Scene designs and user experience of VR interventions to manage symptoms among cancer populations: a systematic review of qualitative studies

Abstract

Purpose:

This study systematically reviewed how virtual reality (VR) interventions have been understood in symptom management from perspectives of both intervention designers and individuals with cancer, and we derived a model of VR interventions for cancer symptom management.

Methods:

A systematic review of qualitative studies was conducted across five databases, including the Cochrane Library of Systematic reviews, PubMed, PsycInfo, ScienceDirect, and Scopus. Studies were identified and evaluated using the standard Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research.

Results:

A total of 20 qualitative studies was included in this review. We found seven categories in terms of how VR interventions were designed: 1) immersion and presence as therapeutic support for distraction, 2) multi-sensory content for positive emotion restoration, 3) interactivity and embodiment for engagement and motivation, 4) personalization for resonance, 5) real-world versus computer-generated content, 6) integration with clinical workflow, and 7) purposes of using VR. Seven categories reflecting how VR was perceived by individuals with cancer were identified: 1) ease of use, 2) perceived usefulness for treatment support, 3) enjoyment, satisfaction, and hedonic quality, 4) symptom and functioning benefits, 5) innovativeness and openness to technology, 6) cybersickness and tolerability, and 7) accessibility and flexible use. Based on these categories from designers and participants’ perspectives, three themes of distinct VR mechanisms in symptom management interventions were identified: 1) distraction, 2) self-efficacy improvement, and 3) emotion restoration.

Conclusion:

Based on qualitative evidence of how cancer patients and researchers actually experience VR, we developed a conceptual framework to advance the understanding of the unique nature and implementation of VR interventions in cancer symptom management.

Systematic Review Registration:

https://www.crd.york.ac.uk/PROSPERO/view/CRD42025642992, identifier CRD42025642992.

1 Introduction

Advancements in cancer treatments have significantly improved patient outcomes, leading to a dramatic increase in the 5-year survival rate for all types of cancer from 49% to 69% between 2013 and 2020 (Siegel et al., 2025). However, during and after treatments, the risk of experiencing symptoms is high, such as pain, fatigue, anxiety, dyspnea, sleeplessness, nausea, and vomiting (Tewes et al., 2021). Some symptoms can be managed with effective treatments, while other late effects may linger long after treatments are completed (Harris et al., 2022). Several systematic reviews and meta-analyses have demonstrated that virtual reality (VR) interventions show promise for symptom management in oncology (Burrai et al., 2023; Lu et al., 2024; Rutkowski et al., 2021; Yan et al., 2025; Zhang et al., 2022). Virtual reality enables lifelike simulated experiences while reducing exposure to real-world risks, offering unique possibilities for therapeutic intervention. At the same time, the medium-based format provides both opportunities and limits for VR intervention development (Bell et al., 2024; Harris et al., 2020; Personeni and Savescu, 2023; Slater, 2009; Slater et al., 2020). Therefore, understanding the nature of VR as a medium, including its strengths and weaknesses, is essential for advancing VR science in health and medical interventions. Our fundamental research interest is, throughout the process of VR intervention design, application, and usage in cancer patients, how designers and users understand the uniqueness of VR for cancer symptom management?

A recent systematic review and meta-analysis examined the different components of VR interventions used in current studies based on the unique medium-based VR features, with current standards in VR advancements, and tested how patients’ characteristics, treatment context, and VR design features (immersion¹, scene type, interaction method, and intervention lengths) moderate the efficacy of interventions (Yan et al., 2025). This evidence showed that the VR format—how it is designed and delivered (e.g., content, scene type, level of immersion, length) —impacts its therapeutic effects. However, previous reviews draw almost exclusively on quantitative outcome trials and provide limited insight into how VR interventions have been understood for symptom management from both intervention developers' and users’ (cancer patients) views.

One previous systematic review explored such qualitative evidence and summarized the general experiences and perceptions of patients receiving VR therapy in palliative care (Huang et al., 2024); however, qualitative evidence specific to cancer patients is still needed. Importantly, how the VR therapy has been understood in symptom management, in terms of its medium-based nature, is not clear. The content design, scenery styles, immersive types, and interaction methods constitute the medium-based properties of VR and warrant further exploration to advance the research of VR interventions in symptom management science. Because individual qualitative studies of VR in symptom management for cancer patients are diverse and fragmented across settings, we aim to propose a framework to illustrate the complexity of building and implementing a program of VR interventions for symptom management among individuals with cancer on treatment. Understanding the nature and implementation of VR is the primary driver of this review.

The research questions that guided our exploration include: 1) how VR has been designed in the interventions; 2) how cancer patients as users experience VR interventions, including a) which design features they perceive as helpful or harmful, and b) how VR fits into the realities of treatment; and based on these explorations, our fundamental inquiry is 3) how this evidence illuminates the distinct nature and form of VR intervention? To address these research interests, our study aims to: 1) systematically synthesize qualitative evidence on a) intervention developers’ strategies on VR designs and b) cancer patients’ experiences, and 2) potentially develop a logic model of VR for cancer symptom management based on the concepts and lines of argument and raise questions for future researchers.

2 Methods

This systematic review was registered in PROSPERO (CRD42025642992). The search strategies and inclusion criteria were reported in previously published work focusing on quantitative data (Yan et al., 2025); this review focuses on qualitative evidence. Five databases were searched, including the Cochrane Library of Systematic reviews, PubMed, PsycInfo, ScienceDirect, and Scopus. Initial search included qualitative studies from an open-ended date to March 2025 and an additional search was conducted till October 2025. Eligible studies were qualitative research, mixed-methods or feasibility studies including a qualitative component; conducted among adults with cancer on active cancer treatment; using VR interventions; and those evaluating symptoms as study outcomes. We reported the review in accordance with the Reporting the Synthesis of Qualitative Research (ENTREQ) statement guideline (Tong et al., 2012) and appraised study quality using the standard Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research (JBI-QARI) (Institute, 2017).

A qualitative evidence synthesis was conducted using an inductive approach to form a conceptual framework (Charmaz, 2006). First, we extracted and summarized key information on VR format-related design features and users’ experiences from each study. Second, we compared these findings across studies to identify similarities and differences. Third, we translated concepts across studies by aligning similar ideas described using different terms. Finally, we used an inductive approach to generate overarching themes from the data. As we interpret the meanings and examine the impact, our goal is to move beyond the concepts and descriptive categories presented in the studies. We applied open, line-by-line coding, followed by constant comparison within and across studies. Through focused and axial coding, we identified concepts and developed higher-level categories that described contextual conditions, mechanisms, and proposed/perceived impacts. This process was used to generate an explanatory model of how, for whom, and under what conditions VR-based interventions address symptom management in cancer care, including the working mechanisms and behavioral process of using VR for symptom management. Throughout the synthesis, we used reflexive memos to document analytic decisions and consider how study quality and context shape our confidence in the resulting model.

Because our study interest is the nature of VR from both designer/researcher and consumer/participant perspectives, we drew data not only from the reported results but also from the introductions, methods, and discussions that researchers described in the publications. For VR customer experience, we extracted information based on user acceptance model (Sagnier et al., 2020). Two reviewers independently extracted data.

