Cancer patients often struggle to understand their own disease, symptoms, therapy and treatment-related toxicities with current educational methods. Virtual reality (VR) has the potential to intuitively convey abstract, complex information. Patients' review and interaction of their own imaging in 3D may improve comprehension. This study aimed to assess the impact of using VR with cancer patients and their caregivers.In a single arm prospectively accrued mixed-method study during clinical visits in radiation oncology, 38 cancer patients and caregivers were shown their own 2D planer medical imaging on a computer screen followed by a 3D VR volumetric review of diagnostic imaging and radiation targets. Participants completed pre- and post-VR Likert scale questionnaires and interviews. Survey analysis utilized Wilcoxon signed-rank test. Interview data was analyzed qualitatively.Patient ages ranged from 11-95 years old with a median of 5 months from diagnosis to VR. Participants typically noted poor comprehension using standard educational tools in clinical visits. 2D imaging review was reported as challenging to interpret, confusing and nonintuitive. Quantitatively, patient and caregiver understanding of their own disease/tumor improved significantly from pre-VR (mean 5.6) to post-VR (mean 9.2; P < 0.0001; 0 = none, 10 = full). VR was rated the top educational tool by 83% of participants over all other educational strategies with 97% preferring VR over a 2D-computer screen in imaging review. In a head-to-head comparison, VR led to a higher level of understanding over 2D-imaging in every survey domain including tumor, symptoms, radiation target, treatment-related symptoms and therapy rationale (P < 0.0001). VR was also superior to 2D imaging review in decreasing anxiety, increasing engagement and providing higher satisfaction (P < 0.0001). Participants rated the importance of the VR experience with a mean value of 9.1 (0 = none, 10 = full). VR was recommended by 97% of participants to become standard of care. Qualitatively, participants noted VR as simple, obvious, informative and an easier method to understand their disease and treatment. VR provided additional comprehension and improved patient engagement with treatment and their providers. VR positively impacted attitudes in behavioral change towards improved adherence. Patients reported the value of VR in being able to understand what was transpiring within their own bodies.Current educational strategies for cancer patients need improvement. In this prospective study, 3D VR imaging review was shown to be more effective in conveying and contextualizing complex information regarding tumor anatomical spatial relationships by substantially improving understanding over currently utilized methods. VR was patients' most preferred and top-rated educational tool. These findings warrant evaluation of VR as a next generation educational tool in cancer patient consultations.