Transcutaneous vagus nerve stimulation in breast cancer: a neuroimmune model to improve quality of life

Breast cancer care has shifted beyond remission toward optimizing long-term physiological, emotional, and functional recovery. Many survivors continue, however, to experience persistent symptom clusters, such as insomnia, fatigue, anxiety, pain, depression, and cognitive impairment. These poor quality of life outcomes reflect underlying dysregulation of autonomic, neuroendocrine, and immune systems. Autonomic imbalance characterized by vagal withdrawal and sympathetic hyperactivation is linked to increased inflammatory load, impaired stress regulation, disrupted sleep, and poorer survival outcomes. Given the role of the vagus nerve in coordinating brain-body signaling and immune modulation, transcutaneous vagus nerve stimulation (tVNS) has emerged as a promising intervention to restore autonomic balance and attenuate psychophysiological burdens. Evidence suggests that tVNS modulates locus coeruleus-norepinephrine activity, regulates arousal and sleep, reduces fatigue and anxiety, enhances cognitive function, and activates the cholinergic anti-inflammatory pathways. Supported by mechanistic and clinical evidence, we propose tVNS as a precision-guided bioelectronic strategy for improving survivorship outcomes in breast cancer.