Kazuyuki Niki

Effect of Immersive Virtual Reality on Chemotherapy-Related Side Effects in Patients Receiving Paclitaxel-Carboplatin With or Without Bevacizumab: 2-Arm Randomized Controlled Trial

Abstract Background Symptomatic drug treatment is generally used to treat various side effects associated with paclitaxel-carboplatin (TC) or TC plus bevacizumab (TC+Bev). However, this can lead to increased adverse effects from additional drugs. Immersive virtual reality (iVR) reduces pain and anxiety. Objective This study aimed to investigate the efficacy of iVR in managing side effects associated with TC or TC+Bev therapy. Methods This 2-arm randomized controlled trial included patients with gynecologic cancer scheduled to undergo their first course of TC/TC+Bev. Patients in the intervention group received iVR for approximately 10 minutes/day for 7 consecutive days, starting on the first day of treatment. The primary endpoint was the severity of physical and psychiatric symptoms measured using the Japanese version of the revised Edmonton Symptom Rating System (ESAS-r-J). The secondary endpoint included the proportion of patients who used additional antiemetic medications, the complete response (CR) rate to nausea, and the severity of anxiety, measured using the state-trait anxiety inventory-JYZ (STAI) Y-1. Patients in the nonintervention group received supportive and symptomatic treatments. Results The analysis included 28 and 30 patients in the intervention and nonintervention groups, respectively. The change in ESAS-r-J scores between days 1 and 7 and nausea were significantly worse in the intervention group on day 4 only (P<.001); however, the nonintervention group showed significantly worse scores on days 3, 4, and 5. Depression was not significantly worse in the intervention group on any day other than on day 1; however, the nonintervention group showed significantly worse scores on day 4. The proportion of patients who used additional antiemetic medications from days 2 to 7 was significantly lower in the intervention group than in the nonintervention group (P=.02). Regarding the change in STAI Y-1 on day 1 of TC or TC+Bev therapy, the mean score was significantly lower after the iVR experience than before the experience in the intervention group (from 43.8 to 34.8; P<.001), whereas, in the nonintervention group, no significant difference was observed before and after anticancer drug administration (from 44.9 to 43.9; P=.54). Conclusions iVR may reduce the deterioration of nausea and depression more effectively in patients with gynecologic cancer undergoing TC or TC+Bev therapy than in those undergoing nonintervention, especially in delaying the onset of nausea and accelerating recovery.