Table 3.

Characteristics of aim, intervention, measures, and results of the included studies.

First Author and Year [No. Ref.]	Aim of the Study	Type of Intervention Using VR	Duration of Therapy	Tested Variables	Result
Atef 2020 [29]	Establishing and comparing PNF and VR therapy in the treatment of lymphoedema after mastectomy	non-immersive VR Nintendo Wii® video game (exercises such as boxing, tennis, triceps extension)	2 sessions per wk. of 30 min, for 4 wks.	-Lymphedema: circumferential method: The excess arm volume (EAV) = VL − VH, where VL refers to the lymphoedematous limb’s volume, and VH refers to the healthy extremity’s volume. -Function: QuickDASH-9 scale	-In the VR group was a greater improvement in lymphedema and upper limb function than in the PNF group. -No statistically significant differences were found between EAVs and QuickDASH-9 scores between these groups. The results before and after therapy with the use of VR improved EAVs (p = 0.001) and QuickDASH-9 scores (p = 0.001)
Chirico 2019 [30]	Effectiveness and comparison of the effects of therapy with the use of VR and MT in alleviating the psychological stress associated with CHT in BC patients	Immersive and interactive VR. The VR equipment: head-mounted glasses (Vuzix Wrap 1200 VR) with a head motion tracking system. Relaxing images virtual surroundings created on the Second Life® platform (Linden Lab), e.g., being on an island, walking through a forest, observing animals, climbing a mountain, and swimming in the sea.	20 min. during CHT treatment lasted 45–90 min.	-Anxiety levels: State Anxiety Inventory (SAI) for adults -Mood states: short version of Profile of Mood States (SV-POMS) -Cybersickness symptoms: The Virtual Reality Symptom Questionnaire (VRSQ)	VR therapy turned out to be more effective than MT. The anxiety decreased significantly in the CG group and was statistically insignificant in IG. Cybersickness symptoms occurred at a frequency of less than 20% (except for difficulty concentrating).
Feyzioğlu 2020 [31]	Evaluation of the impact of VR therapy with the use of Kinect equipment on the functions of the upper limb in women after BC surgery.	Kinect Sports I (boxing, darts, bowling,), Kinect Sports I (beach volleyball, table tennis), and Fruit Ninja.	35 min for one session during 6 wks.	-Pain intensity: VAS -Shoulder range of motion was measured in degrees using a digital goniometer -Arm strength was measured during maximal voluntary isometric muscle contraction with the J Tech Commender Muscle Tester handheld dynamometer -Handgrip strength was measured with the Saehan hydraulic hand dynamometer -The disability of the arm, shoulder, and hand (DASH) questionnaire was used to assess upper extremity functionality -Fear of movement as assessed with the Tampa Kinesiophobia Scale (TKS)	Kinect therapy was more effective in improving the assessed parameters than standard therapy (apart from the DASH results and the strength of the handgrip strength)
House 2016 [32]	BrightArm Duo therapy assessment in the context of coping with postoperative pain and disability after surgery treatment in BC patients with depression	The BrightArm Duo Rehabilitation System consisted of a low-friction robotic rehabilitation table, computerised forearm supports, a display, a laptop computer for the therapist station, a remote clinical server, and rehabilitation games. Nine games for manual motor training, cognitive and emotive training.	2 sessions (session lasted 20–50 min) per wk. for 8 wks	-Therapy session data consisted of supported arm reach baseline on the BrightArm Duo table (as measured by overhead digital cameras), power grasp strength baseline (as measured by a forearm support grasp sensor), HR and BP, number of active movements, and grasp repetitions for each arm during a session collected during play. -Pain: Numerical Rating Scale -The subjects rated their experience on a custom subjective questionnaire. The 10 questions were rated using a 5-point Likert scale; -Upper extremity function: the Fulg–Meyer Assessment, Upper Extremity Section, the Chedokee Arm and Hand Activity Inventory-9 (CAHAI-9) for bimanual tasks, and the Jebsen Hand Function Test (JHFT)24 for hand function. -Arm and hand range of motion: mechanical goniometers -Shoulder strength: wrist weights, -Grasp strength: a Jamar mechanical dynamometer and a pinch meter. -Independence in ADL involving the upper extremity: the upper extremity functional index 20 (UEFI-20). -Neuropsychological evaluations: the Beck Depression Inventory, Second Edition (BDI-II), the Neuropsychological Assessment Battery (NAB) Attention Module (orientation, digit span, and dots) and Executive Functioning Module (generation subtest), the Hopkins Verbal Learning Test, Revised (HVLT-R), the Brief Visuospatial Memory Test, Revised (BVMT-R), and the Trail Making Test (TMT) A and B.	There was a decrease in pain and severity of depression (p = 0.1; p = 0.04), an increase in 17 out of 18 motor indices, an improvement in 13 out of 15 indices of strength and function.
