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These poor quality of life outcomes reflect underlying dysregulation of autonomic, neuroendocrine, and immune systems. Autonomic imbalance characterized by vagal withdrawal and sympathetic hyperactivation is linked to increased inflammatory load, impaired stress regulation, disrupted sleep, and poorer survival outcomes. Given the role of the vagus nerve in coordinating brain\u2013body signaling and immune modulation, transcutaneous vagus nerve stimulation (tVNS) has emerged as a promising intervention to restore autonomic balance and attenuate psychophysiological burdens. Evidence suggests that tVNS modulates locus coeruleus\u2013norepinephrine activity, regulates arousal and sleep, reduces fatigue and anxiety, enhances cognitive function, and activates the cholinergic anti-inflammatory pathways. Supported by mechanistic and clinical evidence, we propose tVNS as a precision-guided bioelectronic strategy for improving survivorship outcomes in breast cancer.<\/jats:p>","DOI":"10.3389\/fonc.2026.1731999","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:49:14Z","timestamp":1770187754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Transcutaneous vagus nerve stimulation in breast cancer: a neuroimmune model to improve quality of life"],"prefix":"10.3389","volume":"16","author":[{"given":"Melissa","family":"Do","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, University of Alabama at Birmingham, School of Engineering","place":["Birmingham, AL, United States"]},{"name":"Center for Neuroengineering and Brain Computer Interfaces, Heersink UAB School of Medicine","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Tyler","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Alabama at Birmingham, School of Engineering","place":["Birmingham, AL, United States"]},{"name":"Center for Neuroengineering and Brain Computer Interfaces, Heersink UAB School of Medicine","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA: A Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.3794","article-title":"Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review","volume":"10","author":"So","year":"2021","journal-title":"Cancer Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1586\/erp.11.55","article-title":"A literature review of symptom clusters in patients with breast cancer","volume":"11","author":"Nguyen","year":"2011","journal-title":"Expert Rev Pharmacoeconom Outcomes Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ddmod.2011.05.001","article-title":"The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: severity of the problem and treatment options","volume":"8","author":"Fiorentino","year":"2011","journal-title":"Drug Discov Today Dis Models"},{"key":"B5","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s10549-020-05522-8","article-title":"Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics","volume":"180","author":"Bjerkeset","year":"2020","journal-title":"Breast Cancer Res Treat"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-016-3417-6","article-title":"Quality of life (QOL) and symptom burden (SB) in patients with breast cancer","volume":"25","author":"Hamer","year":"2017","journal-title":"Supportive Care Cancer"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1080\/j.1440-1614.2004.01358.x","article-title":"Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis","volume":"38","author":"Kissane","year":"2004","journal-title":"Aust New Z J Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4103\/2347-5625.178163","article-title":"Patient care and outcomes: why cancer care should screen for distress, the 6th vital sign","volume":"3","author":"Bultz","year":"2016","journal-title":"Asia-Pacific J Oncol Nurs"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1188\/06.ONF.E18-E26","article-title":"Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life","volume":"33","author":"Byar","year":"2006","journal-title":"Oncol Nurs Forum"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2018.01.005","article-title":"Physical symptom burden and its association with distress, anxiety, and depression in breast cancer","volume":"59","author":"McFarland","year":"2018","journal-title":"Psychosomatics"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.05.012","article-title":"Symptom burden clusters: A challenge for targeted symptom management. 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