Twenty people with stage IV colorectal cancer sat through a single 30-minute virtual reality session and the study recorded sharp pre to post drops in pain, stress, anxiety, tension and low mood. The numbers came from a small pilot, yet they were large enough to suggest that a short immersive break may offer some relief for patients who often carry persistent symptoms even when standard care is already in place.
A Palliative & supportive care study followed patients at Duke Cancer Institute who had advanced colorectal cancer and at least moderate pain on most days for at least three months. The researchers were testing a program called VR Blue, an underwater experience built around coral reef and deep sea scenes, to see first whether patients would actually use it safely and whether the session showed enough promise to justify a larger trial.
Patients with advanced colorectal cancer often live with a hard mix of pain and emotional strain. Medication can help, but the paper notes that side effects such as nausea, constipation and sedation can limit how far drug treatment can go. A non-drug pain relief tool that gives even brief symptom relief could therefore matter in clinics, at home and during treatment visits, especially if patients find it easy to use while they are already tired or overwhelmed.
The study asked a basic question first
The research team did not start by asking whether virtual reality had already proven itself as a cancer pain treatment. Their first goal was more practical. Could adults with stage IV colorectal cancer, many of whom were already dealing with persistent pain, complete the session, tolerate the headset and provide the kind of data needed for a serious follow-up trial?
The answer in this pilot was yes. All 20 participants completed the single VR Blue session, all pre-, mid- and post-session assessments were collected, satisfaction cleared the study benchmark and significant side effects were not reported. One participant said quick head movement caused mild dizziness, yet even that person did not describe the symptom as a major problem.
Those feasibility numbers matter because the project focused on a group with high symptom burden rather than on healthy volunteers. The sample had a mean age of 56.55 years, 70 percent were men and every participant had stage IV colorectal cancer with moderate to severe ongoing pain. A tool can look impressive in a lab and still fail in a palliative cancer setting, so simply showing that patients would engage with the session was one of the study’s central results.
The underwater scenes were meant to hold attention away from pain
VR Blue immersed participants in a virtual ocean world for half an hour. The session used visual and audio cues from underwater and sea environments, including coral reef and deep sea scenes, to pull attention into a place far removed from clinic rooms, household routines and symptom monitoring. Immersion is the key idea behind many VR pain approaches: the headset narrows a person’s attention so pain has less room to dominate the moment.
The authors linked this cancer study to earlier VR pain work, including a 2020 pain study showing that the same VR Blue environment increased tolerance for experimentally induced pain and improved mood and anxiety. The new paper extends that line of work into a clinical population that faces persistent symptoms rather than a short-lived laboratory stimulus.
The study also measured more than pain. Researchers tracked tension, stress, anxiety, relaxation and mood because the symptom burden of advanced cancer often comes as a cluster, with one difficult sensation feeding the next. If virtual reality only softened pain while leaving distress unchanged, its value would be narrower. The pilot results moved in the same helpful direction across all of those measures.
The biggest numbers came after just one session
Pain right now fell by 58.93 percent from pre-session to post-session. Tension dropped by 74.33 percent. Stress went down by 68.40 percent, anxiety by 65.22 percent and mood burden by 70.20 percent. Relaxation moved upward by 37.78 percent. For a single half-hour session, those are eye-catching changes, especially in a population dealing with advanced disease and ongoing discomfort.
The paper judged those shifts against a 30 percent threshold for a minimally clinically important difference drawn from prior pain research. Every main outcome cleared that bar. In plain terms, the changes were large enough to look meaningful rather than trivial on the study’s own scale, even before any larger trial tests whether the same pattern survives a stricter comparison.
Researchers also looked at two thinking patterns that can affect pain: pain catastrophizing, which is the tendency to expect the worst from pain and pain self-efficacy, which reflects confidence in handling symptoms. The only statistically significant correlation in that small dataset linked increased relaxation with reduced catastrophizing. The rest of the cognitive measures pointed in the expected direction, but the sample was too small to treat those patterns as settled findings.
Patients seemed ready to use VR more than once
The exit interviews help explain why a single session may have worked as well as it did. Nineteen participants said the headset was easy to use, 17 said it felt comfortable and 17 said they felt immersed in the scenery. Nineteen participants said they enjoyed the session and all 20 said they liked the virtual ocean scenery itself.
Participants were also thinking ahead to repeated use. About half said the 30-minute session length felt right, while the other half wanted more time. Eleven said they would use VR Blue multiple times per week and 12 said they would use it during cancer treatment appointments. Thirteen said they would reach for it when pain, anxiety or depression felt especially high.
Home use stood out in the interviews. Although some people were open to using VR in either the clinic or the home, most preferred home access, which fits the broader push in supportive cancer care toward tools patients can use without waiting for a scheduled office visit. The trial itself remained clinic-based and was also a registered ClinicalTrials.gov study, but the qualitative results suggest that convenience could become one of the strongest reasons to test a home version later.
The pilot design leaves major questions open
The paper’s own conclusion stays careful and it should. This was a single-arm pilot trial with 20 participants, no control group and one session per person. The design can show feasibility, acceptability and a promising before-and-after pattern, yet it cannot fully separate the effect of immersion from the effect of sitting quietly, taking a break, expecting relief or receiving extra attention from a study team.
The study also focused on one disease group. Advanced colorectal cancer is common and burdensome, but it is still only one corner of palliative oncology. The authors say directly that larger randomized trials with a control condition are needed and that next step is important because it would test whether the strong pre to post changes hold up when VR is compared with another structured activity instead of with each patient’s own baseline alone.
Even the promising percentages should be read in that context. A small pilot can produce large early signals, particularly when everyone knows they are receiving the new intervention. The safest conclusion is that VR Blue looks feasible, acceptable and safe for this patient group and that the symptom changes are strong enough to justify more rigorous testing rather than to settle the treatment question today.
Why researchers still see real potential here
The reason this result remains interesting, even with careful caveats, is that palliative care often needs simple tools that can stack alongside standard treatment. Patients in this study continued their usual medical care and were not asked to change pain medication or decline other strategies. Virtual reality therefore entered the picture as an added layer of support, which is how many clinics would likely use it if later trials confirm benefit.
There is also a practical advantage to the format. The session was brief, the experience was enjoyable for almost everyone and the technology burden looked manageable. Participants even suggested concrete improvements such as a cordless headset and higher image resolution, while some said they were open to caregiver involvement. Those responses give researchers a roadmap for refinement rather than a sign that the concept itself needs to be abandoned.
Future work could move in several clear directions. A larger trial could compare VR Blue with standard rest, guided imagery or another non-drug strategy; a home-based study could test whether the effect survives repeated use; and supportive care teams could examine whether relief during treatment appointments improves the day as a whole. Until then, the strongest message from this study is modest and useful: a half-hour underwater VR session gave a small group of patients with advanced colorectal cancer immediate symptom relief and a reason for researchers to keep going.
