Abstract
Trials.
The study aimed to investigate the effect of virtual reality interventions on relieving pain and anxiety in children and adolescents receiving cancer treatment. A search that involved Cochrane Library (comprising Cochrane Central Register of Controlled Trials (CENTRAL)), PubMed, ProQuest, MEDLINE, Web of Sciences, Science Direct, and Scopus electronic databases covering the records from January 1, 2000 up to May, 2023 was conducted to determine randomized controlled trials that could be included in our study. The results of the search were limited to “anxiety and pain, adolescents, children, virtual reality, cancer.” Of the 160 articles that were reached during the search, seven were found eligible based on inclusion criteria. Hedges’ g effect size was calculated for each article. Random effects model was used to test effect sizes and moderator variables. The registration number of this meta-analysis on PROSPERO is CRD42022304737. The outcomes were pain and anxiety. Compared with standard care, virtual reality had a medium and significant effect on anxiety (g = 0.60, 95% CI: [− 1.05 − 0.15]) and pain (g = − 0.667, 95% CI: [− 1.08− -0.24]). In addition, age has been identified as an important moderator in the use of virtual reality in pain management. This meta-analysis shows that virtual reality applications are effective interventions for reducing pain and anxiety in the field of pediatric oncology. However, it is necessary to carry out randomized controlled trials that have large samples for evidence-based virtual reality applications in pediatric oncology.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available from the corresponding author upon reasonable reques.
References
World Health Organization (2022) Childhood cancer. https://www.who.int/news-room/fact-sheets/detail/cancer-in-children. Accessed 21 May 2022.
Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, Satpathy M (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study, JAMA oncol. 3(4):524–548. doi:https://doi.org/10.1001/jamaoncol.2016.5688.
Chow H, Hon J, Chua W, Chuan A (2021) Effect of virtual reality therapy in reducing pain and anxiety for cancer-related medical procedures: a systematic narrative review, J Pain Symptom Manage. 61(2):384–394. https://doi.org/10.1016/j.jpainsymman.2020.08.016.
Czech O, Wrzeciono A, Rutkowska A, Guzik A, Kiper P, Rutkowski S (2021) Virtual reality interventions for needle-related procedural pain, fear and anxiety—A systematic review and meta-analysis. J. Clin. Med. 10(15):3248. https://doi.org/10.3390/jcm10153248.
Satija A, Bhatnagar S (2017) Complementary therapies for symptom management in cancer patients, Indian J. Palliat. Care. 23(4):468. doi: https://doi.org/10.4103/IJPC.IJPC_100_17.
Leggiero NM, Armstrong TS, Gilbert MR, King AL (2020) Use of virtual reality for symptom management in solid-tumor patients with implications for primary brain tumor research: a systematic review. Neuro-oncol. Pract. 7(5):477–489. https://doi.org/10.1093/nop/npaa012.
Caruso TJ, George A, Menendez M, De Souza E, Khoury M, Kist MN, Rodriguez ST (2020) Virtual reality during pediatric vascular access: A pragmatic, prospective randomized, controlled trial. Paediatr. Anaesth. 30(2):116–123. https://doi.org/10.1111/pan.13778.
Chan E, Hovenden M, Ramage E, Ling N, Pham JH, Rahim A, Leong P (2019). Virtual reality for pediatric needle procedural pain: two randomized clinical trials, J. Pediatr. 160–167. https://doi.org/10.1016/j.jpeds.2019.02.034.
Eijlers R, Dierckx B, Staals LM, Berghmans JM, van der Schroeff MP, Strabbing EM, Utens EM (2019). Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial, Eur J Anaesthesiol. 36(10):728. doi: https://doi.org/10.1097/EJA.0000000000001059.
Hoffman HG, Rodriguez RA, Gonzalez M, Bernardy M, Peña R, Beck W, Meyer WJ (2019) Immersive virtual reality as an adjunctive non-opioid analgesic for pre-dominantly Latin American children with large severe burn wounds during burn wound cleaning in the intensive care unit: a pilot study Front. Hum. Neurosci 13:262. https://doi.org/10.3389/fnhum.2019.00262.
Jeffs D, Dorman D, Brown S, Files A, Graves T, Kirk E, Swearingen CJ (2014) Effect of virtual reality on adolescent pain during burn wound care. J Burn Care Res. 35(5):395–408. https://doi.org/10.1097/BCR.0000000000000019.
Chaudhary S, Showkat I, Sinha A (2019) Comparative Evaluation of the Effectiveness of Active and Passive Distraction Aids in the Management of Anxious Pediatric Dental Patients, Chron. Dent. Res. 8(2):2–6.
Lambert V, Boylan P, Boran L, Hicks P, Kirubakaran R, Devane D, Matthews A (2020) Virtual reality distraction for acute pain in children. Cochrane Database Syst. Rev. 10:1–93. https://doi.org/10.1002/14651858.CD010686.pub2.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 10:372 doi: https://doi.org/10.1136/bmj.n71.
Higgins JP, Savović J, Page MR, Elbers RG, Sterne JA (2019) Assessing risk of bias in a randomized trial. Cochrane Database Syst. Rev. 205–228. https://doi.org/10.1002/9781119536604.ch8.
