The use of virtual reality in cancer patient health education: A scoping review

Abstract

Objectives

This scoping review aimed to identify and summarize the current research on virtual reality (VR) technologies used for health education in cancer patients, as well as to identify key areas of application.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a comprehensive literature search was performed across 11 electronic databases and gray literature sources from inception to 12 September 2025. Studies employing immersive VR tools to improve health education outcomes in cancer patients were included. Data extraction and thematic synthesis were conducted to map evidence regarding VR modalities, educational applications, and outcome measures.

Results

Twenty-eight studies met the inclusion criteria. VR was applied across four primary educational scenarios, including radiotherapy, chemotherapy, surgery, and healthy behavior (including rehabilitation, smoking cessation, and self-management). Eight distinct VR modalities were identified, namely VR videos, virtual environments, virtual environment for radiotherapy training (VERT), VR interactions, 3D models, VR games, VR non-player characters (VR NPCs), and virtual libraries. Among these, VR videos (50.0 %), virtual environments (46.4 %), and VR interactions (28.6 %) were the most frequently employed. The interventions led to significant improvements in patient knowledge, skills, attitudes, health behaviors, and psychological well-being. A clear evolution in VR educational approaches has been observed, shifting from static environmental familiarization toward interactive, gamified, and intelligence-driven experiences. Nevertheless, notable gaps remain regarding safety protocols and data privacy protections, with only a minority of studies addressing these issues.

Conclusions

VR technologies demonstrate considerable promise as an innovative educational tool in oncology care, enhancing patient understanding, psychological preparedness, and engagement throughout the cancer journey. Future implementation must address infrastructural, ethical, and user-centered design barriers to facilitate the scalable and sustainable integration of this approach into clinical practice.

What is known?

• •Cancer itself and its complex treatment processes, if poorly managed, can impose a significant burden on individuals and society.
• •Virtual reality (VR) tools demonstrated significant potential in advancing cancer health education.

What is new?

• •Eight VR tools are primarily employed for health education among cancer patients. These include virtual environments, virtual libraries, virtual environments for radiotherapy training (VERT), VR videos, 3D models, VR interaction, VR games, and VR non-player characters (VR NPCs).
• •VR tools are predominantly employed across four educational settings: radiotherapy, chemotherapy, surgical procedures, and health behavior promotion. They have beneficial impacts on five core patient outcomes: knowledge, skills, attitudes, health behaviors, and psychological well-being.
• •A transformation is underway in VR health education, shifting from static environments and video presentations toward intelligent modalities characterized by interactivity, gamification, and guidance from virtual characters. Concurrently, its function is expanding from merely elevating knowledge levels to enabling comprehensive improvements in health behaviors and psychological well-being.

1. Introduction

Cancer poses a serious threat to human health and life and has imposed an enormous burden on both individuals and society [1,2]. Cancer patients often undergo multiple complex treatment and rehabilitation processes, such as surgery, radiotherapy, chemotherapy, and postoperative rehabilitation training [2]. If inadequately managed, this may lead to a range of psychological symptoms, such as anxiety (61.0 %) [3] and depression (42.6 %) [4], in addition to physiological issues, including physical functional impairment and reduced activity capacity [5,6]. This subsequently increases complications by 28.4 % or more [7,8], prolongs hospital stays by more than two days [8], and severely affects quality of life. Multiple studies have demonstrated that health education enables patients to comprehend the cancer treatment process fully, encouraging active participation that, in turn, enhances treatment efficacy and adherence, thereby improving long-term survival rates [[9], [10], [11]].

Currently, diverse approaches are employed to provide health education to cancer patients. Methods such as lectures and group sessions enable immediate offline feedback on educational outcomes, enhancing knowledge acquisition [12]. Telephone follow-ups reinforce knowledge retention and further improve self-management capabilities [12]. With advancements in medical technology, virtual reality (VR) has emerged as an effective tool for enhancing cancer patient health education [13,14]. Immersive VR employs head-mounted displays to integrate visual, auditory, and other sensory inputs, fully immersing patients within simulated environments [15]. Following video sequences or engaging in interactive games stimulates learning interest, enabling patients to acquire knowledge and skills related to cancer treatment through enjoyable experiences [16]. Conversely, nonimmersive VR employs computer-generated instructional imagery, with knowledge acquisition facilitated through keyboard and mouse interactions [15]. Nevertheless, to date, no comprehensive review has synthesized evidence regarding the types, applications, and efficacy of VR tools developed explicitly for cancer patient education. Although a range of VR technologies pertinent to cancer patient health education, such as digital immersive virtual libraries for storing and presenting disease-related information resources [17] and virtual nonplayer characters designed to advance the educational process [18], have been developed and are currently under active investigation, these approaches have demonstrated efficacy in enhancing knowledge acquisition, improving self-management capabilities, and bolstering physical function [16,19]. However, the development of these techniques has been fragmented, involving diverse research methodologies with considerable heterogeneity, making it challenging to select the most effective approach.

