Virtual Reality Rehabilitation Systems for Cancer Survivors: A Narrative Review of the Literature

Abstract

Rehabilitation plays a crucial role in cancer care, as the functioning of cancer survivors is frequently compromised by impairments that can result from the disease itself but also from the long-term sequelae of the treatment. Nevertheless, the current literature shows that only a minority of patients receive physical and/or cognitive rehabilitation. This lack of rehabilitative care is a consequence of many factors, one of which includes the transportation issues linked to disability that limit the patient’s access to rehabilitation facilities. The recent COVID-19 pandemic has further shown the benefits of improving telemedicine and home-based rehabilitative interventions to facilitate the delivery of rehabilitation programs when attendance at healthcare facilities is an obstacle. In recent years, researchers have been investigating the benefits of the application of virtual reality to rehabilitation. Virtual reality is shown to improve adherence and training intensity through gamification, allow the replication of real-life scenarios, and stimulate patients in a multimodal manner. In our present work, we offer an overview of the present literature on virtual reality-implemented cancer rehabilitation. The existence of wide margins for technological development allows us to expect further improvements, but more randomized controlled trials are needed to confirm the hypothesis that VRR may improve adherence rates and facilitate telerehabilitation.

Opportunities and challenges of virtual reality-based interventions for patients with breast cancer: a systematic review

“…A systematic review by de Araújo et al showed that VR-based interventions in different rehabilitation protocols improved motor function, balance, aerobic function, driving skills, pain level, and psychological and motivational aspects [52]. Most studies found that VR intervention can be effective in upper limb rehabilitation and improve physical aspects such as strength and function metrics and range of motion metrics [48,[53][54][55], consistent with our findings. Quality of life (QoL) is related to the level of physical activity.…”

“…Chirico et al in their study reported cybersickness symptoms using the Virtual Reality Symptom Questionnaire (VRSQ) [58]. Their findings showed that except for [33,41] User resistance because of first exposure to the VR [19,41] Quality of visual image [33] Weakness of learning ability [41] Need for familiarization stage to use of VR [19] Adverse effects of medication on the effective use of VR [37] Cost of the equipment [20] Study-related Small sample size [30,33,34,37,[41][42][43] Study design [7,31,32,36,38,42] Single study site [33][34][35]42] Lack of generalizability [20,41,42] Risk of bias [7,36,42] Lack of standardized measurement tools [30,35] The intervention was used only once with each patient [7,35] Lack of blinding [7] Investigating short-term effects [7] Short duration of the study [38] Non-compliance of patients [43] Insufficient data collection [41] Patient unwillingness to complete questionnaires…”

“…The oldest and newest studies were published in 2003 and 2021, respectively. Study designs in most of the studies were before-after (N = 5) (19,(29)(30)(31)(32), cross-over (N = 5) [33][34][35][36][37], and RCT (N = 4) [7,20,38,39]. Other study designs in reviewed articles were cross-sectional [40], experimental design [41], quasi-experimental [42] and quasi-randomized clinical trials [43], each with one study.…”

“…The intervention duration varied from 7 to 90 min. Figure 2 shows six studies from the United States [30,[33][34][35][36][37], four from Italy [7,31,40,44], and one from Australia [42], Brazil [29], China [41], Egypt [43], France [19], Jordan [20], Poland [32], and Turkey [38].…”

“…Reducing depression severity [7,30] No motion sickness [30] Improving knowledge about treatment [42] Increase of confidence [42] Increase of satisfaction [42] Reducing tension [7] Reducing anger [7] Relaxation [31] Patients experienced a more pleasant state [31] Reducing fear of movement [38] Reducing negative emotional arousal [19] Increase in positive emotional state [19] Physical aspects Strength and function metrics improved [30,38,43] Increase of range of motion metrics [30,38] Reducing heart rate [37] Reducing blood pressure [37] Reducing saliva cortisol [37] Improvement of lymphedema state [43] Static postural control [32] Dynamic postural control [32] Increase of flexion and abduction [29] Increase of electrical activity [29] This study showed that therapists could use VR in different stages of treatment to improve the condition of patients with breast cancer. As mentioned, VR can be used in chemotherapy, radiotherapy, and the post-surgery period, and therapists can achieve different goals with this technology in these stages of treatment.…”