Exploring the temporal dynamics of circadian rhythm-aligned VR intervention in mitigating fear of cancer recurrence: mediating roles of illness uncertainty and hope in gynecological cancer patients

Apr 29, 2026Frontiers in psychology

Timed VR sessions aligned with body clock may reduce fear of cancer returning by changing uncertainty and hope in women with gynecological cancer

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Abstract

The virtual reality intervention significantly reduced fear of cancer recurrence (FCR) by an average of 4.11 points at one week post-intervention.

Patients in the virtual reality group reported significantly lower FCR scores compared to the control group at all follow-up points.
Effect sizes for the reductions in FCR were large, indicating a substantial impact of the intervention.
Illness uncertainty (IU) and hope were identified as mediating factors in the relationship between the intervention and reduced FCR.
At one week post-intervention, 74.7% of the total effect on FCR was mediated by IU and hope.
By one month, IU alone accounted for 50.3% of the mediation, while the direct effect became more dominant by three months.

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BACKGROUND: Fear of cancer recurrence (FCR) is a prevalent and clinically significant psychological burden that adversely affects the quality of life and treatment adherence among gynecological cancer survivors. Virtual reality (VR), an emerging therapeutic modality, has demonstrated potential applications in oncology-related psychological interventions. This study investigates the efficacy of a chronotype-based timed VR intervention in alleviating FCR and explores the mediating mechanism of illness uncertainty (IU) and hope.

METHODS: A total of 63 patients were randomly allocated to either the VR intervention group ( = 31) or the control group ( = 32). Both groups received standard medical care. The intervention group completed a 4-week VR intervention (5 sessions per week, 20 min per session) scheduled according to individual chronotypes, which were assessed via the Morningness-Eveningness Questionnaire. Outcome measures, including FCR, IU, and hope, were collected at baseline, 1 week (T1), 1 month (T2), and 3 months (T3) after the intervention. Data were analyzed using ANCOVA and PROCESS macro for mediation effects. n n

RESULTS: Baseline characteristics were well balanced (all > 0.05). Compared with controls, the VR group had significantly lower FCR scores at T1 (mean difference = 4.11), T2 (6.03), and T3 (5.86) (all < 0.001), with large effect sizes (partial = 0.535-0.617). Mediation analyses revealed dynamic mechanisms: T1 (parallel/chain mediation by IU and hope, accounting for 74.7% of total effect); T2 (only IU mediated, 50.3%); T3 (direct effect dominant, 82.0%). p p η 2

CONCLUSION: A chronotype-based timed virtual reality intervention effectively reduces fear of cancer recurrence in gynecological cancer patients and acts through mediating pathways by reducing illness uncertainty and enhancing the level of hope. These findings provide empirical support for integrating chronotype-aligned virtual reality intervention into clinical practice and underscore the importance of considering temporal dynamics in psychological intervention design.

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Exploring the temporal dynamics of circadian rhythm-aligned VR intervention in mitigating fear of cancer recurrence: mediating roles of illness uncertainty and hope in gynecological cancer patients

Abstract

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