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Background Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited.This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy.This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention.Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group.Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted.Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.Acute leukemia is a life-threatening malignant neoplasm of hematopoietic stem cells and is associated with poor prognosis.1 Once diagnosed, the acute and rapid nature of the disease requires emergent aggressive treatment, normally including 1 to 3 weeks of induction chemotherapy followed by consolidation chemotherapy, maintenance chemotherapy, and hematopoietic stem-cell transplantation.2,3The diagnosis and intensive treatment of acute leukemia usually leads to substantial psychological suffering, especially for the newly diagnosed patients who received induction chemotherapy.4 Previous studies reported high levels of anxiety (ranged from 20% to 46%) and depression (ranged from 17% to 54%) in these patients.5,6 Anxiety predicts patients' unfavorable survival status, thereby increasing their tendency to adopt a negative coping style, such as avoidance, to current problems.7 Higher levels of depression are associated with worsened perceptions of chemotherapy-related symptoms, hindering patients' adherence to continued systemic chemotherapy.8 Impaired psychological well-being is negatively correlated with lower quality of life (QOL) in patients with acute leukemia.9 Considering the high prevalence of anxiety and depression and their negative impact on patients, offering interventions for patients newly diagnosed with acute leukemia is of utmost importance.Interventions aimed at relieving anxiety and depression during induction chemotherapy in acute leukemia patients include pharmacological and nonpharmacological approaches. @@@ Owing to the potential risks of medication resistance and the possibility of recurrence after withdrawal of medication, nonpharmacological interventions such as exercise therapy, cognitive-behavioral therapy, and mindfulness meditation therapy are given greater consideration.10-16 Exercises are reportedly effective in relieving negative emotions in acute leukemia patients10; however, a meta-analysis has highlighted that exercise has little effect on hospitalized patients.11 Moreover, acute leukemia patients are at high risk of infection, anemia, and hemorrhage because of myelosuppression after receiving induction chemotherapy, so acute leukemia patients need to be cautious when performing exercises during induction chemotherapy.Cognitive-behavioral therapy, which aims to change potentially unhealthy behaviors by helping patients correctly understand the disease, is extensively used in clinical practice.12-14 Studies have suggested that cognitive-behavioral therapy has positive effects in addressing cancer-related psychological problems and reducing anxiety and depression.13,14 However, some cancer patients may not benefit from correcting distress-related cognition through effort, which could further increase their suffering.15 Patients also tend to avoid receiving medical information to reduce the psychological burden caused by the disease.17Emerging evidence suggests that mindfulness meditation is adopted to relieve anxiety and depression in patients with acute leukemia.18 Mindfulness meditation is characterized by focusing on the present moment nonjudgmentally.19 It reduces the observation of negative states and maintains absent psychological responses to negative states, thereby relieving negative emotions,20 leading to the reduction of anxiety and depression.21 However, the effects of meditation interventions on patients with acute leukemia are inconsistent.18 This may be due to severe fatigue, pain, and other adverse effects caused by induction chemotherapy that distract patients from meditation activities. Furthermore, during induction chemotherapy, the meditative process can easily be interrupted by treatments and noisy ward environment. These conditions cause patients to have difficulty in focusing their attention and thus reduce the effects of mindfulness meditation. Therefore, strategies are needed to improve the attention of acute leukemia patients during induction chemotherapy.Virtual reality (VR) provides users with an immersive experience through human-computer interaction.22 A review showed that VR intervention is more effective compared with the control (ie, standard care) for anxiety and depression.23 By immersing into the joyful computer-generated VR environment, participants can effectively be distracted from the real world and focused on the VR content, so their anxiety and cancer-related symptoms are likely reduced.24-26 A previous study has shown that VR-based meditation intervention for 30 min can effectively improve sleep quality among patients in the intensive care unit, suggesting the feasibility of using VR-based meditation in hospitalized patients.27 In addition, VR-based meditation intervention for 10 min has effectively alleviated chronic