{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:27:53Z","timestamp":1783110473364,"version":"3.54.6"},"reference-count":48,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast cancer patients frequently experience psychological burdens such as anxiety, depression, and distress, alongside physical symptoms like fatigue. Immersive virtual reality (IVR), particularly nature\u2010based experiences, may provide a scalable, nonpharmacological adjunct to promote well\u2010being by fostering relaxation, distraction, and positive affect. However, the effectiveness of nature\u2010based IVR in this population remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of nature\u2010based immersive virtual reality trials on psychological and physical health outcomes in breast cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review followed the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines. A comprehensive search was conducted in seven databases from inception to July 31, 2025. Two reviewers independently screened articles, extracted data, and assessed study quality. RevMan 5.3 was used for risk of bias assessment and meta\u2010analysis. The review was registered with PROSPERO (CRD420251123651).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies were included; nine contributed data to the meta\u2010analysis (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01037). Interventions employed two primary formats: exposure to static, nature\u2010based environments (e.g.,\u00a0forests) accompanied by calming music, and interactive experiences that allowed patients to virtually explore the natural environment. The findings revealed several benefits, including reduced anxiety (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a07; SMD\u00a0=\u00a0\u22121.76, 95% CI \u20132.61 to \u22120.91;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a094%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01; low certainty) and distress (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03; SMD\u00a0=\u00a0\u22120.83, 95% CI \u20131.30 to \u22120.36;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a083%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01; low certainty).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For breast cancer patients, nature\u2010based IVR may be considered as a promising supportive care intervention to reduce anxiety and distress. Clinicians may offer brief sessions (5\u201320\u00a0min) during chemotherapy infusion, radiotherapy waiting periods, perioperative recovery, and survivorship visits using head\u2010mounted displays with calming, nature content.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70493","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T06:26:57Z","timestamp":1780295217000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Nature\u2010Based Immersive Virtual Reality on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1820-5867","authenticated-orcid":false,"given":"Surui","family":"Liang","sequence":"first","affiliation":[{"name":"School of Nursing Tung Wah College  Hong Kong SAR China"},{"name":"Shenzhen Hospital of Southern Medical University  Shenzhen Guangdong China"},{"name":"Translational Research Centre for Digital Mental Health Tung Wah College  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8242-811X","authenticated-orcid":false,"given":"Jing Jing","family":"Su","sequence":"additional","affiliation":[{"name":"School of Nursing Tung Wah College  Hong Kong SAR China"},{"name":"Translational Research Centre for Digital Mental Health Tung Wah College  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2731-1613","authenticated-orcid":false,"given":"Winnie Wai In","family":"Wong","sequence":"additional","affiliation":[{"name":"School of Nursing Tung Wah College  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4332-780X","authenticated-orcid":false,"given":"Rick Yiu Cho","family":"Kwan","sequence":"additional","affiliation":[{"name":"School of Nursing Tung Wah College  Hong Kong SAR China"},{"name":"Translational Research Centre for Digital Mental Health Tung Wah College  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21863"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2022.08.010"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1451101"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/10732748241249355"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41416\u2010021\u201001542\u20103"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ncc.0000000000001048"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.13131"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2542\u20105196(22)00268\u20106"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.2"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/cyber.2009.0308"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10937404.2016.1196155"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3233\/bd\u2010249005"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4980"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911\u2010023\u201002108\u20104"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlpt.2023.100741"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-23161-2_165"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1017\/s1478951518000639"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2023.2257627"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.2196\/38300"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.29422"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.2196\/53825"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/ncc.0000000000001099"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n160"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2020-209567"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885\u2010021\u201009081\u2010z"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnss.2025.02.008"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_2_10_30_1","unstructured":"J. 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