McGarvey 2009 [33]	using a computer-imaging program called help with adjustment to alopecia by image recovery (HAAIR) to provide educational support and reduce stress in women with post-chemotherapy hair loss	HAAIR system allows you to see yourself in VR with a bald head and of her head wearing a variety of different wigs and hairstyles	one session (60-90 min)	-Qualitative data were obtained verbally by open-ended questions asked during or following use of HAAIR (e.g., ‘Did you enjoy using the system?’, ‘Are you glad that you were able to try the system?’) -The quantitative measures: A Demographic Characteristics Questionnaire, The Brief Symptom Inventory (BSI-18), The Importance of Hair Questionnaire (IHQ), The Brief Cope, was used to assess the manner in which patients coped with having cancer.	Hair loss distress decreased in both the CG and IG groups at time after hair loss than at baseline with 3 months follow-up distress scores increasing in the SCG and decreasing in the IG. Those with avoidance coping reported more distress.
Mohammad 2018 [34]	Assessment of the effectiveness of immersive VR distraction technology in reducing pain and anxiety among female BC patients.	-Immersive VR -The IG chose from two scenarios on a CD-ROM, which included deep-sea diving ‘Ocean Rift,’ or sitting on the beach with the ‘Happy Place’ track. Then, the patients wore a head-mounted display with headphones. The VR exposure session was ended at the peak time of painkiller efficacy.	once	-Pain intensity: VAS -Anxiety: The State Anxiety Inventory (SAI)	-One session of the immersive VR plus morphine made a significant reduction in pain and anxiety self-reported scores, compared with morphine alone, in BC patients. -The independent-sample t-test showed a significant difference post intervention between the two groups’ pain scores. -The paired t-test showed a significant difference in the means of pain scores at the pre-and post-test in IG and the CG. -Regarding the anxiety testing, the independent sample t-test showed a significant difference post intervention between the two groups. The IG mean was lower than in the CG (p < 0.001).
Piejko 2020 [35]	Impact of medical resort treatment extended with modern feedback exercises using VR to improve postural control in BC survivors.	-Individual exercises were conducted using feedback based on VR and were aimed at improving motor coordination and body balance. Exercises on Alfa and Gamma stabilometric platforms and exercises of motor coordination of lower limbs with elastic resistance were used using the Telko device. Rehab software enabling feedback based on VR and collecting data on the type of tasks ordered to patients and the accuracy of their performance by patients.	3 weeks (6 d/wk, for 45 min./d)	-Static postural control was assessed in a Romberg test -Dynamic postural control was evaluated in the dynamic test, during which the patient’s task was to move the centre of gravity of the body in different directions in a targeted and controlled manner in accordance with the task displayed on the monitor screen.	-In the assessment of dynamic postural control, the length of the centre of foot pressure (COP) movement path before the treatment and after treatment was statistically significant (p = 0.0083) shortened. In the assessment of static postural control, no statistically significant differences were found between the length of the COP pathway before treatment compared to the condition before treatment (p > 0.05).