3 Results

A total of 20 qualitative studies were included in this review. The results for quality evaluation of included studies can be found in Table 1. The most common quality issues were the lack of disclosure of the researchers’ cultural or theoretical backgrounds and their influence on the research, as addressed in Questions 6 and 7, though such information was often not reported.

3.1 Study characteristics

Detailed study characteristics can be found in Table 2. Sample sizes in these studies spanned N = 6 to N = 58 participants. The mean age of participants across studies ranged from 42.6 to 67.4 years. Four studies focused on breast cancer, one on lung cancer, one on head and neck cancer, and the remaining studies included mixed cancer types. Six studies included patients undergoing chemotherapy, two involved radiotherapy, and two involved surgeries. In four studies, VR interventions were used at participants’ homes, and the majority were in hospital or clinical settings. For qualitative methods, ten studies used open-ended written questions, eight used interviews, and five used focus groups, including three studies that combined interviews and focus groups.

A detailed characterization of the VR design features across included studies was described in Supplementary Table S1, including the immersion type, display format, sensory components, devices and software of VR interventions used for cancer symptom management. The reviewed interventions ranged from non-immersive screen- or wall-based systems to immersive head-mounted displays, including systems using wide-angle multi-screen displays, desktop interfaces, television-based programs, smartphone-based headsets, Oculus/Meta/Pico/Samsung Gear VR devices, and WebXR or game-engine platforms. Some studies described their sensory or interactive features, such as stereo sound, music, guided narration, nature sounds, scent, gentle breeze, motion capture, head tracking, whereas others provided limited information on these features.

3.2 Synthesis of the qualitative data

We found seven categories in terms of how VR interventions were designed (Table 3), and seven categories for how VR was perceived (Table 4). The extracted codes from each study can be found in Supplemental Materials (Supplementary Tables S1, S2).

3.2.1 How VR has been designed

Category 1: Immersion and presence as therapeutic support for distraction. Two concepts of design features were identified: immersion (Dang et al., 2021; Garrett et al., 2020; Gerlach et al., 2024; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019; Sommer et al., 2024) and tracking/haptic feedback (Dang et al., 2021; Ryu and Price, 2022; Sichi et al., 2019). The concept of immersion found in these studies is more related to cognitive or psychological absorption (Dang et al., 2021; Garrett et al., 2020; Gerlach et al., 2024; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019; Sommer et al., 2024). In contrast, tracking and haptic feedback in these studies are technological features indicating different levels of immersive capability of their VR systems (Dang et al., 2021; Ryu and Price, 2022; Sichi et al., 2019). In the designs of studies, these two features helped foster presence, or the sense of being situated and engaged in the virtual environment, thereby diverting attention from the treatment environment and reducing perceived anxiety, pain, and distress.

Category 2: Multi-sensory content for positive emotion restoration. From a designer’s perspective, researchers used VR’s rich sensory input to support emotional restoration. We identified eight concepts that recurred across the included studies: 1) nature-based scenes (Baños et al., 2013; Kelleher et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004), 2) artistic exploration (Sichi et al., 2019), 3) comfort zones (Gerlach et al., 2024; Hoffman and Brintnall, 2017), 4) clinical education (Greenway et al., 2023; Johnson et al., 2020; Sommer et al., 2024), 5) fantasy (Garrett et al., 2020; Janssen et al., 2022), 6) nature sounds (Gerlach et al., 2024; Rolbiecki et al., 2023), 7) clinical sounds (Sommer et al., 2024), and 8) relaxing music (Garrett et al., 2020; Gerlach et al., 2024; Kelleher et al., 2022; Reynolds et al., 2022; Rolbiecki et al., 2023). In these studies, visually and acoustically rich but soothing VR content—ranging from nature scenes, art, and familiar “comfort zones” to clinical walk-throughs, fantasy worlds, and calming soundscapes—provided immersive but non-overstimulating experiences that reduced uncertainty, fostered relaxation, and restored positive emotion.

Category 3: Interactivity and embodiment for engagement and motivation. The third category was interactivity and embodiment for engagement and motivation, involving four concepts: 1) guided experience (Baños et al., 2013; Johnson et al., 2020; O'Gara et al., 2022; Rolbiecki et al., 2023), 2) self-navigation (Garrett et al., 2020; Gerlach et al., 2024; Greenway et al., 2023; Hoffman and Brintnall, 2017; Kelleher et al., 2022; Kriegler et al., 2024; Oyama et al., 1999; Reynolds et al., 2022; Sichi et al., 2019; Sommer et al., 2024), 3) interactive gameplay (Garrett et al., 2020; Janssen et al., 2022), and 4) tracking-based embodiment (Dang et al., 2021; Ryu and Price, 2022). These were used to keep patients actively engaged, increase their sense of control, and strengthen coping and self-efficacy.

Category 4: Personalization for resonance. The fourth category was personalization for resonance, including two concepts of patients’ choice of environment (Baños et al., 2013; Garrett et al., 2020; Gerlach et al., 2024; Kriegler et al., 2024; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004) and their choice of audio (Dang et al., 2021; Ryu and Price, 2022). Designers provided different environments (beach, mountain, city, living room, etc.) and voiceover (male/female, or content type) to increase relevance and acceptability.

Category 5: Real-world versus computer-generated content. The fifth category was real-world versus computer-generated content, and four concepts were found: 1) market-ready app (Garrett et al., 2020; Janssen et al., 2022; Kelleher et al., 2022; Kriegler et al., 2024; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019), 2) clinically developed content (Greenway et al., 2023; Johnson et al., 2020; McGarvey et al., 2010; Sommer et al., 2024), 3) real video captured (Gerlach et al., 2024), 4) computer-generated environments (Baños et al., 2013; Dang et al., 2021; Greenway et al., 2023; Kelleher et al., 2022; O'Gara et al., 2022; Ryu and Price, 2022). Some designers created their own content using real video captured footage or computer-generated graphics to provide more realistic or optimized environments for enhancing recovery; some developed clinical and cancer care content (radiation therapy/chemo walk-throughs; observation tailored to hospital context) to demystify treatment and reduce fear of the unknown, while others used off-the-shelf applications.

Category 6: Integration with clinical workflow. The sixth category of design considerations was integration with clinical workflow, including two identified concepts: 1) integrated with the treatment process (Hoffman and Brintnall, 2017; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; McGarvey et al., 2010; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sommer et al., 2024), and 2) physiological monitoring (Dang et al., 2021; Oyama et al., 1999; Rolbiecki et al., 2023; Ryu and Price, 2022), which makes VR feasible for bedside use and enables monitoring for safety and research purposes.

Category 7: Purposes of using VR. The last category was the purposes that designers/researchers proposed for using VR interventions, including seven concepts: 1) emotional support and improved quality of life (Baños et al., 2013; Gerlach et al., 2024; Kriegler et al., 2024; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Ryu and Price, 2022), 2) symptom relief through distraction and presence (Garrett et al., 2020; Gerlach et al., 2024; Janssen et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019), 3) self-efficacy and coping (Hoffman and Brintnall, 2017; Kelleher et al., 2022; McGarvey et al., 2010; Schneider et al., 2003), 4) preparation, education, and understanding of treatment (Greenway et al., 2023; Johnson et al., 2020; Sommer et al., 2024), 5) life review, identity, and meaning-making (Dang et al., 2021; Ryu and Price, 2022), 6) sanctuary from treatment (Gerlach et al., 2024; Janssen et al., 2022; Oyama et al., 1999; Rolbiecki et al., 2023), and 7) accessible and flexible support platform (Greenway et al., 2023; Hoffman and Brintnall, 2017).