This study employs a scoping review methodology to identify research on VR technology for health education among cancer patients, and to elucidate its primary application domains and evaluation metrics.

2. Methods

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [20] and reported following the Joanna Briggs Institute methodology for Scoping Reviews [21]. It was also preregistered on the Open Science Framework website (https://doi.org/10.17605/OSF.IO/D7ZYG).

2.1. Criteria for eligibility

As anticipated in a scoping review, the inclusion criteria for the studies in this review were broadly defined by population, context, and concept [20,22]. The population encompassed patients with any form of cancer, without restrictions based on age, sex, race, beliefs, type of course being studied, or country of origin. Health education was conceptualized as a systematic activity aimed at disseminating health knowledge, skills, and attitudes to individuals and groups, specifically cancer patients, through various educational means and methods. This process encourages positive changes in lifestyle and behavior to improve health, prevent disease, and promote overall wellness. Its primary objectives include enhancing health knowledge, modifying health behaviors, and improving self-care abilities and quality of life [9]. In this study, the health education tools refer specifically to VR methods. The context included papers from diverse cultures that focused on the design, development, or implementation of VR techniques to enhance health education for cancer patients. Regarding publication categories, to ensure a comprehensive retrieval of relevant evidence and mitigate publication bias, this review considered not only peer-reviewed journal articles employing qualitative, quantitative, and mixed-method designs, but also academic dissertations and theses. These gray literature sources often contain detailed methodologies and valuable preliminary data that contribute to a fuller understanding of the research landscape. To mitigate linguistic bias, studies not published in Chinese or English were excluded from the analysis.

2.2. Search strategy

The research utilized a three-phase search approach. A preliminary search was performed in CINAHL and PubMed, facilitating an examination of keywords in the titles, abstracts, and index terms. The search approach was then refined and tailored for each subsequent database. Finally, reference lists from the ultimately selected research were examined for additional acceptable studies, along with recommendations from the library personnel. The databases examined included the CINAHL, PubMed, Web of Science, Embase, the Cochrane Library, Scopus, and IEEE Xplore, as well as the following Chinese databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBM). The investigation of unpublished or gray literature included the ProQuest Dissertations and Theses Global database. The search period spans from the database’s establishment to 21 October 2024, with updates on 12 September 2025. A combination of MeSH terms, free words, and Boolean connectives was utilized for searching. At least the following terms were incorporated: neoplasms/oncology/Tumor/Cancer, patients, virtual reality/virtual reality therapy/smart glasses/head-mounted display, as well as education/teaching/learning (Appendix A).

2.3. Study selection

All the search results were imported into NoteExpress for data management. After all duplicate studies were removed, two researchers independently conducted a primary screening by examining the titles and abstracts of the studies. Afterward, they reviewed the full text of each study in accordance with the inclusion and exclusion criteria. Moreover, they cross-checked the screening results. Any discrepancies were resolved by discussion or consultation with a third researcher.

2.4. Data extraction and synthesis

The studies' first author, year, country, objective, study design, intervention, and outcome were extracted and coded using an Excel data extraction form. The data collection instrument and process were pilot tested to ensure consistency and complete data extraction. Following the pilot testing, one member of the research team independently extracted data from each included article. A second reviewer conducted a review of the extracted data. Any discrepancies were resolved by discussion or, if necessary, by consulting a third reviewer. Based on the extracted data, we describe the general characteristics of the included literature and the application of VR.

