A VIRTUAL REALITY-BASED MINDFULNESS INTERVENTION FOR MANAGING IMMUNOTHERAPY-RELATED FATIGUE: A RANDOMIZED CONTROLLED TRIAL.
Keywords:
Fatigue, Immunotherapy, Mindfulness, Neoplasms, Quality of Life, ; Randomized Controlled Trial, Virtual RealityAbstract
Background: Immunotherapy-related fatigue is a persistent and debilitating symptom among patients receiving immune checkpoint inhibitors, often impairing physical functioning and overall well-being. Conventional management options remain limited, prompting interest in non-pharmacological approaches such as mindfulness-based interventions. Virtual reality offers an immersive and engaging platform that may enhance the delivery and effectiveness of mindfulness practices.
Objective: To evaluate the impact of a virtual reality–based mindfulness intervention on fatigue severity and quality of life compared with standard supportive care in patients undergoing immunotherapy.
Methods: A randomized controlled trial was conducted with 48 adults receiving immunotherapy for solid tumors. Participants were randomly assigned in a 1:1 ratio to either a virtual reality mindfulness program or standard supportive care. Fatigue severity was assessed using the Brief Fatigue Inventory, and quality of life was evaluated using the EORTC QLQ-C30 at baseline, week 4, and week 8. Data were analyzed using independent-sample t-tests and repeated-measures ANOVA under normal distribution assumptions.
Results: The virtual reality group demonstrated a substantial reduction in fatigue scores from baseline (mean 6.8 ± 1.2) to week 8 (3.9 ± 1.0), compared with smaller changes observed in the control group (6.7 ± 1.3 to 5.9 ± 1.3). Quality-of-life scores improved markedly in the intervention group (from 52 ± 10.7 to 71 ± 11.5), whereas the control group showed minimal improvement (51 ± 11.1 to 56 ± 10.6). Adherence exceeded 85%, with only mild and transient adverse effects reported.
Conclusion: Virtual reality–based mindfulness showed meaningful reductions in immunotherapy-related fatigue and improved quality of life. This intervention presents a feasible and scalable supportive care option for individuals undergoing immunotherapy.
References
1. Wang G, Pan SJAoSO. Psychological Interventions and Sleep Improvement for Patients with Gastric Cancer: Effects on Immune Function, Inflammation, and Tumor Progression—A Randomized Controlled Trial. 2025:1-19.
2. Světlák M, Malatincová T, Halámková J, Barešová Z, Lekárová M, Vigašová D, et al. The effectiveness of three mobile-based psychological interventions in reducing psychological distress and preventing stress-related changes in the psycho-neuro-endocrine-immune network in breast cancer survivors: Study protocol for a randomised controlled trial. 2023;32:100628.
3. Zuniga JAM. Beyond Survival: Evaluating the Effectiveness and Quality of Life Outcomes of Chemoimmunotherapy Compared to Standalone Cancer Treatments.
4. Lee S-C, Tsai P-H, Yu K-H, Chan T-M, editors. Effects of Mind–Body Interventions on Immune and Neuroendocrine Functions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Healthcare; 2025.
5. Fuller-Shavel N, Krell JJCOR. Integrative Oncology Approaches to Supporting Immune Checkpoint Inhibitor Treatment of Solid Tumours. 2024;26(2):164-74.
6. Cuthrell KMJINDJ. Integrative psychocardiology: strategies for managing mental and cardiac risks in oncology patients. 2025;22:37-52.
7. Huang B, An H, Wu H, Qiu Y, Su Y, Chen L, et al. Chronic Psychological Stress in Oncogenesis: Multisystem Crosstalk and Multimodal Interventions. 2025;8:0948.
8. Tyagi V, Tanwar N, Kumar N, Phogat N, Kumar P, Kumar VJCCTR. Non-Pharmaceutical Interventions in Cancer Therapy. 2025;21(4):462-86.
9. Casciano F, Caruso L, Zauli E, Gonelli A, Zauli G, Vaccarezza MJB. Emerging Mechanisms of Physical Exercise Benefits in Adjuvant and Neoadjuvant Cancer Immunotherapy. 2024;12(11):2528.
10. Standish LJ, Malani SM, Lynch K, Whinkin EJ, McCotter CM, Lynch DA, et al. Integrative oncology’s 30-year anniversary: What have we achieved? A North American naturopathic oncology perspective. 2023;22:15347354231178911.
11. Biskupiak Z, Ha VV, Rohaj A, Bulaj GJJocm. Digital therapeutics for improving effectiveness of pharmaceutical drugs and biological products: preclinical and clinical studies supporting development of drug+ digital combination therapies for chronic diseases. 2024;13(2):403.
12. Andavar A, Bhagavathi VR, Cousin J, Parekh N, Razavi ZS, Tan BJB. Current research in drug-free cancer therapies. 2025;12(4):341.
13. Bora SJ, Deka DJ, Malakar C, Kashyap N, Das BKJCCTR. Breast Cancer Management: The Role of Nutrition, Exercise and Psychosocial Well-being. 2025;21(3):403-19.
14. Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, et al. Cancer-related fatigue in lung cancer: a research agenda: an official American Thoracic Society research statement. 2023;207(5):e6-e28.
15. De Nys L. A Literature Review on Hypothalamic–Pituitary–Adrenal (HPA) Axis Dysregulation in Older Adults with Cancer: A Missing Link in Predicting Treatment Toxicity? 2025.
16. Disis ML, Adams SF, Bajpai J, Butler MO, Curiel T, Dodt SA, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gynecologic cancer. 2023;11(6):e006624.
17. Aquino-Acevedo AN. Stress Hormones Are Associated With Inflammatory Cytokines and Attenuation of T-Cell Function in High Grade Serous Ovarian Cancer: Ponce Health Sciences University; 2023.
18. Wang Y, Malek MJJoOR. Molecular, cellular, biochemical, and rehabilitative insights into exercise interventions for gynecological cancer prevention and survivorship: a narrative review. 2025;18:147.
19. Cleanclay WD, Zakari S, Adigun TO, Ayeni TO, Nnaji PC, Nnenna AD, et al. Cancer Biology and Therapeutics: Navigating Recent Advances and Charting Future Directions. 2023;7(12).
20. Eschler BD, Wefel JS, Bradshaw ME. The neuropsychology of oncology. 2024.
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Copyright (c) 2025 Hafiz Niamat Ullah, Misbah Nargis (Author)
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