This randomized controlled trial aims to evaluate the effectiveness of virtual reality-guided imagery in reducing pain, anxiety, and fatigue among female breast cancer patients undergoing adjuvant chemotherapy. Participants will be randomly assigned to either an intervention group receiving virtual reality-guided imagery in addition to routine care, or a control group receiving routine care

This study is a randomized controlled trial with a parallel-group design conducted to evaluate the effect of virtual reality-guided imagery in reducing pain, anxiety, and fatigue among female breast cancer patients undergoing chemotherapy at the National Hospital for Oncology and Hematology in Najaf Governorate, Iraq.

Eligible participants will be randomly allocated into two groups in a 1:1 ratio using block randomization with a fixed block size of four. The experimental group will receive virtual reality-guided imagery in addition to routine hospital care, while the control group will receive routine care only.

The intervention will be delivered during chemotherapy sessions over the study period. The content of the virtual reality-guided imagery will be designed to promote relaxation and psychological comfort, aiming to reduce symptom burden during chemotherapy administration.

Primary and secondary outcomes will be assessed using validated instruments. Pain intensity will be measured using the Numerical Rating Scale (NRS). Anxiety levels will be assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, and fatigue will be measured using the Brief Fatigue Inventory (BFI). Assessments will be conducted at baseline and after the intervention period.

Data will be analyzed by comparing changes in outcomes between the intervention and control groups to determine the effectiveness of virtual reality-guided imagery in improving symptom management among cancer patients undergoing chemotherapy.

Inclusion Criteria:

• Female patients aged 18 years or older.
• Histologically confirmed breast cancer.
• Stage I, II, or III breast cancer.
• Underwent surgery as the initial treatment and are scheduled to receive the first cycle of adjuvant chemotherapy, with or without biologic therapy (e.g., AC or TC regimens).
• Able to read, write, and communicate.
• Able and willing to use a virtual reality headset.
• Able to provide written informed consent.

Exclusion Criteria:

• Visual or hearing impairment that prevents the use of virtual reality.
• Serious neurological or psychiatric disorders.
• Current participation in other non-pharmacological interventions (e.g., meditation or relaxation therapy) that could influence the study outcomes.
• Previous experience with virtual reality-guided imagery.
• Use of analgesics, anxiolytics, or other medications during the intervention that may affect the study outcomes.

Individual participant data (IPD) will not be shared in order to protect participant privacy and confidentiality. The study data will be used solely for the purposes of this research and related academic publications.

The study is single-blinded. Due to the nature of the intervention, participants will be aware of whether they receive virtual reality-guided imagery or routine care. However, the outcome assessor responsible for collecting and evaluating study data will be blinded to group allocation to minimize assessment bias. This approach is used to ensure objectivity in outcome measurement and improve the internal validity of the study.