Purpose <p>Virtual Reality (VR)-based interventions emerge as promising tools for symptom management among cancer survivors receiving active treatments. Evidence from previous systematic reviews and meta-analyses is limited by small numbers of studies and lack of sub-group analyses. The purpose of this review was to evaluate the effectiveness of VR/AR/MR interventions on symptom management for cancer survivors receiving active treatments.</p> Methods <p>Five electronic databases were searched up to March 2025. A meta-analysis was conducted. Sub-group analyses for age, treatment type, cancer type, VR type (immersive or non-immersive), lengths of interventions, scene type, and interaction methods were evaluated.</p> Results <p>Twenty-seven unique randomized controlled trials (RCTs) were included. In total, 62 effect sizes for eight symptom outcomes, including fatigue, pain, anxiety, depression, nausea, distress, confusion, and dyspnea, were computed. Meta-analyses showed that the effects of VR interventions were significant on fatigue (n = 12, SMD—0.9494 [- 1.5083, -0.3904]), pain (n = 13, SMD—0.7426 [-1.2694, -0.2158]), and anxiety (n = 16, SMD—1.8063 [-3.0549, -0.5576]). In our sensitivity test, the effect of VR on depression was also significant (n = 8, SMD—0.3682 [-0.5774, -0.1589]). No significant effect was found for outcomes of nausea, distress, confusion, and dyspnea.</p> Conclusions <p>VR interventions showed efficacy in decreasing fatigue, pain, and anxiety among individuals with cancer receiving active treatment.</p> Implications for Cancer Survivors <p>As the VR interventions demonstrated differential effects across subgroups defined by age, cancer type, treatment type, and their unique VR features, tailored intervention designs are needed to address the specific needs of each patient group.</p>