An Interactive Preoperative Virtual Reality Intervention for Breast Cancer Patients Undergoing Oncological Surgery: A Feasibility and Pilot Randomized Clinical Trial

BACKGROUND AND OBJECTIVES: Preoperative anxiety is common before surgery and is associated with adverse outcomes, yet access to mental health support remains limited. We evaluated the feasibility and acceptability of a novel preoperative virtual reality (VR) prototype designed to reduce anxiety in patients undergoing cancer surgery. METHODS: In a multi-method feasibility and pilot trial, participants were randomized to either the VR intervention or standard of care (SoC) between 2021 and 2023. VR participants completed a simulation 1-2 weeks before surgery exploring the operating room (OR) and experiencing anesthesia induction. Intervention feasibility and acceptability (primary outcomes), and preliminary trends in anxiety and distress (secondary outcomes) were explored using measures and open-ended questions administered at four perioperative timepoints. RESULTS: Of 33 interested individuals, 27 were randomized, and 23 completed the study (VR: n = 12; SoC: n = 11). No adverse VR effects occurred. Most participants reported elevated preoperative anxiety (78.3%-87%), rated the VR as helpful (M = 80.4%), enjoyable (M = 87.7%), and all viewed it as worthwhile. Six qualitative themes emerged: preparation for the OR, psychological and emotional impact, realism, interactivity, technical issues, and supporting others. Trends suggested reduced postoperative distress and anxiety for the VR group. CONCLUSION: The VR intervention was feasible and acceptable, supporting further development and advancement to a larger clinical trial. TRIAL REGISTRATION: The clinical trial was registered at clinicaltrials.gov: https://clinicaltrials.gov/study/NCT04544618 on September 10th, 2020.