Virtual reality could become new treatment tool for cancer pain and anxiety, meta-analysis finds

Virtual reality may give patients with cancer short-term relief from pain and anxiety, according to a meta-analysis published in Healthcare and Rehabilitation. The most consistent benefits were seen during medical procedures and among children.

The study was co-led by Jiaojaio Zhang, Ph.D., and Yi Chen, Ph.D., RN, both of the School of Nursing at Fudan University in Shanghai, China.

Pain and anxiety are common among patients with cancer. Symptoms are often hard to manage and can complicate care. Approximately 70% of cancer patients experience pain and up to 65% have anxiety symptoms, with more than half receiving inadequate management, the authors wrote in the study.

“Pain may make cancer treatment more challenging, while anxiety can make procedures and symptoms feel more overwhelming,” Zhang said in a news release. “VR can offer an immersive environment that may help patients shift attention away from pain or fear during treatment and care.”

What the VR meta-analysis found for cancer pain and anxiety

The research team searched nine databases and included 13 randomized controlled trials involving 969 patients from eight countries, published between 2002 and 2024.The trials enrolled adults and children and tested headset-based immersive VR as well as screen-based systems such as Xbox Kinect, with sessions lasting 3 to 45 minutes.

In the 12 trials that measured pain (909 participants), VR was associated with a statistically significant reduction compared with control conditions, with a standardized mean difference (SMD) of −0.76. In the seven trials that measured anxiety (572 participants), VR was also associated with a significant reduction (SMD, −1.53). Both analyses relied mainly on assessments taken immediately after the intervention.

Findings were more consistent in procedural settings, such as port accesses, blood draws and lumbar punctures, and among children, the authors reported. The three pediatric trials in the anxiety analysis each used a single VR session of 10 minutes or less.

How VR compared with iPad distraction for cancer pain

VR was associated with greater pain reduction than usual care or pharmacological care alone. But in the four trials that used iPad-based 2D distraction as the comparator, the iPad groups saw comparable or greater pain reductions, and three of those trials took place in hospital wards or patients’ homes.

The authors described these subgroup analyses as exploratory and said the available evidence cannot determine whether VR outperforms other distraction-based approaches. They called for adequately powered head-to-head trials.

Why the evidence for VR in oncology remains limited

The researchers rated the certainty of evidence for both outcomes as low under the GRADE framework. Most included trials were judged at high risk of bias, largely because participants and outcome assessors were not blinded and pain and anxiety were self-reported. Heterogeneity across trials was also substantial.

Safety data were sparse. Only one trial documented symptoms such as dizziness or cybersickness, at rates comparable between the VR and iPad groups, which the authors said is not enough to reliably assess the safety profile of VR.

“Larger and better-designed trials are needed to understand which patients benefit most, how VR should be delivered, and how safe and acceptable it is in routine care,” Zhang said. “Future studies should systematically monitor and report adverse events to better understand the safety and tolerability of VR in oncological settings.”

What VR reimbursement looks like for payers

Coverage remains a hurdle for VR therapeutics. In 2023, CMS created HCPCS Level II code E1905 for AppliedVR’s RelieVRx, a prescription VR system authorized for chronic low back pain, and classified it as durable medical equipment, making it the first VR therapeutic device to receive an HCPCS code and benefit category determination.

The code can apply to other platforms that meet its requirements, but it covers a combined device and pre-programmed software rather than software alone, according to a guide from Nixon Law Group. Because CMS, rather than the American Medical Association, maintains the code, commercial payers that rely on AMA-maintained codes may not cover it, the firm noted.