Nature-based IVR reduces anxiety and distress in breast cancer patients with low certainty evidence

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Psycho-oncology Published June 2, 2026 Medically reviewed June 2, 2026 Study authors: Liang Surui, Su Jing Jing, Wong Winnie Wai In, Kwan Rick Yiu Cho PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider nature-based IVR for anxiety and distress in breast cancer patients with low certainty evidence.

This systematic review and meta-analysis examined the use of nature-based immersive virtual reality (IVR) as a supportive care intervention for breast cancer patients. The analysis included 1037 participants across studies where the setting was not reported. The primary outcomes were not explicitly defined, but secondary outcomes focused on anxiety and distress.

The meta-analysis found that IVR significantly reduced anxiety with a standardized mean difference (SMD) of -1.76 (95% CI -2.61 to -0.91; I = 94%, p < 0.01). Distress was also reduced with an SMD of -0.83 (95% CI -1.30 to -0.36; I = 83%, p < 0.01). These results were derived from a pooled effect size calculation.

Safety data, including adverse events and discontinuations, were not reported. The authors acknowledge low certainty in the evidence. Clinicians may consider offering brief sessions lasting 5-20 minutes during chemotherapy infusion, radiotherapy waiting periods, perioperative recovery, or survivorship visits using head-mounted displays with calming nature content.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID42219922

View Original Abstract ↓

BACKGROUND: Breast cancer patients frequently experience psychological burdens such as anxiety, depression, and distress, alongside physical symptoms like fatigue. Immersive virtual reality (IVR), particularly nature-based experiences, may provide a scalable, nonpharmacological adjunct to promote well-being by fostering relaxation, distraction, and positive affect. However, the effectiveness of nature-based IVR in this population remains uncertain. AIM: To evaluate the effectiveness of nature-based immersive virtual reality trials on psychological and physical health outcomes in breast cancer patients. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was conducted in seven databases from inception to July 31, 2025. Two reviewers independently screened articles, extracted data, and assessed study quality. RevMan 5.3 was used for risk of bias assessment and meta-analysis. The review was registered with PROSPERO (CRD420251123651). RESULTS: Eleven studies were included; nine contributed data to the meta-analysis (n = 1037). Interventions employed two primary formats: exposure to static, nature-based environments (e.g., forests) accompanied by calming music, and interactive experiences that allowed patients to virtually explore the natural environment. The findings revealed several benefits, including reduced anxiety (n = 7; SMD = -1.76, 95% CI -2.61 to -0.91; I = 94%, p < 0.01; low certainty) and distress (n = 3; SMD = -0.83, 95% CI -1.30 to -0.36; I = 83%, p < 0.01; low certainty). CONCLUSION: For breast cancer patients, nature-based IVR may be considered as a promising supportive care intervention to reduce anxiety and distress. Clinicians may offer brief sessions (5-20 min) during chemotherapy infusion, radiotherapy waiting periods, perioperative recovery, and survivorship visits using head-mounted displays with calming, nature content.