Effects of Immersive Virtual Reality and Relaxation Video on Symptom Severity, Distress, and Quality of Life in Lung Cancer Patients During Initial Chemotherapy Cycles: A Three-Arm Randomised Controlled Trial

Background/Objectives: To examine the effects of immersive virtual reality (VR) and a theme-matched relaxation video (RV) on symptom severity, distress, and quality of life in lung cancer patients. Methods: In this open-label, three-arm, parallel-group randomised controlled trial, 315 patients were allocated (1:1:1) to the VR (n = 106), RV (n = 104), or control (CG; n = 105) group. During the first two chemotherapy cycles, the VR and RV groups were assigned two 20 min sessions of immersive nature-themed VR or theme-matched RV, while the CG received routine care alone. The primary outcome domain was symptom severity, assessed through within-session changes in ten individual Edmonton Symptom Assessment Scale (ESAS) symptom scores; distress and quality of life were secondary outcomes. Data were analysed with linear mixed models, and between-group differences are reported with Bonferroni-adjusted 95% confidence intervals (CI). Results: Compared with the CG, the within-session improvement was greater for eight of the ten ESAS symptoms with VR and for five with RV; the largest differences were for well-being (VR 1.26 points, 95% CI 0.98 to 1.53; RV 0.76, 0.49 to 1.03), with smaller differences for tiredness, depression, and anxiety. Distress also decreased more with VR (1.04, 0.73 to 1.34) and RV (0.73, 0.42 to 1.03) than in the CG. VR improved more than RV for well-being (0.50, 0.22 to 0.77), tiredness (0.47, 0.16 to 0.79), and distress (0.31, 0.002 to 0.62). No intervention-specific effect emerged for nausea, lack of appetite, or quality of life. Conclusions: Compared with routine care, two sessions of VR or RV improved acute symptoms, mainly well-being, tiredness, depression, and anxiety, and reduced distress, with no intervention-specific effect on quality of life. The additional benefit of VR was small and, for the ESAS symptoms, below the minimal clinically important difference, so RV may be a practical and accessible option. Study registration: ClinicalTrials.gov NCT06863623.