Effects of Virtual Reality Interventions for Needle-Related Procedures in Patients with Cancer: A Systematic Review and Meta-Analysis

Abstract

Background: Needle-related procedures (NRPs) in cancer care are often associated with significant pain and anxiety, contributing to psychological and physiological distress. This study aimed to assess the effectiveness of virtual reality (VR)-based interventions in reducing anxiety, pain, depression, fear, and physiological parameters (pulse rate and respiratory rate) in patients with cancer undergoing NRPs.

Methods: A systematic search of 11 databases (CINAHL, Cochrane Library, Embase, IEEE Xplore, Medline, ProQuest, PsycINFO, PubMed, Scopus, Web of Science, and CNKI) was conducted from inception to 15 May 2025. Two independent reviewers selected and extracted studies based on predefined inclusion and exclusion criteria. Meta-analyses were performed using Cochrane RevMan 2024 software. Heterogeneity was assessed using Higgins' I² statistics and Cochran's Q test. The GRADE framework was applied to evaluate the quality of evidence.

Results: Fourteen randomized controlled trials (RCTs) with 1089 participants were included. VR interventions showed significant benefits compared to controls in reducing anxiety (standard mean difference [SMD] = -1.74, 95% confidence interval [CI]: -2.47 to -1.01, p < 0.001), pain (SMD = -1.30, 95% CI: -1.93 to -0.67, p < 0.001), depression (SMD = -0.73, 95% CI: -0.96 to -0.50, p < 0.001), fear (mean difference [MD] = -1.31, 95% CI: -1.56 to -1.06, p < 0.001), and respiratory rate (MD = -3.85, 95% CI: -6.18 to -1.52, p = 0.001). However, no significant difference was found in pulse rate (MD = 0.25, 95% CI: -14.32 to 14.81, p = 0.97).

Conclusions: VR-based interventions are effective in alleviating psychological symptoms (anxiety, depression, fear) and physiological distress (pain, respiratory rate) in patients with cancer undergoing NRPs. However, they do not significantly impact pulse rate. Interpretation of findings should consider limitations such as the small number of studies, limited sample sizes, and high heterogeneity. Further high-quality RCTs with follow-up assessments are warranted. Customizing VR interventions to address demographic and procedural needs may further enhance their effectiveness.

Keywords: needle-related procedures; patients with cancer; psychological symptoms; systematic review and meta-analysis; virtual reality.

Figure 1

PRISMA flow chart.

Figure 2

Risk of bias analysis of the included studies [18,34,35,36,37,38,39,40,41,42,43,44,45,46].

Figure 3

(a) Forest plot of VR on anxiety. (b) Subgroup analyses of VR on anxiety for patients of different age among patients with cancer [18,34,35,36,37,38,39,40,42,43,44,46].

Figure 4

(a) Forest plot of VR on pain. (b) Subgroup analyses of VR on pain for patients of different age among patients with cancer [18,36,38,41,42,43,44,45].

Figure 5

Effectiveness of VR on depression among patients with cancer [34,37,40].

Figure 6

Effects of VR on fear among patients with cancer [18,41,44].

Figure 7

Effects of VR on physiological parameters: (a) Pulse rate and (b) Respiratory rate among patients with cancer [35,36,43,44].