3. Results

3.1. Search results

A total of 4,901 records were initially retrieved, comprising 4,874 studies and 27 gray literature. From the initial 4,874 studies obtained, 2,199 were eliminated as duplicates, and the titles and abstracts of the remaining 2,675 studies were evaluated for relevance according to the inclusion criteria. A total of 2,378 studies were subsequently excluded, resulting in the identification of 297 records for full-text screening. From the total records, 270 were excluded, and data were collected from the remaining 27 records. After 19 irrelevant records at the title/abstract stage were excluded, eight full-text records were reviewed. Among 27 gray literature, after excluding seven irrelevant records, the remaining one was included. In conclusion, 28 studies [[23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50]] satisfied the inclusion criteria and were included in the review (Fig. 1).

Fig. 1.

Flow diagram of study selection. VR = virtual reality.

3.2. Characteristics of the included studies

The included studies were published between 2016 and 2025, with 22 (78.6 %) published within the past five years. Geographically, eight studies were conducted in the United States [24,26,30,35,37,40,45,50], six in China [25,32,34,[47], [48], [49]], and four in Australia [31,39,41,44], three studies were conducted in the Republic of Korea [38,42,46], and two were conducted in the United Kingdom [27,43], with the remaining studies being conducted in Saudi Arabia [23], Amsterdam [36], Canada [33], Denmark [29], and Germany [28]. With respect to the research settings, 24 studies (85.7 %) were conducted exclusively in health care environments such as hospitals, cancer centers, or clinics [[23], [24], [25], [26], [27], [28], [29],[33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43],[45], [46], [47], [48], [49], [50]]; two studies took place in both hospital and home settings [32,44]; one study was conducted in the home [30]; and only one study required patients to operate within a dedicated virtual radiotherapy training environment [31].

In terms of research methodology, the studies included nine pilot studies [24,25,28,30,33,36,37,41,47], seven randomized controlled trials [23,34,40,42,46,48,49], four nonrandomized controlled trials [29,32,39,45], four mixed-method studies [26,27,43,44], two observational studies [35,50], one quasi-experimental study [31], and one case study [38]. The time points for outcome measurement were predominantly immediate postintervention, allowing for the assessment of short-term effects on anxiety, knowledge, and satisfaction. A subset of studies incorporated follow-up assessments to evaluate longer-term effects. For example, Ahmed et al. [23] conducted evaluations both postintervention and at the 2-month follow-up, demonstrating sustained improvements in functional outcomes. Similarly, Tsai et al. [45] assessed outcomes post-intervention and at the 4-week follow-up, noting retained knowledge gains and high eHealth literacy.

The included studies incorporated patients with multiple cancer types, with some investigations covering several cancers simultaneously, including lung cancer, gastrointestinal cancers, breast cancer, prostate cancer, bone cancer, intracranial tumors, head and neck cancers, hematological malignancies, gynecological cancers, and skin cancers. Breast cancer constituted the largest proportion (39.3 %). The majority of the 1,356 patients were female, with an average age typically ranging from 47 to 68 years. More than half of the participants held a high school qualification or higher. Detailed information is provided in Appendix B.

3.3. Types of virtual reality

This review identified eight distinct VR technologies employed in health education for cancer patients, encompassing VR videos, virtual environments, virtual environments for radiotherapy training (VERT), VR interactions, 3D models, VR games, VR non-player characters (VR NPCs), and virtual libraries. 1) VR videos: the most frequently used modality, were employed in 14 studies (50.0 %) [24,28,30,32,33,[38], [39], [40],42,[44], [45], [46], [47], [48]]. They deliver health education content through a 360-degree panoramic format, facilitating the demonstration and clarification of treatment and care procedures [51]. 2) Virtual environments: featured in 13 studies (46.4 %) [23,[25], [26], [27], [28], [29],34,38,40,45,46,49,50], provide immersive, three-dimensional simulated settings that enable user interaction within a digital space, thereby helping patients understand clinical settings and procedures [51]. 3) A specialized form, VERT, was used in three studies (10.7 %) [31,36,43] to simulate radiotherapy equipment and processes, thereby improving patient understanding of and compliance with specialized positioning requirements [25]. 4) VR interactions: applied in eight studies (28.6 %) [25,28,32,34,40,[48], [49], [50]], build upon virtual environments to enable real-time interaction between patients and virtual objects or characters [52]. 5) 3D models: utilized in six studies (21.4 %) [35,37,38,41,46,50], reconstruct organs or anatomical structures from medical imaging data to support disease-related knowledge acquisition [53]. These four modalities — virtual environments, VR interactions, 3D models, and VERT — primarily employed single-session interventions, with durations ranging from ≤15 min to unrestricted time, and focused on enhancing knowledge and reducing anxiety. 6) VR games: incorporating gamification elements to deliver health management education through interactive tasks [54], were implemented in three studies (10.7 %) [23,26,32]. Among these, one study used a single unrestricted session [26], while two employed multiple sessions (each ≤30 min) [23,32]. 7) VR NPCs — algorithm-driven virtual entities that provide guidance and automated feedback [18] — were used in two recent studies (7.1 %) [32,40], both of which employed single 15–30-min sessions. These interactive approaches demonstrated efficacy in improving knowledge, alleviating anxiety, and modifying health behaviors. 8) Virtual libraries: implemented in only one study (3.6 %) [27], function as searchable digital repositories of medical information within VR platforms, enabling resource sharing between clinicians and patients [17]. This format had a positive influence on knowledge, skills, behaviors, and attitudes. Furthermore, several studies employed combinations of multiple technologies from the aforementioned eight categories. Two studies integrated up to four distinct technologies [32,40], including VR videos, VR interaction, VR NPCs, virtual environments, or VR games. Additionally, four studies combined three modalities [28,38,46,50]. Furthermore, eight studies simultaneously employed two distinct types of VR technology [23,[25], [26], [27],34,45,48,49].

