Effects of virtual reality-guided imagery relaxation intervention in improving anxiety among lung cancer patients:A Randomized Controlled Trial.

Purpose: To examine the effectiveness of virtual reality (VR)-guided imagery relaxation (VRGI) intervention in reducing anxiety among lung cancer surgery patients.

Methods: A randomized clinical trial was conducted at the Fourth Affiliated Hospital of Hebei Medical University (Shijiazhuang, Hebei, China) to recruit patients scheduled for their first elective endoscopic lung cancer surgery under general anesthesia between December 2023 and March 2024. Patients were randomly assigned in a 1:1 ratio to either the control group, receiving routine treatment and staged care in thoracic surgery, or the experimental group, receiving VRGI intervention in addition to the control group's protocol. The primary outcome was the State-Trait Anxiety Inventory (STAI) score for anxiety assessment. Secondary outcomes included physiological stress markers changes (systolic blood pressure[SBP], diastolic blood pressure [DBP], and heart rate [HR]). Outcome were assessed at 3 time points: on the day of admission (T1), immediately before surgery (T2), and at discharge (T3). A repeated-measures analysis of variance (ANOVA) was applied to compare changes in outcomes over time.

Results: A total of 98 participants (M [QIR] age, 60.00[54.25, 68.00]years; 39 men [39.8%] and 59 women [60.2%]) were recruited and randomized to the control group (53 participants) and experimental group (45 participants). The age (β, 6.29; 95%CI, 2.09 to 10.69; P=.005), education level (β, -5.57; 95%CI, -9.76 to -1.37; P=.011), awareness of the disease (β, 6.11; 95%CI, 1.80 to 10.62; P=.007), and gender (β, 5.75; 95%CI, 1.09 to 10.40; P=.018) was the major influencing factor of preoperative anxiety. Compared with the control group, the VRGI experimental group showed an even smaller increase in SAI (t=2.20; P=.003), SBP (t=2.75; P=.007), DBP (t=2.53; P=.013) and HR (t=2.17; P=.033) at T2, whereas showed significant decreases in SAI (t= 4.79; P < .001), SBP (t=3.25; P=.0027), DBP (t=2.96; P=.004) and HR (t=4.26; P<.001) at T3. The results of the repeated measures ANOVA demonstrated statistically significant differences in SAI score, SBP, DBP and HR across time effect, group effect and time×group interaction effect (P<.05), the intervention group exhibited superior outcomes compared to the control group. However, no statistically significant difference was observed in the TAI score (P>.05).

Conclusion: The findings of this study suggest that VRGI is a feasible and effective approach to reducing the anxiety in lung cancer patients undergoing elective endoscopic surgery. Furthermore, it demonstrates potential to alleviate physiological stress responses and enhance patient self-confidence. The positive outcomes observed in this investigation suggest that large-scale, multicenter randomized controlled trials are needed to confirm the intervention's efficacy across diverse clinical populations.

Trial Registration: This study is retrospectively registered with the ITMCTR (identifier: ITMCTR2025001481, registered 26 July 2025). http://itmctr.ccebtcm.org.cn/zh-CN/UserPlatform/ProjectView?Pid=48c26a67-4e2b-4aea-a504-f379602513b0.