perspectives on XR safety issues; (e) research on the use of XR for enhancing social and emotional skills development is underrepresented. Future research should focus on the potential of XR technologies for interventions to enhance children's psychosocial wellbeing and health more broadly. The further implications and study limitations for the fast-developing nature of this transdisciplinary research field are also discussed.

The Usefulness of Virtual Reality in Symptom Management during Chemotherapy in Lung Cancer Patients: A Quasi-Experimental Study

Background: Virtual reality (VR) emerges as a promising non-pharmacological intervention for managing symptoms and providing distraction during chemotherapy. This study aims to assess VR's effectiveness on cancer-related symptoms, vital signs, and the patients' perception of chemotherapy in lung cancer patients. Methods: A quasi-experimental study was conducted on 100 patients. Participants were allocated into an intervention group (n = 55), which experienced immersive VR, and a comparison group (n = 45), which received usual care. Data were collected through questionnaires and checklists, including feedback on the VR experience, pain, vital signs, and common cancer symptoms, assessed through the Edmonton Symptom Assessment Scale. Results: VR had a significant impact on reducing the perception of chemotherapy length. Patients reported high levels of satisfaction and tolerability. No adverse events were observed. VR did not have significant influence on pain intensity or vital signs. The only exceptions were oxygen saturation, where a significant difference (p = 0.02) was reported, and the perception of chemotherapy duration. Conclusions: As a non-pharmacological intervention, VR proves to be beneficial in minimizing the perceived length of chemotherapy sessions for lung cancer patients, enhancing their overall treatment experience. The intervention was found to be a safe, feasible, and well-accepted distraction technique. Future research should explore VR's potential effects on a wider range of symptoms and evaluate its impact on long-term outcomes.

The effect of therapeutic play on fear, anxiety, and satisfaction levels of pediatric oncology patients receiving chemotherapy

OBJECTIVE

This study aimed to examine the effect of therapeutic play on the levels of fear and anxiety towards chemotherapy in pediatric oncology patients and evaluate the satisfaction of children and parents regarding therapeutic play.

METHODS

The study was conducted with a one-group pretest-post-design and was developed as a prospective quasi-experimental study. The study was conducted with 40 pediatric oncology patients aged 5-12 and their parents. Data were collected by Child Information Form, Child Fear Scale (CFS), Child State Anxiety (CSA), and Visual Satisfaction Scale.

RESULTS

The mean age was 8.98 ± 2.76, 65% were males. The CSA score was decreased at the end of the second cycle compared to the first (p < 0.001). The CFS score was reduced at the end of the second cycle compared to the first (p < 0.001). There was a statistically significant decrease in CFS scores at the end of the first cycle compared to the beginning (p < 0.001). The decrease in CFS scores at the end of the second cycle compared to the beginning was statistically significant (p < 0.001).

CONCLUSION

The results of the study show that there was a significant decrease in the fear and anxiety levels of children against chemotherapy in the pre-and post-treatment evaluations. Children and their families were satisfied with the therapeutic play intervention.

PRACTICE IMPLICATIONS

Therapeutic play may be an effective method to reduce fear and anxiety levels against chemotherapy in pediatric oncology patients. The use of therapeutic play from the moment of diagnosis is recommended to reduce children's fear and anxiety related to chemotherapy.

Pain and anxiety management with virtual reality for office hysteroscopy: systemic review and meta-analysis

PURPOSE

Office hysteroscopy (OH) is a commonly performed procedure, although it might be associated with some degree of pain and anxiety. Our aim was to determine the effects of virtual reality on pain and anxiety levels felt by patients undergoing OH.

METHODS

MEDLINE, Embase, Google Scholar, Cochrane Library, clinicaltrials.gov, ProQuest, Grey literature, and manual searching of references within studies found in the initial search were systematically searched using the terms 'Virtual Reality' and 'Hysteroscopy' without time or language limitations. The review considered all studies assessing the impact of virtual reality (VR) over OH outcomes, and prospective randomized trials were included in the meta-analysis. Retrospective and case - control studies were excluded from the meta-analysis.

RESULTS

We identified 17 studies, of which four randomized controlled studies were included in the meta-analysis (327 participants, 168 in the VR group and 159 in the control group). On a 0-10 scale, pain sensation and maximal pain sensation during the operation were not statistically different between study and control groups (relative risk (RR) =  -0.64, 95% C.I (-1.57)0.29) and (RR = -0.93, 95% C.I (-3.33) - 1.47), respectively. Anxiety measurement was statistically lower in the study group (RR = -1.73, 95% C.I (-2.79) - ( -0.67)).

CONCLUSIONS

The available data suggest that VR techniques do not decrease the pain sensation during OH however, they do contribute to a reduction in the anxiety levels experienced by patients. PROSPERO registration number CRD42023432819.

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of immersive virtual reality in cancer patients receiving chemotherapy

PURPOSE

Immersive virtual reality (IVR) shows promise in cancer care, especially for chemotherapy patients. This systematic review and meta-analysis assesses IVR's impact on adult and pediatric cancer patients undergoing chemotherapy.

METHODS

We searched PubMed, Cochrane Library, Embase, Scopus, Web of Science, and Google Scholar for relevant randomized controlled trials (RCTs). We focused on anxiety, depression, fatigue, pain, and anxiety in adults and pain and anxiety in pediatric patients.

RESULTS

Fifteen trials were included, enrolling 607 adult and 257 pediatric cancer patients. IVR significantly reduced anxiety (SMD = -1.89, 95% CI = -2.93 to -0.85), depression (SMD = -1.85, 95% CI = -3.14 to -0.55), fatigue (SMD = -3.40, 95% CI = -5.54 to -1.26), and systolic blood pressure (MD = -3.54, 95% CI = -6.67 to -0.40) in adults. In pediatric patients, IVR significantly lowered pain (SMD = -1.17, 95% CI = -1.84 to -0.50) and anxiety (SMD = -1.18, 95% CI = -1.77 to -0.59) but not heart rate (MD = 0.48, 95% CI = -2.38 to 3.34).

CONCLUSION

IVR effectively reduces anxiety, depression, fatigue, systolic blood pressure, pain, and anxiety in cancer patients. More robust RCTs are needed for further IVR research.