Joanna Briggs Institute (2022) Joanna Briggs Institute Reviewers Manual, Australia: Royal Adelaide Hospital. http://joannabriggs.org/assets/docs/sumari/reviewersmanual-2011.pdf. Accessed 21 May 2022.
Nahcivan NO, Secginli S (2015) Joanna Briggs Institute Mastari Critical Appraisal Tools: Psychometric testing of the Turkish versions. The 2nd International Clinical Nursing Research Congress, Abstract Book, Istanbul, pp.85.
Dincer S (2019) Introduction to meta-analysis. Anı Publishing, Ankara.
Cohen J (1992) A power primer. Psychol. Bull. 112(1):155. https://doi.org/10.1037/0033-2909.112.1.155.
Borenstein M, Hedges LV, Higgins JPT (2009) Introduction to meta-analysis. Wiley, Hoboken.
Gerçeker GÖ, Bektaş M, Aydınok Y, Ören, Ellidokuz H, Olgun N (2021) The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: Randomized controlled trial, EJON 50:101886. https://doi.org/10.1016/j.ejon.2020.101886.
Gershon J, Zimand E, Pickering M, Rothbaum BO, Hodges L (2004) A pilot and feasibility study of virtual reality as a distraction for children with cancer, JAACAP 43(10):1243–1249. https://doi.org/10.1097/01.chi.0000135621.23145.05.
Hundert AS, Birnie KA, Abla O, Positano K, Cassiani C, Lloyd S, Stinson J (2022) A Pilot Randomized Controlled Trial of Virtual Reality Distraction to Reduce Procedural Pain During Subcutaneous Port Access in Children and Adolescents With Cancer. Clin. J. Pain. 308(3):189–196. doi: https://doi.org/10.1097/AJP.0000000000001017.
Semerci R, Akgün Kostak M, Eren T, Avci G (2021) Effects of virtual reality on pain during venous port access in pediatric oncology patients: a randomized controlled study. JPON 38(2):142–151. https://doi.org/10.1177/1043454220975702.
Tennant M, Youssef G, McGillivray J, Clark TJ, McMillan L, McCarthy M (2020) Exploring the Use of Immersive Virtual Reality to enhance psychological wellbeing in Pediatric Oncology, EJON 48:101804. Doi: https://doi.org/10.31234/osf.io/hujgz.
Wolitzky K, Fivush R, Zimand E, Hodges L, Rothbaum BO (2005) Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients, Psych Health. 20(6): 817–824. https://doi.org/10.1080/14768320500143339.
Wong CL, Li CK, Chan CW, Choi KC, Chen J, Yeung MT, Chan ON (2021)Virtual reality intervention targeting pain and anxiety among pediatric cancer patients undergoing peripheral intravenous cannulation: A randomized controlled trial, Cancer Nurs. 44(6) (2021) 435–442. doi: https://doi.org/10.1097/NCC.0000000000000844.
Merikangas KR, Nakamura EF, Kessler RC (2022) Epidemiology of mental disorders in children and adolescents, Dialogues in clinical neuroscience 11(1):7–20. https://doi.org/10.31887/DCNS.2009.11.1/krmerikangas.
Toruner EK, Buyukgonenc L (2022) Çocuk Sağlığı Temel Hemşirelik Yaklaşımları. Nobel Medicine Bookstore, Ankara.
Nordgård RK, Låg T (2021). The effects of virutal reality on procedural pain and anxiety in pediatrics: A systematic review and meta-analysis. Front. Virtual Real. 2:699383. doi: https://doi.org/10.3389/frvir.2021.699383.
Bukola IM, Paula D (2017) The effectiveness of distraction as procedural pain management technique in pediatric oncology patients: a meta-analysis and systematic review. J. Pain Symptom Manag. 54(4):589–600. https://doi.org/10.1016/j.jpainsymman.2017.07.006.
Ridout B, Kelson J, Campbell A, Steinbeck K (2021) Effectiveness of virtual reality interventions for adolescent patients in hospital settings: Systematic review. J. Med. Internet Res. 23(6):e24967. doi:https://doi.org/10.2196/24967.
Lim NL, Shorey S (2019) Effectiveness of technology-based educational interventions on the empowerment related outcomes of children and young adults with cancer: A quantitative systematic review. J. Adv. Nurs. 75(10):2072–2084. https://doi.org/10.1111/jan.13974.
Ge L, Tian JH, Li YN, Pan JX, Li G, Wei D, Yang KH (2018) Association between prospective registration and overall reporting and methodological quality of systematic reviews: a meta-epidemiological study. J. Clin. Epidemiol. 93:45–55. https://doi.org/10.1016/j.jclinepi.2017.10.012.
Funding
No external or intramural funding was received.
Author information
Authors and Affiliations
Contributions
Conceptualization, C.S.O and E.K.T; methodology, C.S.O and E.K.T; software and formal analysis, C.S.O; writing—original draft preparation, C.S.O and E.K.T; writing, review and editing, C.S.O; visualization, C.S.O and E.K.T; supervision, C.S.O and E.K.T ; All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Competing Interests
The authors report no actual or potential conflicts of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ozturk, C.S., Toruner, E.K. Effectiveness of Virtual Reality in Anxiety and Pain Management in Children and Adolescents Receiving Cancer Treatment: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Syst 47, 103 (2023). https://doi.org/10.1007/s10916-023-01995-4
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10916-023-01995-4