Transforming Cancer Rehabilitation: Innovative Treatment With Virtual Reality (VR)

Side effects of cancer and its treatments, such as pain, anxiety, nausea or neuropathy, make daily activities and planned exercise difficult. They reduce quality of life and can lead to inactivity and muscle loss.

Cancer rehabilitation (oncological rehabilitation) is a process intended to improve the physical, psychological and social well-being of people receiving cancer treatment. It is important during and after treatment to improve quality of life, minimize side effects and make daily activities easier.

Advancing technology now helps minimize treatment-related side effects in cancer rehabilitation. One development is virtual reality (VR) technology.

VR has attracted attention as an innovative medical approach in recent years. Its use in cancer rehabilitation has considerable potential to support physical, psychological and social recovery.

Through virtual environments, VR applications can help patients with

• pain control,
• exercise,
• stress management,
• sleep problems and
• patient education.

This technology is emerging as a new, effective tool to improve quality of life for people receiving cancer treatment and help overcome treatment-related challenges. Virtual environments, for example, may provide a more motivating rehabilitation experience beyond the limitations of conventional methods. Interactive, personalized VR experiences may also improve adherence and encourage active participation in recovery. Its role in cancer rehabilitation may therefore become increasingly important, with the potential to transform healthcare.

FDA Approval of a Virtual Reality Program for Chronic Pain

The virtual reality (VR) program used for chronic pain treatment, EaseVRx, received FDA approval in November 2021, attracting considerable interest and demonstrating the effectiveness of VR technology in this field. EaseVRx helps reduce chronic low back pain using cognitive behavioral therapy and other behavioral methods, and clinical studies have shown successful pain-management outcomes. This approval highlighted the potential of VR-based treatments and led to their adoption as a new, effective approach to chronic pain.

EaseVRx is also an example of gamification. By offering interactive, engaging content, it aims to distract users and improve treatment adherence, making pain management and rehabilitation more tolerable and motivating.

How VR Headsets Work

VR is an innovative technology using computer simulation to let users experience and perform activities in virtual or artificial environments. It incorporates sensory stimuli such as sound, visuals and touch into a three-dimensional virtual world. This creates a perception of physical presence, enabling users to interact with their surroundings.

In healthcare, VR is a noninvasive method for managing cancer treatment-related symptoms. Systems include stereoscopic head-mounted displays (HMDs) and headphones, 3D glasses, body-tracking sensors and other somatosensory devices, including input devices such as gloves and joysticks. They bridge the real and virtual worlds, enabling interactive feedback between users and the virtual environment.

VR has recently emerged as a promising tool to support patients receiving cancer treatment and minimize suffering. As a distraction intervention, it can alleviate pain, fatigue, anxiety, depression and cognitive impairment. Applications include calming scenes, virtual interaction and feedback, task-based activities, and combinations with music therapy. Guided sessions can also support relaxation or meditation. VR has important physical rehabilitation applications for improving function and encouraging daily activities.

Cancer Treatment-Related Impairments and the Importance of Exercise Rehabilitation

Studies of functional impairment caused by cancer treatment report rates approaching 20% in pediatric patients and exceeding 50% in adults. Common impairments include:

• chemotherapy-induced neuropathy,
• sexual dysfunction,
• cancer-related fatigue,
• cancer-related sleep disorders,
• cognitive impairment,
• postoperative syndromes in breast cancer,
• and cardiopulmonary dysfunction.

These impairments substantially reduce quality of life and increase the economic burden on healthcare systems. Exercise rehabilitation, including aerobic, resistance, flexibility and neuromuscular training, is widely discussed as a treatment approach.

Exercise rehabilitation has been shown to substantially improve cancer-related impairments. Studies report improved sexual function with approaches such as pelvic floor exercises, and substantial improvement in chemotherapy-induced neuropathy after an 8-week program incorporating endurance, resistance and balance training.

Virtual Reality-Based Exercise Rehabilitation (VR-ER)

Virtual reality-based exercise rehabilitation (VR-ER) is a promising intervention combining VR with exercise rehabilitation. It creates three-dimensional environments with body tracking to provide safe, realistic settings. Studies suggest it can effectively improve impairments arising from various diseases. For people with balance and coordination problems, multisensory VR exercise programs add virtual scenarios for gait and balance rehabilitation to the benefits of physiotherapy. These exercises offer promise where conventional rehabilitation is insufficient.

VR Studies in Oncology

Various studies and articles address VR headsets in cancer rehabilitation. The technology may improve patients' rehabilitation experience in several ways:

1. Physical Rehabilitation: VR exercise programs make rehabilitation more engaging and effective. Sessions may include virtual rafting, cross-country running and other interactive games (gamification). Physiotherapists generally supervise them to ensure safety and effectiveness. They can improve muscle strength, balance and overall endurance. Studies in chronic obstructive pulmonary disease (COPD) suggest that this rehabilitation may provide similar benefits in lung cancer rehabilitation.