3.2.2 How VR was perceived by cancer patients

Seven categories emerged on how participants perceived VR.

Category 1: Ease of use. Participants reported that VR was generally easy and comfortable to use, with comfortable headsets and intuitive controls, although some participants noted ergonomic, weight, and heat-related discomfort, as well as occasional technical problems (Baños et al., 2013; Dang et al., 2021; Gerlach et al., 2024; Greenway et al., 2023; Hoffman and Brintnall, 2017; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Reynolds et al., 2022; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019; Sommer et al., 2024).

Category 2: Perceived usefulness for treatment support. The second category is perceived usefulness for treatment support. Participants reported that VR was helpful for reducing pain/anxiety, improved overall treatment experience, served as a good distraction from chemo, and was a useful educational tool; nurses also observed fewer symptom-related calls among patients who used the VR intervention (Baños et al., 2013; Dang et al., 2021; Greenway et al., 2023; Hoffman and Brintnall, 2017; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; McGarvey et al., 2010; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019; Sommer et al., 2024).

Category 3: Enjoyment, satisfaction, and hedonic quality. The third category is enjoyment, satisfaction, and hedonic quality. Virtual reality was perceived as enjoyable, pleasant, fun, entertaining, and “nice to enjoy nature and reminisce”; many expressed interest in using it again and reported being very/quite satisfied (Baños et al., 2013; Dang et al., 2021; Garrett et al., 2020; Gerlach et al., 2024; Hoffman and Brintnall, 2017; Janssen et al., 2022; Kelleher et al., 2022; Kriegler et al., 2024; McGarvey et al., 2010; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2004; Sichi et al., 2019; Sommer et al., 2024).

Category 4: Symptom and functioning benefits (pragmatic quality). The fourth category is symptom and functioning benefits. Participants reported decreased anxiety, stress, tension, depression, pain, fatigue; increased relaxation, positive mood, energy, functional independence; better memory; and improved quality of life (Baños et al., 2013; Dang et al., 2021; Garrett et al., 2020; Hoffman and Brintnall, 2017; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; McGarvey et al., 2010; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sommer et al., 2024).

Category 5: Innovativeness and openness to technology. The fifth category is innovativeness and openness to technology. In some studies, participants described the VR interventions as innovative and interesting, showed interest in future developments, and viewed VR as a promising new tool for managing anxiety (Kriegler et al., 2024; O'Gara et al., 2022; Sichi et al., 2019).

Category 6: Cybersickness and tolerability. The sixth category is cybersickness and tolerability. There were no unusual side effects for most patients; however, some reported side effects such as dizziness, nausea, and eye strain, while others noted issues with headset weight and fit and preferred shorter videos (Baños et al., 2013; Garrett et al., 2020; Gerlach et al., 2024; Janssen et al., 2022; Kelleher et al., 2022; O'Gara et al., 2022; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sommer et al., 2024).

Category 7: Accessibility and flexible use. The seventh category is accessibility and flexible use. Virtual reality interventions were perceived as convenient for home-based use, with patients able to operate the system independently, access resources from home, and engage in treatment in an acceptable at-home format. Virtual reality was also reported to integrate well with chemotherapy and radiotherapy sessions and to be suitable during lengthy procedures (Greenway et al., 2023; Hoffman and Brintnall, 2017; Janssen et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Reynolds et al., 2022; Sommer et al., 2024).

3.3 Mechanism of VR in symptom management interventions

Based on the identified categories from designers’ and participants’ perspectives, three themes of distinct VR mechanisms in symptom management interventions were identified.

4 Discussion

Qualitative evidence on VR design and customer experience of VR interventions is limited, especially for VR interventions for symptom management among people with cancer. This systematic review uses an inductive approach to summarize such evidence from 20 studies and explore the unique nature of VR intervention for cancer symptom management. To our knowledge, this is the first study that summarizes the qualitative evidence to propose a conceptual model for VR’s role in symptom management.

These VR interventions differ in immersion level, display format, content type, sensory features, and interactivity. The differences in VR modality and design may help explain variation in presence, engagement, acceptability, tolerability, and symptom-management outcomes across studies. For example, immersive head-mounted displays with 360° scenes and head tracking may enhance presence, whereas non-immersive screen-based systems may be easier to tolerate for patients who are fatigued, nauseated, or physically frail. Personalized or interactive content may improve engagement and perceived relevance, while generic or passive content may be less compelling. These design differences may also influence mechanisms of symptom relief: nature-based relaxation environments may support calmness and emotional regulation, procedural simulations may reduce uncertainty, and interactive games may provide distraction from pain or distress. However, VR reporting was inconsistent across studies, and some key design features were missing or insufficiently described.

We found seven categories of VR design strategies used by researchers, and seven categories of customer experience of VR interventions. Across studies, design features such as high immersion and presence, rich sensory input (particularly nature scenes and soothing audio), and flexible interactivity and personalization were used together to create an environment for individuals to recover and regain their control. Within this VR environment, patients reported feeling temporarily “inside” an alternative world instead of the treatment environment, which redirected attention away from aversive cues, shortened the perceived duration of procedures, and reduced anxiety, pain, and distress.

Nature-based and comfort-oriented environments offered “soft fascination” and emotional ease, supporting restoration of depleted attentional and emotional resources. Unfortunately, visual/audio design features were usually not reported in these publications, thus we cannot analyze the design of nature-based scenes further. In the literature, evidence has shown that fundamental visual-audio properties systematically shape people’s emotional responses. For example, the color (Jacobson et al., 2024; Jonauskaite et al., 2020), contour (curvature vs. angularity) (Chuquichambi et al., 2022; Vartanian et al., 2024), symmetry (Bertamini et al., 2020), complexity (Redies and Bartho, 2023; Sun and Firestone, 2022), and lighting/composition(Stefani et al., 2024; Xie et al., 2022) have long been known to influence affective responses. Systematically testing how filming design features, such as shot size, depth of field, tertiary motion, lighting/exposure/contrast, and soundscape, influence perceptions and symptoms experience will move the field from “VR works/doesn’t work” to which designs work best, for whom, and in what context.

From the participants’ view, most reported that VR was easy to use and served as a useful form of treatment support. However, some also noted technical difficulties and a need for additional technological assistance. While certain concerns may reflect the use of earlier-generation VR hardware, others—such as heat generation and headset weight—remain limitations of current devices and highlight the need for continued technological refinement and closer attention to VR-specific adverse (Yan and Loerzel, 2025). Importantly, participants also expressed varying levels of engagement and differing opinions about the same intervention content. Our findings indicate that VR experiences provided immediate symptom relief and supported broader psychological recovery/enhancement. Guided experiences and tangible interactions helped patients rehearse coping strategies, feel more capable of tolerating treatment, and make sense of their illness through life review and meaning making. Virtual reality clinical walk-throughs reduced uncertainty and anticipatory anxiety by demystifying complex treatments, while at-home and web-based platforms increased accessibility between visits.

