Pelin KARATAS, Cigdem GOK
Annals of Medical Research - 2026;33(7):300-311
Aim: Procedures involving central venous access devices (CVADs) are painful and distressing for pediatric oncology patients. This systematic review and meta-analysis evaluated the efficacy of virtual reality (VR) interventions in reducing pain, fear, and anxiety during CVAD puncture among pediatric oncology patients. Materials and Methods: PubMed, EBSCO, Web of Science, and the Cochrane Library were systematically searched from inception to September 2025. Randomized controlled trials (RCTs) evaluating the use of VR for pain management during CVAD procedures in children and adolescents under 18 years of age were included. Two independent reviewers performed study selection and data extraction, and assessed risk of bias using RoB 2.0. Effect sizes were pooled as standardized mean differences using a DerSimonian-Laird random-effects model. Heterogeneity was quantified using the tau² and I² statistics. Results: Five RCTs were included (participants aged 6-18 years). VR reduced child-reported pain (SMD=-1.11; 95% CI: -1.82 to -0.40; I² =82.4%). Parent-reported pain likewise favored VR (SMD = -1.18; 95% CI: -1.89 to -0.47; I² =82.0%). VR reduced child-reported fear (SMD = -1.29; 95% CI: -2.33 to -0.25; I² = 87.2%) and parent-reported fear (SMD = -1.46; 95% CI: -2.00 to -0.91; I²=36.1%). VR also lowered child-reported anxiety/distress (SMD=-1.18; 95% CI:-1.73 to -0.62; I² =61.4%). Parent-reported anxiety showed a statistically significant reduction (SMD = -1.12; 95% CI: -2.08 to -0.16; I² =85%). Risk of bias was generally low for randomization and outcome completeness, whereas some concerns were identified in the risk of bias assessment, mainly related to the lack of blinding. Conclusion: VR interventions during CVADS access appear to be effective in reducing pain and fear based on both child- and parent-reported outcomes, and they significantly reduce child-reported anxiety; however, they also reduce parent-reported anxiety. However, the certainty of the evidence is limited due to small sample sizes, heterogeneity, and methodological variability across the included studies.
