Effects of nature-based virtual reality interventions on physical and mental health symptoms in patients with cancer undergoing chemotherapy: a systematic review and meta-analysis protocol

Objectives The study aims to evaluate the effectiveness of nature-based virtual reality (NBVR) interventions in alleviating physical symptoms (eg, pain, fatigue, nausea) and mental symptoms (eg, anxiety, depression, distress) in patients with cancer undergoing chemotherapy. Methods This systematic review protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will conduct a comprehensive electronic search of healthcare databases for studies published in English from 2012 to February 2025. The databases to be searched include PubMed, EMBASE, Web of Science, PsycINFO, Allied and Complementary Medicine, CINAHL Complete and Cochrane Library. We will include randomised controlled trials investigating NBVR aimed at improving the physical and psychological outcomes for patients with cancer during chemotherapy, compared with waitlist controls or traditional methods. The risk of bias will be systematically evaluated using the Cochrane Risk of Bias tool. Results As this is a protocol, no results are available yet. The review will present quantitative and qualitative syntheses of NBVR effects on physical and psychological outcomes in chemotherapy patients. Discussion By evaluating rigorously designed trials, this review will clarify the potential of NBVR as a supportive intervention for patients with cancer during chemotherapy. Findings are expected to inform clinical practice and guide future research directions in integrating immersive natural environments into cancer care. Conclusion This systematic review will provide comprehensive evidence on NBVR interventions for patients with cancer receiving chemotherapy, highlighting their potential benefits for physical symptom relief and mental health improvement. PROSPERO registration number CRD420251016213.