Based on these findings, three themes of VR mechanisms were derived. Distraction was mostly established as a mechanism and has been widely used in VR interventions to manage symptoms among cancer populations (Buche et al., 2023; Chirico et al., 2020; Fabi et al., 2022; Groninger et al., 2024; Ioannou et al., 2022; Menekli et al., 2022; Mohammad and Ahmad, 2019; Santana et al., 2023; Schrempf et al., 2022; Stansel et al., 2025; Uslu and Arslan, 2023). However, it is also important to note that this framework does not adequately account for effects that persist beyond VR use (Chuan et al., 2023; Li et al., 2024). Our synthesis suggests that VR-based interventions during active cancer treatment work through the “self-efficacy enhancing engagement” and “emotion restoration” pathway rather than through distraction alone. Self-efficacy is increasingly used as a key mechanism in VR therapy, supported by processes including enhancing motivation, skill mastery, immediate feedback, goal setting and achievement, engagement, sense of control over virtual environment, and repeated successful experiences (Basha et al., 2022; Feyzioğlu et al., 2020; Hoffman and Brintnall, 2017; Hoffman et al., 2017; Kelleher et al., 2022; McGarvey et al., 2010; Schneider et al., 2003), which map onto Bandura’s four sources of self-efficacy (mastery, modeling, persuasion, physiological/affective states) (Bandura, 1997). Within the “real” but safe environments in VR, individuals may manage symptoms via improved self-efficacy, which warrants further investigation in future studies.

4.1 Nature of VR: a logic model

Sherman and Craig describe virtual reality as an interactive computer-generated simulation that tracks a participant’s actions and provides multisensory feedback, e.g., computer-generated imagery shown in a head-mounted display, to create a sense of immersion or presence [78]. In this study, we explore VR as a medium for the treatment of symptoms within virtual environments. Our findings showed that the media features directly shape the effectiveness of interventions on patients’ symptom experiences, such that the format of VR is as important as the content. In fact, VR has been defined using concepts from different disciplines of computer science, film art, and cognitive psychology. Some VR theorists have sought to define the unique conceptual domain of virtual reality by explaining the experience of presence—the perception of “being there” (Schubert, 2009) in a mediated environment—through two core constructs: place illusion, the sensation of being physically located within the virtual space, and plausibility illusion, the sense that events occurring in that space are genuinely happening to the user (Slater, 2009; Slater et al., 2022). These experiential qualities of “presence” are supported by immersion, defined as the sensory and interactive capabilities of the system, and coherence, defined as the internal consistency and reasonableness of the virtual environment (Skarbez et al., 2021; Skarbez et al., 2017). Presence is a distinctive concept because it captures the subjective, first-person quality of VR experience, which cannot be fully reduced to objective system properties, such as immersion or coherence (Murphy and Skarbez, 2020; Skarbez et al., 2021; Slater and Wilbur, 1997). The concept of presence has aroused discussions and is considered one of the central properties of a VR experience (Murphy and Skarbez, 2020; Skarbez et al., 2017; Slater, 2003). Some researchers also argued that presence alone may not be the central explanatory concept for understanding VR experiences and their effects and proposed that congruence and plausibility—the degree to which elements of the virtual environment logically fit together and align with user expectations—may be more fundamental conditions for meaningful VR experiences (Latoschik and Wienrich, 2022). Other research emphasizes that plausibility, coherence, and congruence can independently influence how believable and effective a virtual experience feels (Hofer et al., 2020; Mal et al., 2023). The concepts of copresence (Skarbez et al., 2017), illusion of ownership (Slater et al., 2022), among others, further expanded our understanding beyond the fundamental quale of VR’s unique experience.

In therapeutic contexts, this broader understanding helps explain why VR can be fundamentally different from earlier media for symptom management in cancer patients. A film may evoke emotion, a meditation app may guide relaxation, and social platforms may promote connection, but VR places the user in a separate experiential world (Slater et al., 2022) integrating these elements into a single, interactive experience (Bell et al., 2024; Slater, 2009). At the technical and design level, two foundational conditions are involved: immersion and coherence. The concept of immersion here refers to the system’s ability to engage patients’ senses—through head-mounted displays, spatial audio, and interactive tracking—so that their attention shifts away from the clinical setting and treatment-related discomfort toward the virtual experience (Cummings and Bailenson, 2016; Slater and Wilbur, 1997). Coherence refers to the consistency/clarity of the virtual scenario, meaning that the environment, events, and interactions behave in ways that are understandable and aligned with the expectations set for the patient (Latoschik and Wienrich, 2022; Skarbez et al., 2021). When immersion and coherence are effective, users may experience place illusion and plausibility illusion (Slater, 2009; Slater et al., 2022), and feel more deeply engaged with the virtual situation, which can activate therapeutic mechanisms. As a result, VR can support symptom management not merely by presenting content but by allowing individuals to experience coping strategies and emotional regulation within a believable simulated context. This may enhance engagement and therapeutic effects compared with traditional media. In summary, VR differs from earlier media and art forms in that it is not only something a person observes, but something the person can enter and experience as an enacted situation.

The three identified mechanisms (distraction, self-efficacy improvement, and emotion restoration) are enabled by these VR properties in the context of cancer symptom management. Distraction occurs when immersive engagement redirects attention away from unpleasant sensations or worries, reducing perceived pain or distress (Dang et al., 2021; Garrett et al., 2020; Gerlach et al., 2024; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Reynolds et al., 2022; Rolbiecki et al., 2023; Ryu and Price, 2022; Schneider et al., 2003; Schneider et al., 2004; Sichi et al., 2019; Sommer et al., 2024). Motivation and self-efficacy may increase when patients successfully interact with the environment—for example, practicing breathing exercises, completing calming tasks, or receiving encouragement from a virtual companion—thereby strengthening confidence in coping with symptoms (Dang et al., 2021; Garrett et al., 2020; Gerlach et al., 2024; Greenway et al., 2023; Hoffman and Brintnall, 2017; Janssen et al., 2022; Kelleher et al., 2022; Kriegler et al., 2024; Oyama et al., 1999; Reynolds et al., 2022; Ryu and Price, 2022; Sichi et al., 2019; Sommer et al., 2024). Emotion restoration can be supported by calming or meaningful environments, such as nature scenes (Baños et al., 2013; Kelleher et al., 2022; Kriegler et al., 2024; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004), that promote relaxation and positive affects. Distraction in VR is typically driven by immersion, embodiment, and sensory richness, whereas self-efficacy is more often fostered through interactivity and a sense of control. Emotion restoration draws on both sets of processes. The three mechanisms are not mutually exclusive; instead, they are interconnected. In fact, distraction alone is unlikely to yield sustained benefits; restorative effects depend on engagement that supports cognitive and emotional recovery, rather than mere attentional diversion (Kaplan and Kaplan, 1989). Together, these mechanisms explain how VR can reduce psychological/cognitive symptoms (Baños et al., 2013; Dang et al., 2021; Garrett et al., 2020; Hoffman and Brintnall, 2017; Janssen et al., 2022; Johnson et al., 2020; Kelleher et al., 2022; Kriegler et al., 2024; McGarvey et al., 2010; O'Gara et al., 2022; Oyama et al., 1999; Reynolds et al., 2022; Rolbiecki et al., 2023; Schneider et al., 2003; Schneider et al., 2004; Sommer et al., 2024), strengthen coping (Hoffman and Brintnall, 2017; Kelleher et al., 2022; McGarvey et al., 2010; Schneider et al., 2003), and improve quality of life (Dang et al., 2021; Reynolds et al., 2022; Ryu and Price, 2022; Schneider et al., 2004) for patients undergoing active treatment.