pain and stress among veterans.28 Nevertheless, the effects of just one 10-min VR-based meditation intervention on psychological outcomes such as alleviating anxiety or depression are controversial. Moreover, the effects of VR-based meditation on reducing anxiety and depression in acute leukemia patients have not yet been explored. @@@ The Roy adaptation model (RAM) was adopted as the theoretical framework to guide this study.29 Cognitive and physiological regulators interact to foster adaptive or maladaptive responses. Physiological, self-concept, role function, and interdependence domains are defined as the models of physiological and cognitive processes. The maladaptive responses provide feedback to be the stressors and restart the physiological and cognitive processes.29 For patients newly diagnosed with acute leukemia, symptoms caused by acute leukemia, adverse effects caused by induction chemotherapy, unfamiliarity with hospitalization procedures, and fear of death become the main stressors. These factors lead to an imbalance in adaptation manifesting in high levels of anxiety and depression among patients.6 In such circumstances, patients' adaptation strategies are impaired, and the efforts to adapt are inefficient, so intervention is needed. Meditation can enhance the cognitive reserve, and VR can potentially help patients focus on meditation and can aid the emotional activation of negative cognition and cognitive restructuring.22,30 Therefore, we hypothesized that a VR-based meditation intervention could promote patients' cognitive processes so that they can achieve adaptive outcomes. Consequently, anxiety and depression can be alleviated, and QOL can be improved.This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression (primary outcomes) and improving QOL among patients with acute leukemia during induction chemotherapy.Background Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited.This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy.This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention.Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group.Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted.Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.Acute leukemia is a life-threatening malignant neoplasm of hematopoietic stem cells and is associated with poor prognosis. @@@ 1 Once diagnosed, the acute and rapid nature of the disease requires emergent aggressive treatment, normally including 1 to 3 weeks of induction chemotherapy followed by consolidation chemotherapy, maintenance chemotherapy, and hematopoietic stem-cell transplantation.2,3The diagnosis and intensive treatment of acute leukemia usually leads to substantial psychological suffering, especially for the newly diagnosed patients who received induction chemotherapy.4 Previous studies reported high levels of anxiety (ranged from 20% to 46%) and depression (ranged from 17% to 54%) in these patients.5,6 Anxiety predicts patients' unfavorable survival status, thereby increasing their tendency to adopt a negative coping style, such as avoidance, to current problems.7 Higher levels of depression are associated with worsened perceptions of chemotherapy-related symptoms, hindering patients' adherence to continued systemic chemotherapy.8 Impaired psychological well-being is negatively correlated with lower quality of life (QOL) in patients with acute leukemia.9 Considering the high prevalence of anxiety and depression and their negative impact on patients, offering interventions for patients newly diagnosed with acute leukemia is of utmost importance.Interventions aimed at relieving anxiety and depression during induction chemotherapy in acute leukemia patients include pharmacological and nonpharmacological approaches. Owing to the potential risks of medication resistance and the possibility of recurrence after withdrawal of medication, nonpharmacological interventions such as exercise therapy, cognitive-behavioral therapy, and mindfulness meditation therapy are given greater consideration.10-16 Exercises are reportedly effective in relieving negative emotions in acute leukemia patients10; however, a meta-analysis has highlighted that exercise has little effect on hospitalized patients.11 Moreover, acute leukemia patients are at high risk of infection, anemia, and hemorrhage because of myelosuppression after receiving induction chemotherapy, so acute leukemia patients need to be cautious when performing exercises during induction chemotherapy.Cognitive-behavioral therapy, which aims to change potentially unhealthy behaviors by helping patients correctly understand the disease, is extensively used in clinical practice.12-14 Studies have suggested that cognitive-behavioral therapy has positive effects in addressing cancer-related psychological problems and reducing anxiety and depression.13,14 However, some cancer patients may not benefit from correcting distress-related cognition through effort, which could further increase their suffering.15 Patients also tend to avoid receiving medical information to reduce the psychological burden caused by the disease.17Emerging evidence suggests that mindfulness