Schneider 2003 [36]	Answer the questions: -Is VR an effective distraction intervention for reducing CHT-related symptom distress levels in older women with BC? -Does VR have a lasting effect?	-The individual wears an 8-oz head-mounted device, which projects an image with the corresponding sounds. The sense of touch is involved through the use of a computer mouse that allows for the manipulation of the image. Participants chose from three CD-ROM-based scenarios; (Oceans Below®, A World of Art®, or Titanic: Adventure Out of Time®).	once during IV CHT	-Fatigue measures: Revised Piper Fatigue Scale (PFS) -Transitory anxiety states in adults: State-Anxiety Inventory for Adults (SAI) -Indicator of symptoms experienced by cancer patients Symptom Distress Scale (SDS)	Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores following CHT treatments when participants used VR. -No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of CHT. Evaluation of the intervention indicated that women t experienced no cybersickness, and 100% would use VR again.
Schneider 2004 [37]	To explore the use of VR as a distraction intervention to relieve symptom distress in women receiving CHT for BC.	For this study, a commercially available headset (Sony PC Glasstron PLM-S700) was used. Subjects chose from three scenarios on CD-ROM. Each scenario lasts several hours, and choices included deep-sea diving, walking through an art museum, or solving a mystery.	once during IV CHT	-Concerns of patients receiving CHT treatments: The Symptom Distress Scale (SDS) -Anxiety and fatigue: The State-Trait Anxiety Inventory (SAI) for Adults and Revised Piper Fatigue Scale (PFS) -Evaluation of VR intervention-open-ended questionnaire that was used to elicit subjects’ opinions about the intervention	Significant decreases in symptom distress and fatigue occurred immediately following CHT treatments when women used the VR intervention.
Schneider 2007 [38]	To explore VR as a distraction intervention to relieve symptom distress in adults receiving CHT for breast, colon, and lung cancer.	A commercially available headset (i-Glasses® SVGA Head-Mounted Display, i-O Display Systems, Menlo Park, CA) was used. Participants chose from 4 possible CD-ROM–based VR scenarios: deep-sea diving (Oceans Below®, CounterTop Software, Renton, WA), walking through an art museum (A World of Art®, CounterTop Software), exploring ancient worlds (Timelapse®, Hammerhead Entertainment, Encinitas, CA), and solving a mystery (Titanic: Adventure Out of Time®, Hammerhead Entertainment).	once during IV CHT	-Validation of the distracting qualities of the intervention: Presence Questionnaire (PQ) and the Evaluation of Virtual Reality Intervention -Symptom distress: Adapted Symptom Distress Scale-2 (ASDS-2), State Anxiety Inventory for Adults (SAI), Revised Piper Fatigue Scale (PFS)	Individuals who received the VR during their first CHT had significantly less anxiety, compared with the control condition during the second CHT treatment.
Schneider 2011 [39]	Explore the influence of age, gender, state anxiety, fatigue, and diagnosis on time perception in cancer patients receiving IV CHT with a VR intervention within the cognitive model of time perception and predict the effects of these variables on the difference between the actual time elapsed while patients received CHT while immersed in a VR environment and their retrospective estimates of elapsed time.	The VR intervention delivered using commercially available HMDs, it was provided during the entire period of IV infusion, including delivery of pre-medications, antiemetics, and CHT agents. The researcher installed the HMD on the participant’s head as IV infusion started and removed the HMD as soon as the infusion process was completed. Patients selected an initial VR scenario from a menu of multiple options and were free to switch scenarios at any point during the treatment period.	once during IV CHT	-Anxiety: State-Trait Anxiety Inventory for Adults (STAI) -Fatigue: Revised Piper Fatigue Scale (PFS) -Actual time elapsed during CHT	In a forward regression model, three predictors (diagnosis, gender, and anxiety) explained a significant portion of the variability for altered time perception (p = 0.0008). Diagnosis was the strongest predictor; individuals with breast and colon cancer perceived time passed more quickly.

Abbreviations: VR—virtual reality; IG—intervention group; CG—control group; MT—music therapy; CHT—chemotherapy, MT—music therapy; IV—intravenous; ADL—activities of daily living; VAS—visual analogue scale.