Due to its unique nature, VR can engage multiple senses in an integrated way, creating a more lifelike experience that requires little effort or practice for users to accept the presented scenes. The plausible, immersive, and intuitive nature of VR may make it an especially effective medium through which these mechanisms operate. This can be explained by the Attention Restoration theory (Kaplan and Kaplan, 1989; Kaplan, 1995), that soft fascination supports reflection and imagination while allowing attention to be engaged effortlessly. It is also important for therapeutic VR experiences to provide patients with “some form of symbolic value” (Huang et al., 2024), such as meaning, familiarity, or personal relevance. For VR designs, it is suggested that designers create a world with balanced realism yet leave “blank space” for viewers’ imagination (Atherton and Wang, 2020; Lundstedt et al., 2023). The room for personal interpretation and meaning-making may be important to VR’s therapeutic potential.

Virtual reality is not just a delivery channel for content; the specific design features can systematically shape how patients attend, feel, think, and cope during VR treatment. Thus, VR can be regarded as an independent platform with its unique opportunities within its format. Our logic model (Figure 1) explains how cancer patients with diverse clinical and personal characteristics engage with VR interventions incorporating different design features, and how these features activate specific mechanisms of action that lead to short-term and long-term outcomes. It demonstrates the pathways through which VR influences anxiety and other symptom burdens, coping, and quality of life.

FIGURE 1

5 Limitations

Our synthesis was limited by both the diversity of VR formats used across studies and the inconsistent reporting of key design features. The included studies ranged from non-immersive computer- or television-based programs to immersive head-mounted displays and wall-display systems, making direct comparisons across studies difficult. Although this heterogeneity provides useful insight into the breadth of VR applications in cancer care, it also limits direct comparisons across studies and constrains conclusions about the relative effectiveness, feasibility, and tolerability of specific VR modalities. In addition, visual and auditory design features, interaction mechanics, user control, sensory inputs, and implementation details were often sparsely or inconsistently reported. Future studies should provide more comprehensive reporting of VR design features, including immersion level, field of view, interactivity, sensory inputs, content source, user control, and hardware/software specifications. Such reporting would advance our understanding of which VR characteristics are most appropriate for specific symptoms, populations, and clinical contexts.

6 Conclusion

This systematic review brings together qualitative evidence on how researchers and cancer patients design and experience VR, and what features of VR matter for symptom management. Methodologically, we used an inductive approach to synthesize current qualitative evidence and to develop a model of how VR functions as a medium for symptom management in cancer care. This review intends to shift the conversation from asking whether “VR works” to understanding how, for whom, and under what design and clinical conditions VR can be better implemented to support cancer symptom management. Across diverse cancers, treatments, and devices, participants consistently described VR not only as a novel distraction, but as a self-efficacy-enhancing tool and a medium that supports coping, restores attention, and helps make treatment more understandable and tolerable. From this, we developed a conceptual framework, showing key design elements (immersion and presence, sensory richness, interactivity and embodiment, personalization and choice, and integration into clinical workflows), and interconnected mechanisms of distraction, self-efficacy, and emotional restoration in cancer symptom management. Also, this review highlights that VR is not uniformly beneficial: experiences varied; some participants reported discomfort, worry, or disengagement. These findings may suggest that personalized designing, validating video pools with cancer patients, and offering meaningful choices may be some practical strategies to maximize acceptability and effectiveness. Most importantly, how VR is designed and used—especially the choice of nature-based scenes, audio design, level of interactivity, and timing in the treatment pathway—is as important as its content.

References

• 1

  AthertonJ.WangG. (2020). Doing vs. being: a philosophy of design for artful VR. J. New Music Res.49 (1), 35–59. 10.1080/09298215.2019.1705862

  • CrossRef
  • Google Scholar
  • View reference in article

• 2

  BanduraA. (1997). Self-Efficacy: The Exercise of Control. W. H. Freeman.

  • Google Scholar

• 3

  BañosR. M.EspinozaM.García-PalaciosA.CerveraJ. M.EsquerdoG.BarrajónE.et al (2013). A positive psychological intervention using virtual reality for patients with advanced cancer in a hospital setting: a pilot study to assess feasibility. Support. Care Cancer21 (1), 263–270. 10.1007/s00520-012-1520-x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 4

  BashaM. A.AboelnourN. H.AlsharidahA. S.KamelF. H. (2022). Effect of exercise mode on physical function and quality of life in breast cancer–related lymphedema: a randomized trial. Support. Care Cancer30 (3), 2101–2110. 10.1007/s00520-021-06559-1

  • CrossRef
  • Google Scholar
  • View reference in article

• 5

  BellI. H.Pot-KolderR.RizzoA.Rus-CalafellM.CardiV.CellaM.et al (2024). Advances in the use of virtual reality to treat mental health conditions. Nat. Rev. Psychol.3 (8), 552–567. 10.1038/s44159-024-00334-9

  • CrossRef
  • Google Scholar
  • View reference in article

• 6

  BertaminiM.RamponeG.Tyson-CarrJ.MakinA. D. J. (2020). The response to symmetry in extrastriate areas and its time course are modulated by selective attention. Vis. Res., 177, 68–75. 10.1016/j.visres.2020.09.003

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 7

  BucheH.MichelA.BlancN. (2023). When virtual reality supports patients’ emotional management in chemotherapy. Front. Virtual Real.4, 1294482. 10.3389/frvir.2023.1294482

  • CrossRef
  • Google Scholar
  • View reference in article

• 8

  BurraiF.SguanciM.PetrucciG.De MarinisM. G.PireddaM. (2023). Effectiveness of immersive virtual reality on anxiety, fatigue and pain in patients with cancer undergoing chemotherapy: a systematic review and meta-analysis. Eur. J. Oncol. Nurs.64, 102340. 10.1016/j.ejon.2023.102340

  • CrossRef
  • Google Scholar
  • View reference in article

• 9

  CharmazK. (2006). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis Kathy Charmaz Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis, 13. London/Thousand Oaks/New Delhi: SAGE Publications Ltd. 10.7748/nr.13.4.84.s4

  • CrossRef
  • Google Scholar
  • View reference in article

• 10

  ChiricoA.MaioranoP.IndovinaP.MilaneseC.GiordanoG. G.AliverniniF.et al (2020). Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy. J. Cell. Physiology235 (6), 5353–5362. 10.1002/jcp.29422