meditation is adopted to relieve anxiety and depression in patients with acute leukemia.18 Mindfulness meditation is characterized by focusing on the present moment nonjudgmentally.19 It reduces the observation of negative states and maintains absent psychological responses to negative states, thereby relieving negative emotions,20 leading to the reduction of anxiety and depression.21 However, the effects of meditation interventions on patients with acute leukemia are inconsistent.18 This may be due to severe fatigue, pain, and other adverse effects caused by induction chemotherapy that distract patients from meditation activities. @@@ Furthermore, during induction chemotherapy, the meditative process can easily be interrupted by treatments and noisy ward environment. These conditions cause patients to have difficulty in focusing their attention and thus reduce the effects of mindfulness meditation. Therefore, strategies are needed to improve the attention of acute leukemia patients during induction chemotherapy.Virtual reality (VR) provides users with an immersive experience through human-computer interaction.22 A review showed that VR intervention is more effective compared with the control (ie, standard care) for anxiety and depression.23 By immersing into the joyful computer-generated VR environment, participants can effectively be distracted from the real world and focused on the VR content, so their anxiety and cancer-related symptoms are likely reduced.24-26 A previous study has shown that VR-based meditation intervention for 30 min can effectively improve sleep quality among patients in the intensive care unit, suggesting the feasibility of using VR-based meditation in hospitalized patients.27 In addition, VR-based meditation intervention for 10 min has effectively alleviated chronic pain and stress among veterans.28 Nevertheless, the effects of just one 10-min VR-based meditation intervention on psychological outcomes such as alleviating anxiety or depression are controversial. Moreover, the effects of VR-based meditation on reducing anxiety and depression in acute leukemia patients have not yet been explored.The Roy adaptation model (RAM) was adopted as the theoretical framework to guide this study.29 Cognitive and physiological regulators interact to foster adaptive or maladaptive responses. Physiological, self-concept, role function, and interdependence domains are defined as the models of physiological and cognitive processes. The maladaptive responses provide feedback to be the stressors and restart the physiological and cognitive processes.29 For patients newly diagnosed with acute leukemia, symptoms caused by acute leukemia, adverse effects caused by induction chemotherapy, unfamiliarity with hospitalization procedures, and fear of death become the main stressors. These factors lead to an imbalance in adaptation manifesting in high levels of anxiety and depression among patients.6 In such circumstances, patients' adaptation strategies are impaired, and the efforts to adapt are inefficient, so intervention is needed. Meditation can enhance the cognitive reserve, and VR can potentially help patients focus on meditation and can aid the emotional activation of negative cognition and cognitive restructuring.22,30 Therefore, we hypothesized that a VR-based meditation intervention could promote patients' cognitive processes so that they can achieve adaptive outcomes. Consequently, anxiety and depression can be alleviated, and QOL can be improved.This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression (primary outcomes) and improving QOL among patients with acute leukemia during induction chemotherapy.Background Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited.This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy. @@@ This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention.Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group.Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted.Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.Acute leukemia is a life-threatening malignant neoplasm of hematopoietic stem cells and is associated with poor prognosis.1 Once diagnosed, the acute and rapid nature of the disease requires emergent aggressive treatment, normally including 1 to 3 weeks of induction chemotherapy followed by consolidation chemotherapy, maintenance chemotherapy, and hematopoietic stem-cell transplantation.2,3The diagnosis and intensive treatment of acute leukemia usually leads to substantial psychological suffering, especially for the newly diagnosed patients who received induction chemotherapy.4 Previous studies reported high levels of anxiety (ranged from 20% to 46%) and depression (ranged from 17% to 54%) in these patients.5,6 Anxiety predicts patients' unfavorable survival status, thereby increasing their tendency to adopt a negative coping style, such as avoidance, to current problems.7 Higher levels of depression are associated with worsened perceptions of chemotherapy-related symptoms, hindering patients' adherence to continued systemic chemotherapy.8 Im
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单位广东省人民医院; 上海交通大学; 广州中医药大学
