The Effect of Virtual Reality Distraction Intervention on Pain, Anxiety, and Vital Signs of Oncology Patients Undergoing Port Catheter Implantation: A Randomized Controlled Study

Published:March 31, 2022DOI:



      Although the port catheters have many beneficial effects on the patient's quality of life, it was reported in the literature that patients experience pain in the incision area after the implantation or anxiety before, during or, after the implantation.Distraction is a simple and effective method in the management of pain and anxiety.


      To determine the effect of virtual reality (VR) distraction intervention on pain, anxiety, and vital signs of oncology patients undergoing port catheter implantation.


      Randomized controlled study


      The study was carried out with 139 participants (69 intervention, 70 control) between September 2019 and January 2020. Data were collected before, during, and after the implantation by using a patient identification form, State Anxiety Inventory (SAI), a table for vital signs, and a visual analog scale for pain severity. In the intervention group, a virtual reality device, movies, and relaxing music were provided and patients were instructed to use it during the implantation and when they felt pain after the implantation. There wasn't any blinding for patients or researchers throughout the study.


      There was an increase in pain scores of both groups after the implantation; however, pain scores in the intervention group were lower and there was a statistically significant difference between the groups after the implantation. In the intervention group, there was a decrease in anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, and an increase in SpO2. VR use has a great effect on pain scores (Cohen's d = 3.023) and a great effect on SAI scores (Cohen's d = 8.770).


      VR distraction intervention was found an effective way to reduce pain, anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate and increase the SpO2 of the patients undergoing port catheter implantation.