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 11

  ChuanA.HattyM.ShelleyM.LanA.ChowH.DaiE.et al (2023). Feasibility of virtual reality‐delivered pain psychology therapy for cancer‐related neuropathic pain: a pilot randomised controlled trial. Anaesthesia78 (4), 449–457. 10.1111/anae.15971

  • CrossRef
  • Google Scholar
  • View reference in article

• 12

  ChuquichambiE. G.VartanianO.SkovM.CorradiG. B.NadalM.SilviaP. J.et al (2022). How universal is preference for visual curvature? A systematic review and meta‐analysis. Ann. N. Y. Acad. Sci.1518 (1), 151–165. 10.1111/nyas.14919

  • CrossRef
  • Google Scholar
  • View reference in article

• 13

  CummingsJ. J.BailensonJ. N. (2016). How immersive is enough? A meta-analysis of the effect of immersive technology on user presence. Media Psychol.19 (2), 272–309. 10.1080/15213269.2015.1015740

  • CrossRef
  • Google Scholar
  • View reference in article

• 14

  DangM.NoreikaD.RyuS.SimaA.AshtonH.OndrisB.et al (2021). Feasibility of delivering an avatar-facilitated life review intervention for patients with cancer. J. Palliat. Med.24 (4), 520–526. 10.1089/jpm.2020.0020

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 15

  FabiA.FotiaL.GiuseppiniF.GaetaA.FalcicchioC.GiulianiG.et al (2022). The immersive experience of virtual reality during chemotherapy in patients with early breast and ovarian cancers: the patient’s dream study. Front. Oncol.12, 960387. 10.3389/fonc.2022.960387

  • CrossRef
  • Google Scholar
  • View reference in article

• 16

  FeyzioğluÖ.DinçerS.AkanA.AlgunZ. C. (2020). Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?Support. Care Cancer28 (9), 4295–4303. 10.1007/s00520-019-05287-x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 17

  GarrettB. M.TaoG.TavernerT.CordingleyE.SunC. (2020). Patients perceptions of virtual reality therapy in the management of chronic cancer pain. Heliyon6 (5), e03916. 10.1016/j.heliyon.2020.e03916

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 18

  GerlachC.HaasL.GreinacherA.LantelmeJ.GuentherM.Thiesbonenkamp-MaagJ.et al (2024). My virtual escape from patient life: a feasibility study on the experiences and benefits of individualized virtual reality for inpatients in palliative cancer care. BMC Palliat. Care23 (1), 247. 10.1186/s12904-024-01577-2

  • CrossRef
  • Google Scholar
  • View reference in article

• 19

  GreenwayK.FrisoneC.PlacidiA.KumarS.GuestW.WinterS. C.et al (2023). Using immersive technology and architectural design to assist head and neck cancer patients’ recovery from treatment: a focus group and technology acceptance study. Eur. J. Oncol. Nurs.62, 1–9. 10.1016/j.ejon.2022.102261

  • CrossRef
  • Google Scholar
  • View reference in article

• 20

  GroningerH.ViolantiD.MeteM. (2024). Virtual reality for pain management in hospitalized patients with cancer: a randomized controlled trial. Cancer, 130(14), 2552–2560. 10.1002/cncr.35282

  • CrossRef
  • Google Scholar
  • View reference in article

• 21

  HarrisD. J.BirdJ. M.SmartP. A.WilsonM. R.VineS. J. (2020). A framework for the testing and validation of simulated environments in experimentation and training. Front. Psychol.11, 605. 10.3389/fpsyg.2020.00605

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 22

  HarrisC. S.KoberK. M.CooperB.ConleyY. P.DhruvaA. A.HammerM. J.et al (2022). Symptom clusters in outpatients with cancer using different dimensions of the symptom experience. Support. Care Cancer30 (8), 6889–6899. 10.1007/s00520-022-07125-z

  • CrossRef
  • Google Scholar

• 23

  HoferM.HartmannT.EdenA.RatanR.HahnL. (2020). The role of plausibility in the experience of spatial presence in virtual environments. Front. Virtual Real.1, 2. 10.3389/frvir.2020.00002

  • CrossRef
  • Google Scholar
  • View reference in article

• 24

  HoffmanA. J.BrintnallR. A. (2017). A home-based exercise intervention for non–small cell lung cancer patients post-thoracotomy. Seminars Oncol. Nurs., 33(1), 106–117. 10.1016/j.soncn.2016.11.011

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 25

  HoffmanA. J.BrintnallR. A.GivenB. A.Von EyeA.JonesL. W.BrownJ. K. (2017). Using perceived self-efficacy to improve fatigue and fatigability in postsurgical lung cancer patients. Cancer Nurs.40 (1), 1–12. 10.1097/ncc.0000000000000378

  • CrossRef
  • Google Scholar
  • View reference in article

• 26

  HuangY.DengC.PengM.HaoY. (2024). Experiences and perceptions of palliative care patients receiving virtual reality therapy: a meta-synthesis of qualitative studies. BMC Palliat. Care23 (1), 182. 10.1186/s12904-024-01520-5

  • CrossRef
  • Google Scholar
  • View reference in article

• 27

  InstituteJ. B. (2017). JBI critical appraisal checklist for qualitative research. Available online at: https://jbi.global/critical-appraisal-tools (Accessed October 1, 2025).

  • Google Scholar
  • View reference in article

• 28

  IoannouA.PaikousisL.PapastavrouE.AvraamidesM. N.AstrasG.CharalambousA. (2022). Effectiveness of virtual reality Vs guided imagery on mood changes in cancer patients receiving chemotherapy treatment: a crossover trial. Eur. J. Oncol. Nurs.61, 102188. 10.1016/j.ejon.2022.102188

  • CrossRef
  • Google Scholar
  • View reference in article

• 29

  JacobsonH.OngilZ.AlgomD.UsherM. (2024). Valence in perception: are affective valence and visual brightness integral dimensions in visual experience?Conscious. Cognition, 126, 103783. 10.1016/j.concog.2024.103783

  • CrossRef
  • Google Scholar
  • View reference in article

• 30

  JanssenA.FletcherJ.KeepM.AhmadpourN.RoufA.MarthickM.et al (2022). Experiences of patients undergoing chemotherapy with virtual reality: mixed methods feasibility Study. JMIR Serious Games10 (1), e29579. 10.2196/29579

  • CrossRef
  • Google Scholar
  • View reference in article

• 31

  JohnsonK.LiszewskiB.DawdyK.LaiY.McGuffinM. (2020). Learning in 360 degrees: a pilot Study on the use of virtual reality for radiation therapy patient education. J. Med. Imaging Radiat. Sci.51 (2), 221–226. 10.1016/j.jmir.2019.12.008

  • CrossRef
  • Google Scholar
  • View reference in article

• 32

  JonauskaiteD.Abu-AkelA.DaelN.OberfeldD.Abdel-KhalekA. M.Al-RasheedA. S.et al (2020). Universal patterns in color-emotion associations are further shaped by linguistic and geographic proximity. Psychol. Sci.31 (10), 1245–1260. 10.1177/0956797620948810

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 33

  KaplanS. (1995). The restorative benefits of nature: toward an integrative framework. J. Environ. Psychol., 15(3), 169–182. 10.1016/0272-4944(95)90001-2

  • CrossRef
  • Google Scholar
  • View reference in article

• 34

  KaplanR.KaplanS. (1989). The Experience of Nature: A Psychological Perspective. Cambridge University Press.