3.4. Application scenarios for virtual reality

Different VR tools also exhibited distinct characteristics across varying application scenarios, including radiotherapy, chemotherapy, surgery and healthy behavior (rehabilitation, smoking cessation, and self-management).

3.4.1. Radiotherapy

Thirteen studies investigated VR-based health education in radiotherapy for cancer patients [25,26,29,31,33,36,39,40,[42], [43], [44],47,50]. Three studies utilized a mature and established VERT system to familiarize patients with the radiotherapy process in advance [31,36,43]. Other studies have employed custom-built VR apparatuses. Within immersive virtual environments, patients typically begin by viewing VR videos to familiarize themselves with the entire radiotherapy process and associated precautions [39,42,47]. Clinicians subsequently utilized 3D anatomical models to explain the treatment field and positional coordination [50]. Finally, interactive simulations were used to practice patient positioning [25,42,50]. Using this approach, 74 % of patients reported a better understanding of how radiotherapy is used to treat their cancer [50]. One study integrated gamified elements to train patients in treatment coordination, which successfully alleviated pre-radiotherapy anxiety in 78 % of patients and enabled them to master the required treatment maneuvers, such as maintaining a breath-hold for at least 25 s [26].

3.4.2. Chemotherapy

Two studies employed VR for chemotherapy education [24,34]. One study using VR videos reported an increase in patients’ mean self-efficacy scores from 78.5 to 86.3 [24]. In another study, which utilized an immersive environment, patients' chemotherapy-related knowledge scores improved from 65.77 ± 5.14 to 85.97 ± 5.08 post-intervention, a significant increase compared to the control group’s score of 74.73 ± 5.17 (P < 0.0001) [34].

3.4.3. Surgery

There are six studies on preoperative health education for cancer patients [35,37,38,41,45,46]. These interventions commonly feature virtual anatomy centers [38,45,46] or patient-specific 3D anatomical models [35,37,38], enabling the immersive visualization of surgical procedures. Patients view surgical procedures via VR videos [38,45] and interact with doctors to understand the surgical site and perioperative care [37,41,46]. With this method, the anxiety scores (State-Trait Anxiety Inventory, STAI) of the VR group decreased from 45.16 ± 11.2 to 41.02 ± 11.2 (P < 0.05), whereas their knowledge scores increased from 11.34 ± 3.9 to 17.20 ± 2.6 (P < 0.001) [46].

3.4.4. Health behavior promotion

In the realm of health behavior promotion, five studies examined postsurgery VR-based rehabilitation education [23,27,32,48,49]. These programs combined immersive video demonstrations with motion-sensing feedback to guide exercises such as post-mastectomy upper limb mobility training, head and neck cancer swallowing therapy, and post-lung surgery breathing exercises [23,27,32,48,49]. One study revealed that following VR rehabilitation training, the observed group of patients (n = 40) demonstrated significantly superior shoulder abduction range of motion (70.31° ± 10.29°) compared to the control group (52.75° ± 10.63°), with the intergroup difference being statistically significant (P < 0.05) [49]. Another study also reported that patients utilizing this method walked 20 m further than the control group in the 6-min walk test [48]. A pilot study combined VR-based mindfulness exposure therapy with cognitive behavioral techniques, enabling patients to perform desensitization exercises within virtual environments rich in triggers to support smoking cessation [30], resulting in 20 % of cancer patients successfully quitting smoking or substantially reducing their tobacco intake. One study combined virtual environments, VR videos, and VR interactions to enhance self-management capabilities among colorectal cancer patients, encompassing stoma care education, interactive recall exercises, and training in ostomy pouch replacement skills [28].

