Exploring the temporal dynamics of circadian rhythm-aligned VR intervention in mitigating fear of cancer recurrence: mediating roles of illness uncertainty and hope in gynecological cancer patients

Background: Fear of cancer recurrence (FCR) is a prevalent and clinically significant psychological burden that adversely affects the quality of life and treatment adherence among gynecological cancer survivors. Virtual reality (VR), an emerging therapeutic modality, has demonstrated potential applications in oncology-related psychological interventions. This study investigates the efficacy of a chronotype-based timed VR intervention in alleviating FCR and explores the mediating mechanism of illness uncertainty (IU) and hope. Methods: = 32). Both groups received standard medical care. The intervention group completed a 4-week VR intervention (5 sessions per week, 20 min per session) scheduled according to individual chronotypes, which were assessed via the Morningness-Eveningness Questionnaire. Outcome measures, including FCR, IU, and hope, were collected at baseline, 1 week (T1), 1 month (T2), and 3 months (T3) after the intervention. Data were analyzed using ANCOVA and PROCESS macro for mediation effects. Results: = 0.535-0.617). Mediation analyses revealed dynamic mechanisms: T1 (parallel/chain mediation by IU and hope, accounting for 74.7% of total effect); T2 (only IU mediated, 50.3%); T3 (direct effect dominant, 82.0%). Conclusion: A chronotype-based timed virtual reality intervention effectively reduces fear of cancer recurrence in gynecological cancer patients and acts through mediating pathways by reducing illness uncertainty and enhancing the level of hope. These findings provide empirical support for integrating chronotype-aligned virtual reality intervention into clinical practice and underscore the importance of considering temporal dynamics in psychological intervention design.