Objective. Virtual reality (VR) has the potential to improve pain and pain-related symptoms.

We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/

sea environment (VR Blue) for reducing pain and pain-related symptoms in advanced colorectal

cancer patients. A qualitative exit interview was conducted to understand preferences,

thoughts, and feelings about the VR session.

Method. Participants (N = 20) had stage IV colorectal cancer and moderate-to-severe pain.

Participants completed a 30-min VR Blue session that visually and aurally immersed them

in virtual ocean scenarios. Feasibility was assessed by accrual (N = 20), protocol adherence

(≥80% completing VR Blue), and completed data (≥80% assessment completion).

Acceptability was determined by patients reporting ≥80% intervention satisfaction. Safety

was determined by ≥80% of patients completing the session without self-reported side effects.

Measures of pain, tension, relaxation, stress, anxiety, and mood were collected before, during,

and after the VR Blue session. A semi-structured qualitative interview was conducted after VR

Blue to assess participants’ VR experiences.

Results. All participants (100%) completed the VR Blue session. There was 100% data collection

at the pre- and post-assessments. Satisfaction with VR Blue was high M= 3.3 (SD = 0.4)

(83%). No significant side effects were reported. Pain decreased by 59% (Pre-M= 3 [1]; Post-

M= 1 [1]). Tension decreased by 74% (Pre-M= 30 [24]; Post-M= 8 [13]). Relaxation

improved by 38% (Pre-M= 62 [21]); Post-M= 86 [17]). Stress decreased by 68% (Pre-M=

24 [24]; Post-M= 8 [14]). Anxiety decreased by 65% (Pre-M= 20 [23]; Post-M= 7 [13]).

Mood improved by 70% (Pre-M= 13 [16]; Post-M= 4 [11]). Qualitative data suggested a positive

response to the VR Blue protocol.

Significance of results. This work supports the feasibility, acceptability, and safety of VR Blue

for advanced colorectal cancer patients. Participants showed significant pre-post improvement

in pain and pain-related symptoms hinting to the potential feasibility of VR interventions in

this population. Larger, randomized trials with a control condition are needed to examine the

efficacy of VR-based interventions for patients with advanced colorectal cancer and pain.