The Effect of Using Engaging Distraction via Virtual Reality on Stress and Anxiety among Patients with Cancer Undergoing Chemotherapy in Palestine: A Randomized Controlled Trial

Background Virtual reality (VR) is increasingly recognized as a valuable adjunct in cancer supportive care, but evidence for its efficacy in reducing psychological distress during chemotherapy in Middle Eastern settings remains limited. Objectives To evaluate the effectiveness of immersive virtual reality as an engaging distraction on stress and anxiety among cancer patients during chemotherapy in Palestine. Methods Between June and September 2023, 150 cancer patients were randomly assigned to an intervention group ( n = 75) receiving VR during chemotherapy or a control group ( n = 75) receiving standard care. Outcomes were measured using the Generalized Anxiety Disorder scale (GAD-7) and Perceived Stress Scale (PSS-10) before and after intervention. Results Postintervention analysis revealed potential benefits with significantly lower stress levels in the experimental group ( M = 17.7 ± 2.8) compared to controls ( M = 19.2 ± 2.5; mean difference: 1.5 points, 95% CI 0.6, 2.4, p < .05, Cohen's d = 0.58, 95% CI 0.25, 0.91). Mean GAD-7 scores were significantly lower in the VR group ( M = 6.2 ± 3.1) versus controls ( M = 10.8 ± 4.2; mean difference: 4.6 points, 95% CI 3.3, 5.9, p < .001). 54.7% of VR participants ( n = 41) achieved minimal anxiety compared to 26.7% of controls ( n = 20) (Risk Ratio=2.05, 95% CI 1.35, 3.12). Effect sizes were moderate to large for both outcomes. The observed stress reduction of 1.5 points exceeds the established minimal clinically important difference (MCID) of approximately 1.0–1.5 points for the PSS-10, while the anxiety reduction of 4.6 points meets the MCID threshold of 4 points for the GAD-7. Conclusion Engaging distraction via virtual reality demonstrates potential benefit in reducing stress and anxiety among cancer patients during chemotherapy. However, this study design cannot isolate VR-specific immersive effects from general distraction. Future research with active control conditions is needed to establish VR's unique value proposition.