Virtual Reality Relaxation Therapy Eases Anxiety and Fatigue in Breast Cancer Survivors, Meta-Analysis Finds

A systematic review and meta-analysis published in Frontiers in Oncology reports that virtual reality–assisted relaxation therapy (VR-ART) was associated with statistically significant reductions in anxiety, depressive symptoms, psychological distress, and self-reported cancer-related fatigue among breast cancer survivors. The analysis, conducted by researchers at Chongqing Medical University and its Second Affiliated Hospital, pooled data from ten randomized controlled trials involving 995 breast cancer survivors. Because the evidence base consists of randomized trials analyzed at the group level, the findings describe associations measured across study populations rather than guaranteed outcomes for any individual patient.

The research team followed the PRISMA 2020 reporting guidelines and searched nine bibliographic databases, along with the ClinicalTrials.gov registry, the WHO International Clinical Trials Registry Platform, and the GreyGuide repository, for records published from database inception through September 2026, restricted to Chinese- and English-language publications. To capture studies that databases might have missed, the reviewers also performed backward and forward citation chasing through Web of Science, screening the reference lists of included trials and related reviews for additional eligible records. Only parallel-group randomized controlled trials that evaluated VR-assisted relaxation therapy against a control condition and measured psychological symptoms—anxiety, depression, or psychological distress—or cancer-related fatigue in breast cancer survivors were included. Two reviewers independently assessed the risk of bias in each trial using the Cochrane RoB 2 tool, the current standard instrument for judging bias in randomized trials.

The pooled estimates were striking in magnitude. Across the ten trials, VR-ART was associated with a standardized mean difference in anxiety scores of −1.94, with a 95 percent confidence interval of −2.49 to −1.40 and a P value below 0.001. For depressive symptoms, the pooled standardized mean difference was −1.11 (95 percent CI −1.36 to −0.87; P < 0.001). Psychological distress, which was synthesized on the raw mean-difference scale, showed a pooled difference of −1.33 (95 percent CI −1.99 to −0.67; P = 0.005). In each case, the confidence interval lies entirely below zero, indicating that the direction of the effect consistently favored the virtual reality intervention across the combined trials.

Statistical heterogeneity—the variability in effect sizes between trials—emerged as a central theme of the analysis. For anxiety and psychological distress, the between-study heterogeneity disappeared entirely when the reviewers restricted the pooling to trials conducted in patients who were in active treatment stages: for anxiety, the heterogeneity statistic fell to I² = 0 percent with P = 0.91, and for psychological distress, I² = 0 percent with P = 0.79. This pattern suggests that the timing of the intervention relative to cancer treatment may account for much of the inconsistency observed across the full set of trials, although the authors frame this as an observation requiring formal confirmation rather than a demonstrated causal explanation.

For psychological distress, the reviewers combined sensitivity analyses with the existing literature to generate an exploratory hypothesis: that the combination of a concurrent chemotherapy regimen and the degree of VR interactivity might be associated with the variability in effect sizes across trials. When this subgroup structure was applied, heterogeneity again dropped to I² = 0 percent with P = 0.96. The authors are explicit that this observation is hypothesis-generating only. No formal statistical test of the proposed interaction was performed, and the finding should be read as a direction for future research rather than an established moderator of treatment response.

Cancer-related fatigue was handled differently from the psychological outcomes. Because the fatigue data showed high heterogeneity across trials, the reviewers chose not to pool them quantitatively and instead synthesized the results qualitatively. Within that narrative synthesis, the included studies consistently reported reductions in self-reported fatigue among survivors who received VR-assisted relaxation therapy. The absence of a pooled effect size for fatigue means readers should treat this outcome as supported by consistent trial-level reports rather than by a single quantified estimate.

The authors conclude that VR-ART was associated with statistically significant reductions in anxiety, depression, psychological distress, and cancer-related fatigue among breast cancer survivors. Drawing on the exploratory subgroup analyses, they speculate that intervention timing, VR interactivity, and concurrent chemotherapy status might influence the magnitude of the intervention effects, while emphasizing that formal testing of these factors remains absent. They call for further research to develop individualized intervention strategies and to optimize treatment responses, noting that the current evidence base—ten trials and 995 participants—is too limited to support tailored prescriptions.

Several limitations frame the interpretation of these results. The pooled effect sizes are standardized mean differences, which express the size of the effect in units of outcome variability rather than in clinically anchored scores. The search was limited to Chinese- and English-language publications, the fatigue outcome could not be meta-analyzed, and the risk-of-bias assessments of the individual trials, conducted with the Cochrane RoB 2 tool, form part of the evidence base on which the pooled estimates rest. The authors also note that all claims in the article are solely those of the authors and do not necessarily represent those of their affiliated organizations or the publisher. Within those boundaries, the analysis provides a pooled quantitative estimate of how virtual reality–assisted relaxation performs as a supportive intervention for the psychological burden carried by breast cancer survivors.

Subject of Research: Effectiveness of virtual reality–assisted relaxation therapy for psychological symptoms and fatigue in breast cancer survivors

Article Title: The effectiveness of virtual reality–assisted relaxation therapy in improving psychological symptoms and fatigue of breast cancer survivors: a systematic review and meta-analysis

Article References: Deng, Y., Chen, Y., Mo, J., Liang, Y., Yu, S., & Bai, X. (2026). The effectiveness of virtual reality–assisted relaxation therapy in improving psychological symptoms and fatigue of breast cancer survivors: a systematic review and meta-analysis. Frontiers in Oncology, 16, Article 1927287. https://doi.org/10.3389/fonc.2026.1927287

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1927287

Keywords: breast cancer, virtual reality, relaxation therapy, meta-analysis, anxiety, depression, psychological distress, cancer-related fatigue, randomized controlled trials, systematic review, supportive care, PRISMA