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Abstract
Purpose: The aim of this study was to evaluate the anxiety-reducing effects of virtual reality (VR) on patients with breast cancer undergoing adjuvant radiation therapy (RT).

Methods and materials: This randomized controlled trial was conducted among patients with breast cancer receiving RT at a single institution. Of 196 enrolled and randomized patients, 97 were assigned to a VR explanation group (intervention) and 99 were assigned to the standard-of-care group (control). Anxiety levels were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) as the primary endpoint and the State-Trait Anxiety Inventory (STAI) and Linear Analogue Scale Assessment (LASA) as secondary endpoints. Knowledge of the RT procedure, patient satisfaction, and time spent for counseling were also assessed.

Results: Intervention significantly reduced patient anxiety immediately, not only on the primary endpoint, APAIS, but also on the STAI and LASA anxiety scales. Specifically, in the intervention group, there were immediate reductions of 26.0%, 16.1%, and 55.8% for APAIS, STAI, and LASA, respectively, whereas in the control group, the respective reductions were 8.1%, 8.5%, and 13.7%. Among the 3 anxiety scales, long-term anxiety reduction was observed only when anxiety was measured by LASA. Subgroup analyses showed that the effect on anxiety did not differ based on the physician, baseline anxiety level, use of hormone therapy, or health literacy. The intervention also significantly improved knowledge of the RT procedure (81.9/100 vs 76.8/100; P = .006) and patient satisfaction with the explanation manner (6.56 vs 5.72; P < .001) compared with the control group.

Conclusions: Immersive VR applied to the current procedure reduces anxiety during RT planning for patients with breast cancer. Further research is necessary to investigate the long-term effects of VR on anxiety.

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Affiliations

Jaeyong Shin 1, Jee Suk Chang 2, Jin Sung Kim 2, Ji-Yeon An 3, Seung Yeun Chung 4, So-Yeon Yoon 5, Yong Bae Kim 6
1Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea.
2Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
3Department of Economics, Graduate School, Sogang University, Seoul, Korea.
4Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
5Design Environment and Analysis, College of Human Ecology, Cornell University, Ithaca, New York. Electronic address: sy492@cornell.edu.
6Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. Electronic address: ybkim3@yuhs.ac.