Design: Assessor-blinded parallel-group RCT
Population: 128 children aged 6–12 starting first chemotherapy, Hong Kong
Primary outcome: Anxiety, anticipatory nausea and vomiting, CINV
Effect: Anxiety d −0.67 to −1.48 across time points; fewer vomiting episodes

This assessor-blinded randomised trial at a Hong Kong children's hospital allocated 128 children aged 6 to 12 starting their first chemotherapy to immersive virtual reality or usual care. It was published in Pediatrics in September.

Anxiety fell more with virtual reality at each time point, with effect sizes growing from medium before the first cycle (d −0.67) to large after the second (d −1.48). Anticipatory nausea before the second cycle and chemotherapy-induced vomiting after both cycles were less frequent.

This is a low-risk, low-cost addition to antiemetic prophylaxis that addresses the anxiety driving anticipatory symptoms. It does not replace antiemetics.

Consider virtual reality distraction before the first chemotherapy cycle.
Continue guideline antiemetic prophylaxis alongside it.
Ask about anticipatory nausea before each cycle.

Why it matters

Anticipatory nausea is driven by anxiety and responds poorly to drugs alone.

The statistics, in plain English

Cohen's d of −1.48 is a large effect, but children could not be blinded to wearing a headset, and anxiety is self-reported, which can exaggerate benefit. Nausea comparisons used separate non-parametric tests at several time points.