Technology Takes Aim at Psychological Distress in Patients with Cancer

Technology Takes Aim at Psychological Distress in Patients with Cancer
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October 26, 2026/Cleveland Clinic Florida/Cancer

Technology Takes Aim at Psychological Distress in Patients with Cancer

Cleveland Clinic researchers in Florida explore tech-enabled mental health interventions

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approaches to support patients experiencing psychological distress during cancer treatment

The psychological impact of a cancer diagnosis and subsequent treatment can be profound. As many as three out of four patients with cancer experience symptoms of psychological distress, underscoring the importance of addressing mental health as part of comprehensive cancer care.

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“We know that psychological distress can contribute to reduced quality of life and overall well-being in patients with cancer, which makes mental health support critical to improving patient outcomes,” says Zeina Nahleh, MD, FACP, Vice Chief of the Cancer Institute and Regional Chair of Hematology-Oncology for Cleveland Clinic in Florida and Medical Director of the Maroone Cancer Center in Weston, Florida.

Dr. Nahleh is principal investigator of two studies exploring technology-enabled approaches to psychological support during cancer treatment. One study evaluates immersive virtual reality (VR) as a way to reduce distress during chemotherapy. The other is investigating an artificial intelligence (AI)-powered chatbot used in conjunction with standard psychotherapy for patients receiving active treatment.

Together, the studies reflect an effort to explore additional tools that could complement conventional mental health interventions and help address the psychological needs of patients with cancer.

Immersive VR to reduce distress

In the first study, researchers examined whether immersive VR could help reduce psychological distress among patients receiving chemotherapy infusions. Supported through a VeloSano grant, the two-arm randomized controlled trial enrolled 70 patients with high baseline anxiety, defined as a score of 5 or higher on the National Comprehensive Cancer Network (NCCN) Distress Thermometer.

Patients in the intervention group used immersive VR during chemotherapy while the control group continued their preferred activities, such as reading or watching television.

The immersive VR system uses a head-mounted device to place patients in a three-dimensional visual and auditory environment uniquely designed by the research team to provide relaxation and redirect attention away from the treatment setting and transport the patient to a more pleasant experience. Patients chose from more than 20 soothing environments, including a tropical forest, beach, island and lake house, while listening to their preferred music.

“Our goal was to provide patients with a practical, safe and accessible tool using a pleasant immersive experience as a distraction that could shift their attention away from an unpleasant stimulus during treatment,” explains Dr. Nahleh.

Validated questionnaires were administered before and after the experience to measure distress, the primary outcome, as well as depression, pain and anxiety as secondary outcomes. “We found a significant reduction in distress among patients who used immersive VR, with additional improvements observed in measures of depression, pain and anxiety,” reports Dr. Nahleh.

Early data were presented at the 2025 American Society of Clinical Oncology (ASCO) Meeting. The research team, which also included hematology-oncology specialist Rafael Arteta-Bulos, MD, and research fellows Maria Jose Herran Montes, MD, and Theresa Abdo, MD, have since completed patient accrual and data analysis. A peer-reviewed manuscript was recently accepted for publication in the high-impact Journal of Clinical Oncology (JCO) Oncology Advances.

Dr. Nahleh says the potential broad applicability of the technology is particularly encouraging. The intervention is not cancer type-specific and can be used by Spanish-speaking patients, potentially helping extend access to psychological support across Florida’s diverse patient population.

Based on the positive study results, the Maroone Cancer Center acquired several new VR systems over the summer and has already made the technology available to patients, with priority given to those experiencing high levels of distress.

Plans are also underway to expand access to the Scully-Welsh Cancer Center at Indian River Hospital and the Martin North Robert and Carol Weissman Cancer Center.

AI-powered psychological support

While the VR study focuses on managing distress during the treatment experience, the second investigator-initiated study uses AI to extend psychological support outside the clinical setting.

Grant funded by the Casey DeSantis Florida Cancer Innovation Fund, the two-arm randomized pilot study is examining whether an AI-powered mental health app can augment standard psychotherapy for patients with cancer.

The study began recruitment in late 2025 and completed enrollment in May 2026, enrolling 32 patients with high distress. Patients randomized to the intervention group received access to the Wysa app in addition to standard psychotherapy, while those in the control group received standard psychotherapy alone.

Wysa is an AI-powered chatbot that incorporates evidence-based techniques including cognitive behavioral therapy and mindfulness. Patients can select areas they want to address, such as stress, anxiety, frustration or pain, and the app guides them through exercises related to those concerns.

For the Cleveland Clinic study, a multidisciplinary team customized the commercially available app for patients with cancer. The intervention included 31 guided self-care learning modules within the app.

Patients received free access to the app, which is available in English and Spanish. The study protocol required participants to attend at least three psychotherapy sessions and use the app frequently over three months. Researchers assessed patients before and after the intervention, evaluating quality of life, anxiety and depression.

While data analysis is currently underway, preliminary findings indicated the patients showed interest and frequently used the APP in the convenience of their homes and at different times of need. “The initial feedback from patients was positive, but we will await the final analysis to see if the app adds value above and beyond the psychotherapy sessions alone,” states Dr. Nahleh.

The study represents the first use of a cognitive mental health app in a cancer setting. If it demonstrates benefit, Dr. Nahleh says the approach could potentially be extended to help cancer patients access this type of support to improve their quality of life beyond the acute clinical setting.

Integrating psycho-oncology into cancer care

Technology-based interventions, such as immersive VR and AI-powered applications, offer novel approaches to support patients with cancer experiencing psychological distress. Their use also reflects a broader shift toward integrating psychological care into cancer treatment and cancer survivorship rather than treating mental health as a separate concern or only focusing on providing traditional standard cancer treatments.

At the Maroone Cancer Center, integrative oncology services include psychiatric counseling, art therapy, fitness and massage therapy. Several licensed social workers and therapists and an oncology-trained psychiatrist are embedded within the cancer care team, providing specialized mental health and psycho-social support.

For Dr. Nahleh, the goal extends beyond treating the cancer itself.

“We want to help patients navigate through their cancer diagnosis and treatment and live an optimal life, despite the cancer diagnosis, the best way possible,” she says. “That includes always looking for new ways to improve the quality of life of patients with cancer and addressing their frequently overlooked mental health needs.”