Description

The implantation of a subcutaneous venous port is a minor surgical procedure that has become a routine component of oncological care. It is indicated in cases where the expected duration of systemic treatment exceeds six months and where there is a significant risk of damage to the peripheral venous system due to chemotherapy, thereby helping to prevent vascular complications and improve long-term treatment tolerability.

Although generally well tolerated, the procedure is still invasive and often associated with varying degrees of pain, anxiety, and psychological stress. It is performed under local anesthesia, usually accompanied by symptomatic analgesia and/or mild sedation, and lasts approximately 60 minutes.

The application of virtual reality (VR) during such procedures represents a non-pharmacological method that may contribute to alleviating pain and reducing psychological distress by immersing the patient in a controlled, engaging, and calming virtual environment. VR-based distraction techniques have been shown in prior studies to divert attention from unpleasant stimuli and to reduce both subjective and physiological stress responses.

This randomized study aims to evaluate the effectiveness of virtual reality in reducing pain, anxiety, and stress during venous port implantation in adult oncology patients. Two study arms will be compared:

• control group (standard of care with local anesthesia and optional symptomatic sedation),
• VR group (standard of care with additional virtual reality intervention during the procedure).

Pain Assessment

Pain will be evaluated using the Visual Analog Scale (VAS), administered in a standardized three-point timeline:

• 30 minutes before the procedure,
• during the procedure (at a pre-defined time point),
• 30 minutes after the procedure.

In addition, physiological parameters associated with stress and discomfort will be monitored in all patients at the same three time points:

• blood pressure,
• heart rate,
• heart rate variability. These measurements will likewise be obtained 30 minutes before, during, and 30 minutes after the procedure using standardized protocols.

Anxiety and Stress Evaluation

Psychological stress and anxiety will be assessed through a combination of subjective and objective measures:

The State-Trait Anxiety Inventory - short version (STAI-6) will be administered:

• 30 minutes before the procedure, and
• 30 minutes after the procedure.

Salivary cortisol levels, serving as an objective biomarker of stress response, will be collected:

• 30 minutes before the procedure (baseline),
• midway through the procedure, and
• 30 minutes after the procedure.

All measurements will be conducted using standardized collection protocols and under consistent environmental and procedural conditions to ensure reproducibility and comparability of data.

If a statistically and clinically significant reduction in perceived pain and anxiety is observed in the VR group, the second phase of the study will explore the potential of VR as a dose-sparing strategy for pharmacological analgesia, which may contribute to reduced medication burden and enhanced patient comfort during minor oncological procedures.