A novel virtual reality supportive care intervention (BMT-VR) for patients undergoing hematopoietic stem cell transplantation (HSCT): A pilot randomized clinical trial.

Abstract

1504 Background: Patients with hematologic malignancies undergoing HSCT experience immense physical and psychological symptom burden during their extended transplant hospitalization. Interventions that help manage patients’ psychological distress and improve their quality of life (QOL) during this inpatient stay are limited. Virtual reality (VR), with its three-dimension capabilities for user engagement, offers a novel delivery modality for scalable, targeted, and patient-centered supportive care interventions aiming to address the persistent unmet psychosocial needs of these patients. Methods: We conducted a pilot randomized clinical trial (RCT) of a VR supportive care intervention (BMT-VR). Patients undergoing HSCT were randomly assigned to BMT-VR or usual care during their 3-4-week hospitalization. BMT-VR consisted of five self-directed modules addressing 1) supportive psychoeducation and managing expectations during HSCT; 2) effective coping; and 3) acceptance and gratitude while dealing with uncertainty. The primary endpoint was feasibility (≥60% of eligible patients enrolling, and ≥60% of BMT-VR participants completing ≥3/5 modules). To assess BMT-VR’s acceptability, we used the System Usability Scale ( > 80 = excellent acceptability). We assessed psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-BMT), post-traumatic stress symptoms (PTSD-Checklist), coping (Measure of Current Status-A), and self-efficacy (Cancer Self-Efficacy Scale) at baseline (i.e., 3 days post-HSCT) and 4-, 12-, and 24-weeks post-HSCT. We used analysis of covariance (ANCOVA) to explore the preliminary effects of BMT-VR on outcomes. Results: We enrolled 58.3% (81/139) of eligible patients (BMT-VR (n = 40); usual care (n = 41)) with a mean age of 57.9 (SD = 14.7) and 51.9% women. 74.4% of BMT-VR participants completed ≥3/5 modules and 65.1% completed 5/5 modules, with median acceptability score = 81.2. At 4-weeks, BMT-VR vs. usual care participants reported improved anxiety (5.3 vs. 3.6, P = 0.016), QOL (108.2 vs. 96.8, P = 0.014), coping (36.6 vs. 32.4, P = 0.023), and self-efficacy (144.6 vs. 131.9, P = 0.019). Although BMT-VR vs. usual care participants reported sustained improvements in QOL (B = 3.8, P = 0.002), coping (B = 1.8, P = 0.011), and self-efficacy (B = 4.5, P = 0.017), BMT-VR effects became more pronounced for depression (B = -0.5, P < 0.001), and PTSD (B = -1.7, P < 0.001) symptoms longitudinally across all time points. Conclusions: A novel VR-delivered supportive care intervention tailored to the psychosocial needs of HSCT recipients is feasible and acceptable and demonstrated preliminary efficacy for improving psychological distress and QOL. A subsequent multi-site RCT will evaluate BMT-VR’s efficacy for improving outcomes in diverse HSCT settings. Clinical trial information: NCT05629676 .