Virtual Reality in Chemotherapy: Reducing Anxiety and Nausea Without Drugs

The chemotherapy experience

Anyone who has accompanied someone during a chemotherapy cycle knows the scene: an armchair, a needle, an IV drip, hours of waiting. And an anxiety that begins days before the appointment.

Chemotherapy is effective against cancer. But the experience of the treatment generates suffering that goes beyond pharmacological side effects:

Anticipatory anxiety: starts days before the session. Just thinking about the oncology ward triggers stress responses.
Conditioned nausea: the brain associates the environment with nausea. Many patients start feeling sick even before the drug enters their bloodstream.
Dilated perception of time: hours of infusion that seem endless.
Emotional isolation: the patient is physically present but mentally trapped in their own fearful thoughts.

How immersive therapy changes the experience

Against anticipatory anxiety:

Immersion in a pleasant environment interrupts the cycle of negative thoughts. The patient goes from "I am in an oncology ward with an IV in my arm" to "I am in a forest, I am exploring, I am breathing."

Against conditioned nausea:

VR replaces environmental stimuli with a completely different environment. The brain does not receive the conditioned triggers and the nausea response is mitigated. The mechanism is the same as multimodal cognitive distraction, which works in all procedural settings.

Against time dilation:

Cognitive engagement alters the perception of time. 90-minute sessions are perceived as 30-40 minutes.

Against isolation:

Interactive and narrative environments give the patient a sense of agency. They are no longer a passive subject who "undergoes" treatment.

The evidence in oncology

"Patient's Dream" Study (Frontiers in Oncology, 2022)

Clinical trial on breast and ovarian cancer patients undergoing chemotherapy:

Significant reduction in state anxiety
Improvement in mood tone
Decrease in the perception of nausea
Qualitative feedback: "it made me forget where I was"

JMIR RCT Study (2025)

Effect of immersive VR on the side effects of chemotherapy:

Reduction of chemo-induced nausea
Less use of rescue antiemetics
Better post-infusion sleep quality

Italian Tor Vergata Study (Burraia et al.)

RCT on cancer patients during antineoplastic therapy:

Significant reduction in anxiety and pain in the VR group
No adverse events related to VR use
High patient acceptability (>90% would like to use it again)

Chirico et al. (2020) — Sapienza University

Comparison of VR vs music therapy during chemotherapy for breast cancer:

VR shows superiority over music therapy in reducing anxiety
Both effective on mood, but VR has a more pronounced effect

The oncology protocol

Before infusion (5-10 minutes)

The patient wears the headset in the waiting room or as soon as they sit in the chair. Immersion begins before the needle is placed.

During infusion (variable duration, up to 60+ minutes)

The patient can alternate between moments of immersion and break times. The experiences are designed for long sessions.

After infusion (optional 5-10 minutes)

A short guided relaxation session helps the transition back home.

Which patients benefit most

Patients in their first cycles — Intervening early prevents the formation of negative conditioning. As research on procedural memory explains, the first experiences define the patient's relationship with the therapeutic pathway.

Patients with a high anxiety component — Those who already suffer from anxiety disorders benefit most.

Patients with persistent anticipatory nausea — VR offers a complementary approach that acts on the cause, not just the symptom.

Impact for the oncology ward

For the patient:

Reduction of overall suffering along the pathway
Less accumulation of psychological distress cycle after cycle
Better treatment adherence
Active coping tool that restores a sense of control

For staff:

More cooperative patients
Emotionally less heavy environment
Reduction of calls to manage anxiety crises
Concrete tool to offer when the patient is suffering

For the facility:

Improvement of patient experience indicators
Reduction in the use of anxiolytic drugs and rescue antiemetics
Positioning as a center of excellence

Immersive therapy does not cure cancer. But it transforms the experience of the therapeutic journey, restoring dignity and comfort to those facing the most difficult challenge. The Lemons in the Room system is already operational in oncology units in over 30 Italian facilities, with specific content for long sessions and clinically validated protocols.