3.5. Trends in virtual reality technology applications

The application of VR technology among cancer patients initially focused on educating them about radiotherapy. Researchers designed static virtual environments specifically for radiotherapy patients to aid in their adaptation to the radiotherapy setting and positioning requirements. Due to its integration of visual, auditory, and immersive environmental elements, VR technology incorporating dynamic videos has gained widespread application across various educational scenarios, including radiotherapy, chemotherapy, surgery, and health behavior promotion. Concurrently, real-time interactive VR modes underwent further development and implementation in the context of patient education for radiotherapy. With the continuous advancement of big data modeling, VR technology utilizing data-reconstructed three-dimensional virtual organs and human anatomical structures has been deployed for surgical education and training. Over the past three years, VR NPCs and VR games have garnered increased attention. Characterized by role-playing or task-based challenges, these applications leverage big data models to enhance interaction and feedback. As VR technology and methodologies advance, evaluations of intervention efficacy have progressively expanded from knowledge, skills, and information acquisition to encompass behavioral and psychological changes (Fig. 2).

Fig. 2.

Alluvial map based on VR in different health education scenarios. VR = virtual reality. VERT = virtual environments for radiotherapy training. NPCs = non-player characters.

3.6. Privacy and security issues in virtual reality

Ten studies [24,30,33,40,[42], [43], [44], [45], [46],48] examined safety concerns associated with using VR for health education, including motion sickness, device-induced illness, and potential infections. Seven of these studies directly excluded patients at risk of adverse events, such as those with motion sickness, epilepsy, implanted cardiac pacemakers, or methicillin-resistant Staphylococcus aureus infections [24,30,33,40,42,43,46]. The remaining three studies monitored adverse reactions (such as dizziness, nausea, and fatigue) and reported favorable safety outcomes [44,45,48]. Only one study addressed patient privacy concerns, although this involved only basic anonymization and data formatting [55]. The remaining studies did not mention measures concerning patient safety or privacy.

4. Discussion

This scoping review, based on 28 studies, evaluates the application of VR in health education for cancer patients. The findings highlight the potential of VR in enhancing health-related knowledge, skills, behaviors, and attitudes across all stages of cancer treatment. This includes education pertaining to radiotherapy, chemotherapy, and surgery, as well as postoperative rehabilitation. This positions VR not merely as a technological novelty but as a promising adjunct to conventional patient education within oncology nursing care.

Our analysis indicates that VR technology is currently more prevalent in developed nations such as the United States, Australia, and the Republic of Korea, typically targeting hospitalised patients under the age of 70 with at least a secondary school education. Evidently, present VR interventions may predominantly attract individuals with higher health literacy and greater technological familiarity, potentially limiting the generalisability of research findings to elderly, less educated, or outpatient populations. The controlled inpatient setting itself facilitates improved adherence and enables safety monitoring, whereas home-based VR applications face challenges such as technical barriers and low adherence. One study confirmed that actual usage rates were significantly lower than planned protocols [30]. Analysis across disease types reveals that the most prevalent current application is among breast cancer patients. This is partly because breast cancer patients frequently experience significant physical and psychological symptoms, and partly because the immersive nature of VR is well-suited to delivering engaging upper limb rehabilitation training within a secure environment [56,57]. Consequently, breast cancer patients constitute a primary user group for VR technology. This study also found that the effectiveness of VR interventions may be influenced by the duration of time. According to studies, the benefits of anxiety reduction may diminish after four weeks [42], whereas health education knowledge retention continues to improve up to two weeks post-intervention [31,43]. This suggests a potential two-week window of optimal VR impact, prompting the consideration of additional VR sessions in the third week to sustain benefits.

