Effects of immersive virtual reality on anxiety, depression, cancer-related fatigue, and quality of life in cancer patients undergoing chemotherapy: a systematic review and meta-analysis

Background: Cancer patients undergoing chemotherapy usually experience a variety of adverse symptoms, such as anxiety, depression, and cancer-related fatigue, which negatively impact their quality of life. Immersive Virtual Reality (IVR) is considered a promising non-pharmacological intervention for cancer patients undergoing chemotherapy. However, the effects of IVR on anxiety, depression, cancer-related fatigue, and quality of life in adult cancer patients undergoing chemotherapy remain unclear. Methods: A comprehensive search was conducted across eleven electronic databases, including PubMed, Web of Science, Scopus, Embase, Cochrane Library, CINAHL, PsycINFO, CNKI, WanFang, VIP, and CBM, from their inception to January 2026. We included randomized controlled trials examining the impact of IVR on anxiety, depression, cancer-related fatigue, and quality of life among adult cancer patients undergoing chemotherapy. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool 2.0 (ROB 2.0). The certainty of the evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. For quantitative synthesis, a random-effects model was applied to all meta-analyses. Results: A total of 11 randomized controlled trials involving 1160 cancer patients undergoing chemotherapy were included. The meta-analysis results demonstrated that IVR significantly reduced anxiety (SMD = -1.02, 95% CI: -1.70 to -0.33, low certainty evidence), depression (SMD = -1.59, 95% CI: -2.71 to -0.46, low certainty evidence), and cancer-related fatigue (SMD = -1.17, 95% CI: -1.96 to -0.37, low certainty evidence), as well as improved quality of life (SMD = 0.76, 95% CI: 0.32 to 1.21, low certainty evidence) compared to usual care. Conclusions: Compared with usual care, IVR appears to be more effective in reducing anxiety, depression, and cancer-related fatigue in cancer patients undergoing chemotherapy, while also improving quality of life. However, these findings should be validated by more high-quality randomized controlled trials.