Comparing immersive mindfulness and nature interventions for managing preoperative distress in breast cancer patients: A pilot randomized controlled trial.

Preoperative distress in breast cancer patients is highly prevalent and associated with adverse post-surgical outcomes. While both virtual reality (VR) distraction and mindfulness exercises have been increasingly utilized to manage this distress, the clinical impact of integrating active mindfulness meditation into the immersive experience remains under-investigated. Here, we present a pilot randomized controlled trial evaluating the feasibility, acceptability and preliminary efficacy of brief, first-time immersive nature and mindfulness interventions for patients admitted to the holding area prior to the operating room for breast cancer surgery. Sixty participants were randomized to receive an 8-minute preoperative VR experience with mindfulness instruction (VR+Meditation), a standard VR nature experience without audio guidance (VR Only), or Care-as-Usual (CAU). The intervention was feasible and well tolerated with zero patient dropout and minimal indications of cybersickness or general discomfort. Outcomes included patient-reported anxiety and fear, physiological measures, and a computational semantic analysis of post-operative patient interviews. Compared with standard care, both VR interventions significantly reduced self-reported anxiety and heart rate. Although no significant differences were observed between the two active intervention groups, the VR+Meditation group demonstrated a significant and clinically meaningful reduction in surgery-specific fear relative to standard care. Analysis of brief patient interviews provided convergent evidence supporting these findings, showing that patients receiving VR+Meditation used language more strongly aligned with relief than those receiving standard care. These findings suggest that immersive VR represents a feasible and well-tolerated first-time immersive intervention for reducing preoperative distress in patients undergoing breast cancer surgery. The addition of guided mindfulness may provide additional benefit by specifically addressing surgery-related fear, supporting the hypothesis that different digital interventions may target distinct dimensions of preoperative distress. Larger randomized studies are warranted to confirm these preliminary findings.