      pain (pain), Virtual Reality (Virtual Reality), Oncology Patients (Oncology Patients), Port Catheter Implantation (Port Catheter Implantation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ahmadpour N.
        • Randall H.
        • Choksi H.
        • Gao A.
        • Vaughan C.
        • Poronnik P.
        Virtual Reality interventions for acute and chronic pain management.
        International Journal Of Biochemistry & Cell Biology. 2019; 114105568
        • Akhtar N.
        • Lee L.
        Utilization and complications of central venous access devices in oncology patients.
        Current Oncology. 2021; 28: 367-377
        • Attar R.H.
        • Baghdadi Z.D.
        Comparative efficacy of active and passive distraction during restorative treatment in children using an iPad versus audiovisual eyeglasses: A randomised controlled trial.
        European Archives of Paediatric Dentistry. 2015; 16: 1-8
        • Bunke J.
        • Sheikh R.
        • Hult J.
        • Malmsjö M.
        Buffered local anesthetics reduce injection pain and provide anesthesia for up to 5 hours.
        Journal of Plastic, Reconstructive & Aesthetic Surgery. 2018; 71: 1216-1230
        • Carl E.
        • Stein A.T.
        • Levihn-Coon A.
        • Pogue J.R.
        • Rothbaum B.
        • Emmelkamp P.
        • Asmundson G.J.
        • Carlbring P.
        • Powers M.B.
        Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials.
        Journal of Anxiety Disorders. 2019; 61: 27-36
        • Douglas S.L.
        • Pignatello G.
        • Park S.
        • Lipson A.R.
        Psychometric properties of a single-item visual analog scale measuring goals of care in patients with advanced cancer.
        Quality of Life Research. 2020; 29: 1999-2005
        • Eijlers R.
        • Utens E.M.
        • Staals L.M.
        • de Nijs P.F.
        • Berghmans J.M.
        • Wijnen R.M.
        • Hillegers M.H.
        • Dierckx B.
        • Legerstee J.S.
        Systematic review and meta-analysis of virtual reality in pediatrics: Effects on pain and anxiety.
        Anesthesia and Analgesia. 2019; 129: 1344-1353
        • Esfahani H.
        • Ghorbanpor M.
        • Tanasan A.
        Implantable port devices, complications and outcome in pediatric cancer, a retrospective study.
        Iranian Journal of Pediatric Hematology and Oncology. 2016; 6: 1-8
        • Ferlay J.
        • Colombet M.
        • Soerjomataram I.
        • Parkin D.M.
        • Piñeros M.
        • Znaor A.
        • Bray F.
        Cancer statistics for the year 2020: An overview.
        International Journal of Cancer. 2021; (Advance online publication)
        • Fodor L.A.
        • Coteț C.D.
        • Cuijpers P.
        • Szamoskozi Ș.
        • David D.
        • Cristea I.A.
        The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis.
        Scientific Reports. 2018; 8: 1-13
        • Glennon C.
        • McElroy S.F.
        • Connelly L.M.
        • Lawson L.M.
        • Bretches A.M.
        • Gard A.R.
        • Newcomer L.R.
        Use of virtual reality to distract from pain and anxiety.
        Oncology Nursing Forum. 2018; 45: 545-552
        • Ilter S.M.
        • Ovayolu Ö.
        • Ovayolu N.
        The effect of inhaler aromatherapy on invasive pain, procedure adherence, vital signs, and saturation during port catheterization in oncology patients.
        Holistic Nursing Practice. 2019; 33: 146-154
        • Indovina P.
        • Barone D.
        • Gallo L.
        • Chirico A.
        • De Pietro G.
        • Giordano A.
        Virtual reality as a distraction intervention to relieve pain and distress during medical procedures.
        Clinical Journal of Pain. 2018; 34: 858-877
        • Kadimpati S.
        • Zale E.L.
        • Hooten M.W.
        • Ditre J.W.
        • Warner D.O.
        Associations between neuroticism and depression in relation to catastrophizing and pain-related anxiety in chronic pain patients.
        PloS One. 2015; 10e0126351
        • Koller D.
        • Goldman R.D.
        Distraction techniques for children undergoing procedures: a critical review of pediatric research.
        Journal of Pediatric Nursing. 2012; 27: 652-681
        • Madabhavi I.
        • Patel A.
        • Sarkar M.
        • Anand A.
        • Panchal H.
        • Parikh S.
        A study of use of “PORT” catheter in patients with cancer: A single-center experience.
        Clinical Medicine Insights: Oncology. 2017; 111179554917691031
        • Marletti G.
        • Antoniazza B.
        • Pinto M.
        • Ferraraccio M.
        • Damini M.
        • Sollami A.
        Effects of music therapy on vital signs and anxiety: A study with terminally ill patients.
        Journal of Hospice & Palliative Medical Care. 2018; 1
        • Midilli T.S.
        • Ergin E.
        • Yılmaz H.
        The effects of listening to music on vital signs and anxiety in hemodialysis patients.
        International Journal of Health Sciences and Research. 2017; 7: 117-125
        • Miller K.D.
