Virtual reality and play therapy in the management of pain and anxiety in children and adolescents undergoing cancer treatment: quasi-experimental study

Barrêto, Denize Miquele dos Santos; Silva, Carolina Dias dos Santos; Oliveira, Moisés Ferreira Alves de; Cantalice, Anajás da Silva Cardoso

doi:10.63231/2595-0118.20250027-pt

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ORIGINAL ARTICLE • BrJP 8 • 2025 • https://doi.org/10.63231/2595-0118.20250027-en linkcopy

Virtual reality and play therapy in the management of pain and anxiety in children and adolescents undergoing cancer treatment: quasi-experimental study

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES Virtual reality (VR) and play therapy represent important methods to be implemented in the face of painful processes faced in the therapeutic path of children and adolescents with cancer. The objective of this study was to investigate the influence of VR and play therapy with board games for pain reduction in children and adolescents undergoing cancer treatment.

METHODS This is a quasi-experimental study, with non-probabilistic sampling. The population consisted of children and adolescents treated at the pediatric oncology unit of a public hospital in Paraíba state. Data collection occurred in the following stages: application of a form with demographic and clinical data of the child; assessment of pain and anxiety in children and adolescents allocated to control, VR and play therapy groups before any procedure during hospitalization, such as medication administration, dressings and afterwards. For data analysis, the Statistical Package for the Social Sciences (SPSS) software was used.

RESULTS Of the 34 participants evaluated, 59% were male, 79% aged between 4 and 10 years and 58% diagnosed with leukemia. As for pain, 3% reported moderate pain before the implementation of the treatments, and after the practices there was a reduction in the pain score in the VR group. 12% of those assessed had symptoms indicative of anxiety. There was a decrease in heart rate (HR) in all groups, with no difference in the control group.

CONCLUSION VR and play therapy have proven to be effective resources for pain relief in children and adolescents, inserting themselves as attractive forms of humanized care.

Keywords:
Cancer pain; Child; Hospitalized child; Play therapy; Virtual reality

Virtual Reality (VR) has proven to be an effective therapeutic intervention for reducing pain levels in children and adolescents undergoing cancer treatment

Strategies such as playfulness and VR were presented as tools that soften the impact of cancer treatment

The VR group was able to significantly reduce the clinical parameters analyzed among the participants

Characteristics	Participants Total		Virtual Reality		Play Therapy		Control
Characteristics	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
Participants	34	100	10	29.4	13	38.2	11	32.4
Age
Pre-school	15	44	4	40	5	38.5	6	55
School	12	35	5	50	4	30.8	3	27
Adolescent	7	21	1	10	4	30.8	2	18
Ethnicity/color
White	15	44	5	50	4	30.8	6	55
Brown	19	56	5	50	9	69.2	5	45
Gender
Female	14	41	5	50	5	38.5	4	36
Male	20	59	5	50	8	61.5	7	64
Belief or religion
Catholic	14	41	5	50	3	23.1	6	55
Evangelical	17	50	4	40	10	76.9	3	27
Other	3	9	1	10	-	-	2	18
Schooling (in years of study)
Doesn't study	7	21	1	10	3	23.1	3	27
Pre-school	9	26	3	30	3	23.1	3	27
1st to 5th year	9	26	4	40	2	15.3	3	27
6th to 9th year	6	18	1	10	4	30.8	1	9
1st to 3rd year high school	3	9	1	10	1	7.7	1	9
Origin
Urban area	25	74	6	60	10	76.9	9	82
Rural area	9	26	4	40	3	23.1	2	18
Length of stay in hospital (days)
0	8	24	2	20	4	30.8	2	18
1 to 15	18	53	6	60	7	53.8	5	45
16 to 30	4	12	1	10	1	7.7	2	18
31 to 60	3	9	-	-	1	7.7	2	18
61 or more	1	3	1	10	-	-	-	-
Degree of kinship
Mother	29	85	10	100	10	77	9	82
Father	4	12	-	-	2	15	1	9
Other	1	3	-	-	1	8	1	9
Diagnostic time
0 to 6 months	8	24	5	38.5	5	38.5	1	9
6 months to 1 year	4	12	2	15.4	2	15.4	2	18
1 to 2 years	9	26	3	23.1	3	23.1	4	36
2 to 3 years	9	26	2	15.4	2	15.4	3	27
3 years or more	4	12	1	7.7	1	7.7	1	9
Type of tumor
Leukemias	20	58	5	50	6	46.1	9	82
Lymphomas	6	18	3	30	3	23.1	-	-
Other tumors	8	24	2	20	4	30.8	-	-
Type of treatment
Chemotherapy	32	94	9	90	12	92.3	11	100
Chemotherapy and radiotherapy	1	3	1	10	1	7.7	-	-
Surgery	1	3	-	-	--	-	-	-
Frequency of sections
every 7 days	25	74	7	70	7	53.8	10	91
every 15 days	1	3	-	-	1	7.7	-	-
every 21 days	2	6	-	-	2	15.4	-	-
2x a week	1	3	1	10	-	-	-	-
Oral	1	3	1	10	-	-	-	-
Performing tests	3	9	-	-	3	23.1	-	-
Not established	1	3	-	-	-	-	1	9
Anxiety
Yes	4	12	-	-	3	23.1	1	9
No	30	88	10	100	10	76.9	10	91
Pain before
Painless	32	94	9	90	13	100	10	91
Mild	1	3	-	-	-	-	1	9
Moderate	1	3	1	10	-	-	-	-
Pain afterwards
Painless	32	94	9	90	13	100	10	91
Mild	2	6	1	10	-	-	1	9

Variables	Virtual Reality			Play Therapy			Control
Variables	Before µ(±)	After µ(±)	p-value	Before µ(±)	After µ(±)	p-value	Before µ(±)	After µ(±)	p-value
HR	103.5 (15.95)	97.9 (13.79)	0.001	100.4 (17.25)	96 (9.30)	0.006	105 (10.98)	103.64 (15.08)	0.002
SpO₂	98.9 (0.73)	99.2 (0.63)	0.120	98.38 (0.65)	98.31 (0.75)	0.765	98.73 (1.00)	99.09 (0.83)	0.329
Temperature	36.2 (0.34)	36.0 (0.41)	0.036	36.3 (0.26)	36.0 (0.54)	0.735	36.4 (0.34)	36.2 (0.56)	0.119
Pain	0.5 (1.58)	0.3 (0.94)	0.000	0	0	-	0.3	0.3	-

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[1] HR: heart rate, SpO₂: oxygen saturation.