Virtual Reality in Paediatric Oncology: A Scoping Review for A Multidimensional Framework

Childhood cancer involves a demanding diagnostic and therapeutic journey characterized by repetitive, invasive procedures and significant psychological distress. This scoping review aims to systematically map the current evidence regarding the clinical efficacy, usability, and institutional feasibility of Virtual Reality (VR) in pediatric oncology, establishing a multidimensional clinical framework. Following PRISMA-ScR guidelines, 37 distinct studies involving 1,835 participants were synthesized. Results indicate that immersive VR is highly effective in mitigating acute procedural pain and anxiety. Beyond acute management, a paradigm shift is observed toward modulating chronic symptom clusters, such as cancer-related fatigue, nausea, and depressive symptoms. Key theoretical determinants of efficacy include the induction of telepresence and subjective temporal distortion, which enhance the patient's coping capacity. Furthermore, emerging biofeedback-integrated systems represent an evolution from passive distraction toward active physiological mastery. Despite high stakeholder satisfaction among children, parents, and healthcare providers, institutional integration remains hindered by systemic barriers, including strict infection control protocols and nursing workflow constraints. In conclusion, VR serves as a versatile clinical resource that should be integrated into the biopsychosocial model of pediatric oncological care. Future research must prioritize large-scale longitudinal trials to standardize implementation protocols and assess the long-term sustainability of these interventions across the survivorship trajectory.