On-Table Virtual Reality to Reduce Anxiety/Distress during Radiation Treatments: A Pilot Randomized Trial

We report the first randomized trial of a virtual reality (VR) headset used on-table during external beam radiation therapy (RT) treatments to reduce anxiety/distress during receipt of RT. A small pilot study was conducted among 10 patients, with VR randomized to start in the first week ("immediate VR") versus the second week ("delayed VR") of treatment. All patients (100%) in the immediate VR group had declines in measured distress scores after their first radiation treatment, compared to only 1 patient (16.7%) in the delayed VR group (P = .048), yet score declines generally did not meet the minimal clinically important difference threshold in the context of overall low distress scores at baseline. By day 5 of treatment, distress score changes were similar between immediate and delayed VR groups. Overall, 80% of patients in the study, including all patients with moderate or high levels of baseline anxiety/distress, reported that on-table VR improved their RT experience and/or they would recommend VR to others. We propose that on-table VR is a readily available, nonpharmacologic intervention that can be used to help reduce anxiety/distress associated with RT and may be particularly helpful at the start of treatment among those with moderate/high baseline levels of anxiety/distress.