2. Psychological Benefits: VR may reduce anxiety and improve psychological well-being during cancer treatment. Experiences that distract from pain and stress help patients manage the psychological burden of their illness. Cancer Research UK conducted a study investigating whether VR experiences reduced stress and anxiety during cancer treatment. Results showed favorable effects on participants' stress, anxiety, fatigue and overall quality of life.

3. Patient Education and Engagement: VR also educates patients about their condition and treatment. For example, they can visualize their lungs and understand how treatments such as radiation affect their tumors. Better knowledge and engagement may improve adherence and outcomes. A blog post published by ACCC (Association of Community Cancer Centers) examined VR as an innovative patient-education tool. It helps patients better understand their diagnoses and participate in shared decision-making with healthcare providers. Practical Radiation Oncology published a study aiming to develop and evaluate an affordable smartphone-based VR patient-education platform. Breast, pelvic and head-and-neck VR videos were filmed using a 360-degree camera to show standard radiotherapy appointments from a patient's first-person perspective. The videos reduced anxiety during treatment and increased familiarity with the process.

4. Pain Management: VR also plays an important role in pain management. It may reduce perceived pain and treatment-related discomfort, particularly during painful treatment processes such as chemotherapy and radiotherapy. It is also used for acute pain during painful medical procedures and to relieve symptoms in terminally ill patients receiving palliative care. A study published in J Clin Med aimed to evaluate VR's effect on colonoscopy-related anxiety and pain. A systematic review of clinical trials found it as effective as conventional sedation, with a statistically significant reduction among patients not receiving sedation. VR-based education also reduced pre-colonoscopy anxiety and improved bowel preparation quality. 

5. Overall Quality of Life: The varied activities and relaxing environments offered by VR improve overall quality of life. Patients can relieve stress and enjoy themselves in virtual settings, helping maintain morale and motivation during treatment.

VR headsets offer multiple benefits in cancer rehabilitation. Physical, psychological and educational contributions are making the technology an important part of cancer treatment. It may also help establish correct positioning and treatment targets during radiotherapy, particularly for cancers requiring radiation, such as prostate and breast cancer.

VR for Cancer-Related Sleep Problems

Sleep problems are common in cancer. Chemotherapy, radiotherapy and other treatments can cause nausea, fatigue and hormonal imbalances that disrupt sleep. Stress, anxiety, pain and discomfort also contribute.

Some studies use VR to manage sleep problems in cancer. In one pilot trial involving women with metastatic breast cancer, VR therapies reduced anxiety and depression symptoms and improved sleep quality. Participants regularly used VR experiences at home, and the results suggested effectiveness for symptom management.

Another study suggested that, in patients with terminal cancer, VR could manage physical and emotional symptoms such as pain and stress, allowing more comfortable sleep.

These studies suggest that VR may be a useful tool for managing sleep problems in cancer. However, consult healthcare professionals to learn more about appropriate use and develop a treatment plan suited to your individual circumstances.

VR in Breast Cancer

Among cancers, VR has been studied most extensively in breast cancer. The disease's prevalence and the length of treatment create substantial needs for physical and psychological support.

Breast cancer rehabilitation primarily aims to improve upper-limb mobility through approaches such as conventional physiotherapy, kinesitherapy and massage. More varied task-oriented programs offer adaptability to everyday activities and have shown better results than traditional repetitive movement exercises. Technological advances have substantially changed rehabilitation and provided noninvasive methods for managing cancer-related symptoms. VR is one such tool, effectively minimizing both psychological and physical consequences of breast cancer treatment. It is as effective as conventional physiotherapy for improving upper-limb function and daily activities.

VR-based interventions offer a new perspective on breast cancer rehabilitation. They have proved an excellent noninvasive approach to post-treatment symptoms including pain, fatigue, anxiety, depression, cognitive impairment and limited joint movement affecting daily activities. Many tools and devices are available, including computers, televisions and mobile phones. However, widespread availability and use remain limited by cybersickness, uncomfortable headsets, user discomfort or reluctance, and high equipment costs.

Considerations When Using VR: Possible Side Effects

VR is emerging as an innovative, effective way to support physical, emotional and psychological recovery in cancer rehabilitation. Several important issues must nevertheless be considered.

• Possible Side Effects: One possible adverse effect of virtual reality is cybersickness, assessed in the literature using the Virtual Reality Symptom Questionnaire. Symptoms can include dizziness, nausea and balance problems.
• Patient Safety: VR applications must be safe, particularly experiences that may cause dizziness, nausea or balance problems. Cleanliness and hygiene of VR glasses and headsets also require attention.
• Personalized Applications: Each patient's rehabilitation needs differ. Programs should therefore be tailored to specific needs and health status. Regular feedback should inform ongoing assessment of effectiveness and suitability.
• Professional Supervision: Qualified healthcare professionals must guide VR therapy. Physiotherapists, psychologists and oncology specialists help patients benefit appropriately and effectively. Patients should be closely monitored throughout rehabilitation, with intervention when necessary.

Attention to these considerations can ensure the most effective and safest use of VR in cancer rehabilitation.