  • Google Scholar
  • View reference in article

• 35

  KelleherS. A.FisherH. M.WingerJ. G.MillerS. N.AmadenG. H.SomersT. J.et al (2022). Virtual reality for improving pain and pain-related symptoms in patients with advanced stage colorectal cancer: a pilot trial to test feasibility and acceptability. Palliat. Support. Care20 (4), 471–481. 10.1017/S1478951521002017

  • CrossRef
  • Google Scholar
  • View reference in article

• 36

  KrieglerC.DebenhamB.PivaM.BernardoM.BylhouwerA.KarimT.et al (2024). Impacts of intrafraction virtual reality-based environment modification on procedural anxiety, heart rate, and overall radiation therapy experience during external beam radiation therapy. Adv. Radiat. Oncol.9 (11), 101640. 10.1016/j.adro.2024.101640

  • CrossRef
  • Google Scholar
  • View reference in article

• 37

  LatoschikM. E.WienrichC. (2022). Congruence and plausibility, not presence: pivotal conditions for XR experiences and effects, a novel approach. Front. Virtual Real.3, 694433. 10.3389/frvir.2022.694433

  • CrossRef
  • Google Scholar
  • View reference in article

• 38

  LiM.YuZ.LiH.CaoL.YuH.DengN.et al (2024). Effects of virtual reality therapy for patients with breast cancer during chemotherapy: randomized controlled trial. JMIR Serious Games12, e53825. 10.2196/53825

  • CrossRef
  • Google Scholar
  • View reference in article

• 39

  LuM.SongY.NiuY.LiuT.GeS.SunY.et al (2024). Effectiveness of virtual reality in the management of anxiety and pain peri-treatment for breast cancer: a systematic review and meta-analysis. J. Nurs. Res.32 (4), e343. 10.1097/jnr.0000000000000623

  • CrossRef
  • Google Scholar
  • View reference in article

• 40

  LundstedtR.PerssonJ.HåkanssonC.FrennertS.WallergårdM. (2023). Designing virtual natural environments for older adults: Think-Aloud Study. JMIR Hum. Factors10, e40932. 10.2196/40932

  • CrossRef
  • Google Scholar
  • View reference in article

• 41

  MalD.WolfE.DöllingerN.WienrichC.LatoschikM. E. (2023). The impact of avatar and environment congruence on plausibility, embodiment, presence, and the proteus effect in virtual reality. IEEE Trans. Vis. Comput. Graph.29 (5), 2358–2368. 10.1109/tvcg.2023.3247089

  • CrossRef
  • Google Scholar
  • View reference in article

• 42

  McGarveyE. L.Leon-VerdinM.BaumL. D.BloomfieldK.BreninD. R.KoopmanC.et al (2010). An evaluation of a computer-imaging program to prepare women for chemotherapy-related alopecia. Psycho-Oncology19 (7), 756–766. 10.1002/pon.1637

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 43

  MenekliT.YaprakB.DoğanR. (2022). The effect of virtual reality distraction intervention on pain, anxiety, and vital signs of oncology patients undergoing port catheter implantation: a randomized controlled Study. Pain Manag. Nurs.23 (5), 585–590. 10.1016/j.pmn.2022.03.004

  • CrossRef
  • Google Scholar
  • View reference in article

• 44

  MohammadE. B.AhmadM. (2019). Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: a randomized control trial. Palliat. Support. Care17 (1), 29–34. 10.1017/S1478951518000639

  • CrossRef
  • Google Scholar

• 45

  MurphyD.SkarbezR. (2020). What do we mean when we say “Presence”. PRESENCE Virtual Augmented Real.29, 171–190. 10.1162/pres_a_00360

  • CrossRef
  • Google Scholar

• 46

  O'GaraG.MurrayL.GeorgopoulouS.AnstissT.MacquarrieA.WheatstoneP.et al (2022). SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting?BMJ Open12 (2), e047626. 10.1136/bmjopen-2020-047626

  • CrossRef
  • Google Scholar

• 47

  OyamaH.OhsugaM.TatsunoY.KatsumataN. (1999). Evaluation of the psycho-oncological effectiveness of the bedside wellness system. CyberPsychology and Behav.2 (1), 81–84. 10.1089/cpb.1999.2.81

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 48

  PersoneniG.SavescuA. (2023). Ecological validity of virtual reality simulations in workstation health and safety assessment. Front. Virtual Real.4, 1058790. 10.3389/frvir.2023.1058790

  • CrossRef
  • Google Scholar

• 49

  RediesC.BarthoR. (2023). Statistical image properties and aesthetic judgments on abstract paintings by Robert Pepperell. J. Vis.23 (6), 1. 10.1167/jov.23.6.1

  • CrossRef
  • Google Scholar

• 50

  ReynoldsL. M.CavadinoA.ChinS.LittleZ.AkroydA.TennantG.et al (2022). The benefits and acceptability of virtual reality interventions for women with metastatic breast cancer in their homes; a pilot randomised trial. BMC Cancer22 (1), 360. 10.1186/s12885-021-09081-z

  • CrossRef
  • Google Scholar

• 51

  RolbieckiA. J.CraigK.PolniakM.SmithJ.GhoshP.MehrD. R. (2023). Virtual reality and neurofeedback for management of cancer symptoms: a feasibility pilot. Am. J. Hospice and Palliat. Med.40 (3), 291–298. 10.1177/10499091221109900

  • CrossRef
  • Google Scholar

• 52

  RutkowskiS.CzechO.WrzecionoA.KiperP.Szczepańska-GierachaJ.MalickaI. (2021). Virtual reality as a chemotherapy support in treatment of anxiety and fatigue in patients with cancer: a systematic review and meta-analysis and future research directions. Complementary Ther. Med., 61, 102767. 10.1016/j.ctim.2021.102767

  • CrossRef
  • Google Scholar

• 53

  RyuS.PriceS. K. (2022). Embodied storytelling and meaning-making at the end of life: Voicinghan avatar life-review for palliative care in cancer patients. Arts and Health An Int. J. Res. Policy Pract.14 (3), 326–340. 10.1080/17533015.2021.1942939

  • CrossRef
  • Google Scholar

• 54

  SagnierC.Loup-EscandeE.LourdeauxD.ThouveninI.ValléryG. (2020). User acceptance of virtual reality: an extended technology acceptance model. Int. J. Human–Computer Interact.36 (11), 993–1007. 10.1080/10447318.2019.1708612

  • CrossRef
  • Google Scholar

• 55

  SantanaE. D. O.SilvaL. D. S.SilvaL. A. A. D.LemosJ. L. D. A.MarcondesL.GuimarãesP. R. B.et al (2023). Effect of guided imagery relaxation on anxiety in cervical cancer: randomized clinical trial. Rev. Bras. Enferm.76 (5), e20210874. 10.1590/0034-7167-2021-0874

