Immersive Virtual Reality and Anxiety, Nausea, and Vomiting in Children With Cancer: An RCT

OBJECTIVES: To assess the effects of immersive virtual reality (IVR) for alleviating anxiety, anticipatory nausea and vomiting, and chemotherapy-induced nausea and vomiting (CINV) in patients with pediatric cancer receiving their first chemotherapy. METHODS: An assessor-blinded parallel-group randomized controlled trial was conducted in a local children's hospital among pediatric patients (aged 6-12 years) undergoing their first chemotherapy. Outcome measures included (1) anxiety; (2) anticipatory nausea and vomiting; and (3) CINV. Outcome assessments were conducted at baseline (T0), before (T1) and after first (T2) chemotherapy, and before (T3) and after (T4) second chemotherapy. RESULTS: A total of 128 patients (mean age = 9.02 years) were recruited. Generalized estimating equations analyses indicated that the intervention group had significantly greater reduction in anxiety than the control group before and after the first and second chemotherapy (time-by-group interaction, T1: β = -1.76, d = -0.67; T2: β = -3.71, d = -0.87; T3: β = -3.71, d = -0.91; T4: β = -6.30, d = -1.48; all P < 0.001), demonstrating that the IVR intervention effect progressively increased from medium to large over time. The Mann-Whitney U test showed that compared with the control group, the IVR group reported significantly fewer episodes of anticipatory nausea at T3 (P < 0.001), CINV (P = 0.03) at T4, and chemotherapy-induced vomiting (P = 0.003) at T2 and T4. CONCLUSIONS: IVR was beneficial in reducing anxiety, anticipatory nausea, and CINV among patients with pediatric cancer undergoing their first chemotherapy. The findings suggest a convenient and easily applied intervention for pediatric chemotherapy patients to enhance clinical care.