The key finding of this review is that VR technology exists in multiple distinct forms, each suited to different objectives and scenarios. For procedures that require a concrete understanding, such as radiotherapy and surgery, highly realistic virtual environments (e.g., simulated radiotherapy suites [31] and operating rooms [38]) are employed to demystify processes and enhance procedural knowledge. Studies utilizing platforms like VERT have demonstrated effectiveness in enhancing patient confidence regarding treatment adherence [36]. Conversely, for promoting engagement in rehabilitation exercises, VR often leverages familiar, non-clinical game-like environments (e.g., cartoon scene) [32]. This strategic divergence reflects a deliberate design choice between employing realism to mitigate uncertainty in clinical procedures and utilizing engagement-focused immersion to encourage behavioral practice. The tools within these virtual environments — 3D anatomy models, VR videos for skill demonstration, virtual characters for automated education — further facilitate conceptual learning and resource efficiency [32,40]. Crucially, multimodal interventions integrating various VR technologies appear to combine the strengths of each approach, yielding superior outcomes. By more fully engaging patients’ sensory experiences and placing them at the heart of the learning process, this approach aligns with contemporary patient-centered care models [54].

Our findings indicate that VR technology has a positive effect on both the psychological well-being and behavioral attitudes of cancer patients, consistent with prior research [58,59]. VR primarily achieves this by creating a tranquil sensory environment that provides distraction [60], thereby directly alleviating distress and establishing initial psychological conditions conducive to behavioral change. Immersive environments enhance patients’ emotional engagement and cognitive involvement, thereby facilitating the internal processes of attitude transformation [61]. Interacting with virtual elements within realistically recreated scenarios and practising authentic, accurate healthcare behaviours within VR helps strengthen patients’ willingness and capacity for behavioural change [62]. Ultimately, self-efficacy is subtly elevated, with VR driving enduring behavioural adjustments and fostering positive attitudes. However, interactivity within current VR systems is typically constrained by preset scenarios. Where engagement with the real world is essential, augmented reality (AR) may offer marginal advantages, albeit at higher development costs and technical complexity [63].

Our findings indicate that VR technology has a positive effect on both the psychological well-being and knowledge acquisition of cancer patients, consistent with prior research [58,64]. VR primarily alleviates distress directly by creating a tranquil sensory environment that serves as a distraction [60], thereby establishing the initial psychological conditions conducive to behavioural change. Immersive environments enhance patients’ emotional engagement and cognitive involvement, thereby facilitating the internal processes of attitude transformation [61]. Interaction with virtual elements within specific scenarios enables patients to practice authentic healthcare behaviors in a safe environment, thereby strengthening their willingness and capacity for behavioral change [62]. Ultimately, by elevating self-efficacy and perceived control, VR drives enduring behavioural adjustments and the formation of positive attitudes. However, the interactivity in current VR systems is often constrained by pre-scripted scenarios. When interaction with real-world contexts is essential, AR may offer marginal advantages, albeit at higher development costs and technical complexity [63].

Our study outlines the evolutionary trajectory of VR technology in health education for cancer patients, which has progressed from unidirectional knowledge dissemination to immersive interactive experiences, from generic education to personalized engagement, and from a focus on knowledge acquisition to the promotion of both physical and psychological well-being. This trajectory not only reflects the ongoing functional development of VR technology but also embodies the deepening of patient-centered educational principles and shifts in relevant pedagogical theories. Early VR primarily featured static virtual environments, exposing patients to radiotherapy settings beforehand to reduce positioning errors. With the advent of VR video, VR applications expanded into diverse scenarios, including radiotherapy, chemotherapy, and surgery. This shift in patients’ engagement from environmental familiarization to experiential immersion significantly enhanced their cognitive understanding of treatment [62]. Concurrently, VR education transitioned from traditional cognitive models to multimedia cognitive theories, emphasizing multisensory integration [65]. The advent of real-time VR interaction further integrated multisensory stimulation, empowering patients to become active participants in their health management [64]. Within a safe, risk-free virtual space, patients can repeatedly practice rehabilitation skills, effectively facilitating behavioral change. Subsequently, data- and algorithm-driven advancements propelled educational models toward precision, with 3D models providing personalized learning materials and VR NPCs delivering tailored feedback. This supported patients in achieving knowledge internalisation, attitude shifts, and behavioural improvements through exploratory learning. VR games integrate gamified education principles, transforming medical knowledge into goal-oriented activities through character-based tasks and instant rewards, subtly stimulating intrinsic motivation and behavioural adherence [66]. Correspondingly, the evaluation framework for VR interventions has expanded beyond initial knowledge and skill dimensions to include distal indicators, such as behavioral adherence, psychological state, and patient-reported outcomes, further aligning with patient-centered value orientations.