  • CrossRef
  • Google Scholar

• 56

  SchneiderS. M.EllisM.CoombsW. T.ShonkwilerE. L.FolsomL. C. (2003). Virtual reality intervention for older women with breast cancer. Cyberpsychol Behav.6 (3), 301–307. 10.1089/109493103322011605

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 57

  SchneiderS. M.Prince-PaulM.AllenM. J.SilvermanP.TalabaD. (2004). Virtual reality as a distraction intervention for women receiving chemotherapy. Oncol. Nurs. Forum31 (1), 81–88. 10.1188/04.Onf.81-88

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 58

  SchrempfM. C.PetzoldJ.PetersenM. A.ArndtT. T.SchieleS.VachonH.et al (2022). A randomised pilot trial of virtual reality-based relaxation for enhancement of perioperative well-being, mood and quality of life. Sci. Rep.12 (1), 12067. 10.1038/s41598-022-16270-8

  • CrossRef
  • Google Scholar

• 59

  SchubertT. W. (2009). A new conception of spatial presence: once again, with feeling. Commun. Theory19 (2), 161–187. 10.1111/j.1468-2885.2009.01340.x

  • CrossRef
  • Google Scholar

• 60

  SichiV.ErcolaniG.FranchiniL.GolfariL.VaraniS.RizzoliD.et al (2019). “Look of life: the wonder therapy,” in Virtual and Augmented Reality in Mental Health Treatment, 262–270. 10.4018/978-1-5225-7168-1.ch015

  • CrossRef
  • Google Scholar

• 61

  SiegelR. L.KratzerT. B.GiaquintoA. N.SungH.JemalA. (2025). Cancer statistics, 2025. CA A Cancer J. Clin.75 (1), 10–45. 10.3322/caac.21871

  • CrossRef
  • Google Scholar

• 62

  SkarbezR.BrooksJ. F.WhittonM. (2017). A Survey of presence and related concepts. ACM Comput. Surv.50 (96), 91–96. 10.1145/3134301

  • CrossRef
  • Google Scholar

• 63

  SkarbezR.BrooksF. P.WhittonM. C. (2021). Immersion and coherence: research agenda and early results. IEEE Trans. Vis. Comput. Graph27 (10), 3839–3850. 10.1109/tvcg.2020.2983701

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 64

  SlaterM. (2003). A note on presence terminology. Presence Connect.3. Available online at: https://s3.amazonaws.com/publicationslist.org/data/melslater/ref-201/a%20note%20on%20presence%20terminology.pdf.

  • Google Scholar

• 65

  SlaterM. (2009). Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. Philosophical Trans. R. Soc. Lond. Ser. B Biol. Sci.364 (1535), 3549–3557. 10.1098/rstb.2009.0138

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 66

  SlaterM.WilburS. (1997). A framework for Immersive Virtual Environments (FIVE): speculations on the role of presence in virtual environments. Presence Teleoperators and Virtual Environ.6, 603–616. 10.1162/pres.1997.6.6.603

  • CrossRef
  • Google Scholar

• 67

  SlaterM.Gonzalez-LiencresC.HaggardP.VinkersC.Gregory-ClarkeR.JelleyS.et al (2020). The ethics of realism in virtual and augmented reality. Front. Virtual Real.1, 1. 10.3389/frvir.2020.00001

  • CrossRef
  • Google Scholar

• 68

  SlaterM.BanakouD.BeaccoA.GallegoJ.Macia-VarelaF.OlivaR. (2022). A separate reality: an update on place illusion and plausibility in virtual reality. Front. Virtual Real.3, 914392. 10.3389/frvir.2022.914392

  • CrossRef
  • Google Scholar

• 69

  SommerJ. L.ReynoldsK.HebbardP.SmithM. S. D.MotaN.MutchW. A. C.et al (2024). Preoperative virtual reality to expose patients with breast cancer to the operating room environment: feasibility and pilot case series Study. JMIR Form. Res.8, e46367. 10.2196/46367

  • CrossRef
  • Google Scholar

• 70

  StanselC. C.McLeodA. R.GulatiS.IvoryC. H.DietrichM. S.MurrayH. N.et al (2025). Effects of virtual reality on pain, stress, and affect in an outpatient chemotherapy infusion Clinic: a randomized controlled trial. Clin. J. Oncol. Nurs.29 (1), 65–71. 10.1188/25.Cjon.65-71

  • CrossRef
  • Google Scholar

• 71

  StefaniO.SchöllhornI.MünchM. (2024). Towards an evidence-based integrative lighting score: a proposed multi-level approach. Ann. Med.56 (1), 2381220. 10.1080/07853890.2024.2381220

  • CrossRef
  • Google Scholar

• 72

  SunZ.FirestoneC. (2022). Beautiful on the inside: aesthetic preferences and the skeletal complexity of shapes. Perception51 (12), 904–918. 10.1177/03010066221124872

  • CrossRef
  • Google Scholar

• 73

  TewesM.BaumannF.TeufelM.OstgatheC. (2021). Symptoms during outpatient cancer treatment and options for their management. Dtsch. Arztebl Int.118 (17), 291–297. 10.3238/arztebl.m2021.0028

  • CrossRef
  • Google Scholar

• 74

  TongA.FlemmingK.McInnesE.OliverS.CraigJ. (2012). Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med. Res. Methodol.12 (1), 181. 10.1186/1471-2288-12-181

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 75

  UsluA.ArslanS. (2023). The effect of using virtual reality glasses on anxiety and fatigue in women with breast cancer receiving adjuvant chemotherapy: a pretest-posttest randomized controlled study. Seminars Oncol. Nurs., 39 (5), 151503. 10.1016/j.soncn.2023.151503

  • CrossRef
  • Google Scholar

• 76

  VartanianO.FarzanfarD.MunarE.SkovM.Hayn-LeichsenringG.HoP. K.et al (2024). Neural dissociation between computational and perceived measures of curvature. Sci. Rep.14 (1), 26529. 10.1038/s41598-024-76931-8

  • CrossRef
  • Google Scholar

• 77

  XieX.CaiJ.FangH.TangX.YamanakaT. (2022). Effects of colored lights on an individual's affective impressions in the observation process. Front. Psychol.13, 938636. 10.3389/fpsyg.2022.938636

  • CrossRef
  • Google Scholar

• 78

  YanK.LoerzelV. (2025). Adverse events in symptom management interventions using immersive virtual reality in older adults with cancer. Innovation Aging9 (Supplement_2), igaf122.3199. 10.1093/geroni/igaf122.3199

  • CrossRef
  • Google Scholar

• 79

  YanK.AlamianA.HansonA.LoerzelV. (2025). The effects of VR/AR/MR-based interventions on symptom management among adult cancer survivors receiving active treatments: a systematic review and meta-analysis. J. Cancer Surviv.10.1007/s11764-025-01947-6

  • CrossRef
  • Google Scholar

• 80

  ZhangH.XuH.ZhangZ. X.ZhangQ. (2022). Efficacy of virtual reality-based interventions for patients with breast cancer symptom and rehabilitation management: a systematic review and meta-analysis. BMJ Open12 (3), e051808. 10.1136/bmjopen-2021-051808

  • Pubmed Abstract
  • CrossRef
  • Google Scholar