        • Nogueira L.
        • Mariotto A.B.
        • Rowland J.H.
        • Yabroff K.R.
        • Alfano C.M.
        • Jemal A.
        • Kramer J.L.
        • Siegel R.L.
        Cancer treatment and survivorship statistics, 2019.
        CA: A Cancer Journal for Clinicians. 2019; 69: 363-385
        • Mohammad E.B.
        • Ahmad M.
        Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: A randomized control trial.
        Palliative & Supportive Care. 2019; 17: 29-34
        • Mou Q.
        • Wang X.
        • Xu H.
        • Liu X.
        • Li J.
        Effects of passive music therapy on anxiety and vital signs in lung cancer patients undergoing peripherally inserted central catheter placement procedure.
        Journal of Vascular Access. 2020; 21: 875-882
        • Naunheim M.R.
        • Dai J.B.
        • Rubinstein B.J.
        • Goldberg L.
        • Weinberg A.
        • Courey M.S.
        A visual analog scale for patient-reported voice outcomes: The VAS voice.
        Laryngoscope Investigative Otolaryngology. 2020; 5: 90-95
        • Oing T.
        • Prescott J.
        Implementations of virtual reality for anxiety-related disorders: systematic review.
        JMIR Serious Games. 2018; 6: e10965
        • Öner N.
        • Le Compte A.
        Discontinuous and continuous state anxiety inventory book.
        Boğaziçi University Press, Istanbul1983
        • Özden D.
        • Çalişkan N.
        Turkish nurses’ level of knowledge regarding implantable port catheter care.
        Japan Journal of Nursing Science. 2012; 9: 1-8
        • Price D.D.
        • McGrath P.A.
        • Rafii A.
        • Buckingham B.
        The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.
        Pain. 1983; 17: 45-56
        • Pourmand A.
        • Davis S.
        • Marchak A.
        • Whiteside T.
        • Sikka N.
        Virtual reality as a clinical tool for pain management.
        Current Pain and Headache Reports. 2018; 22: 1-6
        • Pu Y.-L.
        • Li Z.-S.
        • Zhi X.-X.
        • Shi Y.-A.
        • Meng A.-F.
        • Cheng F.
        • Ali A.
        • Li C.
        • Fang H.
        • Wang C.
        Complications and costs of peripherally inserted central venous catheters compared with implantable port catheters for cancer patients: A meta-analysis.
        Cancer Nursing. 2020; 43: 455-467
        • Schaal N.K.
        • Brückner J.
        • Wolf O.T.
        • Ruckhäberle E.
        • Fehm T.
        • Hepp P.
        The effects of a music intervention during port catheter placement on anxiety and stress.
        Scientific Reports. 2021; 11: 5807
        • Spielberger C.D.
        • Gorsuch R.
        • Lushene R.E.
        Manual for the state-trait anxiety inventory.
        Consulting Psychologist Press, Palo Alto, CA1970
        • Sung H.
        • Ferlay J.
        • Siegel R.L.
        • Laversanne M.
        • Soerjomataram I.
        • Jemal A.
        • Bray F.
        Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA: A Cancer Journal for Clinicians. 2021; 71: 209-249
        • Surucu S.G.
        • Ozturk M.
        • Vurgec B.A.
        • Alan S.
        • Akbas M.
        The effect of music on pain and anxiety of women during labour on first time pregnancy: A study from Turkey.
        Complementary Therapies in Clinical Practice. 2018; 30: 96-102
        • Walser E.M.
        Venous access ports: indications, implantation technique, follow-up, and complications.
        Cardiovascular and Interventional Radiology. 2012; 35: 751-764
        • Wohlheiter K.A.
        • Dahlquist L.M.
        Interactive versus passive distraction for acute pain management in young children: The role of selective attention and development.
        Journal of Pediatric Psychology. 2013; 38: 202-212
      1. World Health Organization (WHO). (2020). Cancer today, Estimated number of prevalent cases, worldwide, both sexes, all ages. Retrieved April 11, 2021, from

        • Yanık F.
        • Karamustafaoğlu Y.A.
        • Karataş A.
        • Yörük Y.
        Experience in totally implantable venous port catheter: Analysis of 3,000 patients in 12 years.
        Turkish Journal of Thoracic and Cardiovascular Surgery. 2018; 26: 422-428
        • Yayla E.M.
        • Ozdemir L.
        Effect of inhalation aromatherapy on procedural pain and anxiety after needle insertion into an implantable central venous port catheter: A quasi-randomized controlled pilot study.
        Cancer Nursing. 2019; 42: 35-41
        • Zengin S.
        • Kabul S.
        • Al B.
        • Sarcan E.
        • Doğan M.
        • Yildirim C.
        Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure.
        Complementary Therapies in Medicine. 2013; 21: 689-696
        • Zhao Z.
        • Lian Y.
        • Zhu Y.
        • Ye H.
        • Liu M.
        • Li J.
        Depot lidocaine-loaded microemulsion for prolonged local anesthesia: Different efficacy model studies.
        Journal of Drug Delivery Science and Technology. 2020; 55101404