A paramount concern identified in this review is the inadequate attention paid to the safety and privacy implications of VR technology. Only ten of the included studies explicitly addressed these issues. Given the sensitivity of patient health data and the vulnerability of the cancer population, this situation demands urgent attention [67]. Regarding safety, cybersickness — manifesting as symptoms such as dizziness and nausea — remains a barrier to the broader adoption of VR. While most studies wisely limited session duration to under 60 min to mitigate this risk [68], safety protocols predominantly relied on participant exclusion rather than active mitigation strategies. The field currently lacks a standardized safety framework to guide clinical implementation. Concerning data privacy, the capacity of VR devices to continuously capture user behavioral and physiological data within immersive environments presents a potential risk for privacy breaches. However, only a minimal number of studies have outlined specific protective measures against this [50]. While current privacy protection establishes a necessary foundation through device-centric measures, such as data encryption and access control [69,70], it is imperative to strengthen safeguards and compliance protocols throughout the entire implementation process. For instance, enhancing ethical education and standardised training for practitioners is vital to heighten privacy security awareness and protective capabilities. Concurrently, rigorous legal frameworks and security protocols must be established to ensure the confidentiality and integrity of data.

5. Recommendations for nursing practice

The findings of this scoping review offer concrete guidance for integrating VR technology into cancer care practices. For nurses, VR can serve as an innovative educational tool to enhance patient understanding of complex treatment procedures, such as radiotherapy setup or preoperative steps, while simultaneously reducing anxiety. Nurses can facilitate VR sessions during clinical consultations or preparatory visits, using immersive videos or interactive 3D models to demonstrate procedures and answer questions in a visually engaging manner. This approach not only saves time but also standardizes the quality of education across diverse patient populations. Administrators can play a crucial role in supporting VR implementation by investing in user-friendly hardware and software, ensuring staff training, and establishing protocols for data security and patient safety. Cost-effectiveness can be enhanced through the shared use of VR resources across departments and by leveraging low-cost alternatives where appropriate. Furthermore, administrators should advocate for institutional policies that address privacy concerns and ensure ethical handling of patient data generated within VR environments.

6. Limitations

Although numerous studies have investigated improvements in the health knowledge, behaviors, skills, attitudes, and mental well-being of cancer patients, little research exists on the privacy and security aspects of VR technology usage. Consequently, further research is necessary to evaluate the privacy and security implications of this technology comprehensively. Most of the included studies were small sample studies or feasibility studies. Currently, research on the use of VR for health education among cancer patients is still in its formative stage, and large-scale experimental design studies are needed to reveal the causal relationship between VR technology interventions and health education outcomes. The active publication of related studies in recent years has been notable. Finally, most studies were conducted solely in hospital settings and lacked long-term follow-up, limiting insights into the sustained effects of VR interventions. Longitudinal studies should be prioritized in future research to determine the optimal duration and frequency of VR-based health education interventions.

7. Conclusions

In total, this review identifies and outlines the use and characteristics of eight VR technologies for assisted education in four primary directions, including radiotherapy, chemotherapy, surgery and healthy behavior. Improvements in patient health education were assessed in the included studies mainly through knowledge, beliefs, attitudes, behaviors, and skills. However, the field is constrained by small-scale feasibility studies, a lack of long-term follow-up, and insufficient examination of privacy and security risks. Future work should prioritize large-scale trials and longitudinal designs to establish causality and sustainability of outcomes, while also addressing safety and ethical concerns through advanced privacy frameworks and age-adaptive designs to enable personalized, secure, and effective VR-based education.

CRediT authorship contribution statement

Fangping Chen: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – original draft, Writing – review & editing, Project administration. Xingyue Guo: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – review & editing, Supervision, Project administration. Dingyuan Wei: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – review & editing. Mengxing Wang: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – review & editing. Jiayan Wang: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – review & editing. Didi Xu: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – review & editing. Luyang Jin: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – review & editing. Xuemei Xian: Conceptualization, Methodology, Validation, Formal analysis, Funding acquisition, Writing – review & editing, Supervision, Project administration

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Funding

This work was supported by a project supported by Scientific Research Fund of Zhejiang Provincial Education Department (Grant number Y202457058).

Declaration of competing interest

The authors have declared no conflict of interest.

Appendices. Supplementary data

The following are the Supplementary data to this article: