Immersive Virtual Reality (VR) at the Time of Clinical Evaluation to Improve Psychological Distress and Anxiety in Primary Brain Tumor (PBT) Patients
- - INCLUSION CRITERIA: - PBT patients enrolled on the Natural History Study (NHS) trial (16C0151) in the Neuro-Oncology Branch (NOB) who have an upcoming scan & clinical appointment - Participants can be newly diagnosed, receiving active treatment, or on surveillance - Concurrent enrollment in other NOB trials is permissible - Adults (greater than or equal to 18 years of age) who are English-speaking - Participants must be able to reliably self-report symptoms, based on clinician assessment - Participants report greater than or equal to 1 on distress item from MDASI-BT prior to clinic appointment - Active corticosteroid therapy is permissible - Ability of subject to understand and the willingness to sign a written informed consent document EXCLUSION CRITERIA: - Participants who do not have a tissue diagnosis (no past surgery or biopsy to confirm diagnosis) - Cranial surgery less than or equal to 2 weeks prior to initiation of study intervention - Scalp wound healing issues that might interfere with comfortable VR headset use - Those who have epilepsy or have had a seizure in the last 6 weeks - Participants with a current diagnosis of generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), claustrophobia, or panic disorder - Participants who have a hypersensitivity to motion or severe nausea, which could make the VR experience uncomfortable - Those with visual deficits that might interfere with the VR experience, including hemianopsia, diplopia, and agnosia based on their most recent clinical assessment
- Psychological distress is a common concern for patient across the cancer trajectory,
which has been associated with worse clinical outcomes in terms of quality of life,
adherence to treatment regimens, satisfaction with care, and poorer survival in past
- Virtual reality (VR) has the potential to alleviate some of the negative aspects of
illness by allowing individuals to escape from their lives and experience more positive
thoughts and emotions, which can be accomplished using cardiac coherence breathing
techniques and distraction (both of which can improve psychological symptoms).
- Past VR research has shown promising improvements in anxiety, pain, distress and
distraction through use of immersive VR interventions, though there is scant evidence in
PBT populations, particularly in the time period surrounding their neuroimaging and
clinical appointments when distress and anxiety can be highest.
- Recent evidence has demonstrated that the COVID-19 pandemic and associated mitigation
procedures introduce additional stress for cancer patients, with higher levels of
anxiety, depression, loneliness, and financial toxicity being reported during this time.
- The purpose of this phase II clinical trial is to determine the feasibility of
implementing an immersive VR relaxation intervention in a PBT population and to assess
the efficacy of the intervention to improve psychological distress and anxiety at the
time of clinical evaluation. VR is an innovative delivery approach to teach our patients
validated breathing and mindfulness techniques that can improve their psychological
symptoms and their ability to self-manage these symptoms.
-To assess the feasibility of implementing a VR relaxation intervention in a PBT population
at the time of clinical evaluation (i.e. eligibility, accrual, compliance, adverse device
effects, study completion, and participant satisfaction)
- PBT patients enrolled on the Natural History Study (NHS) trial in the Neuro-Oncology
Branch (NOB) (all tumor types and grades eligible)
- Patients can be newly diagnosed, receiving active treatment, or on surveillance
- Adults (greater than or equal to 18 years of age) who are English-speaking and able to
- Active corticosteroid therapy is permissible
- Exclude patients without tissue diagnosis, recent cranial surgery (less than or equal to
2 weeks), scalp wound healing issues, or seizures within the last 6 weeks
- Participants have reported greater than or equal to 1 on distres item from MDASI-BT
prior to past clinic appointment
- Exclude patients who have a hypersensitivity to motion, severe nausea, or visual field
deficits that might interfere with VR experience
- Exclude patients with a current diagnosis of generalized anxiety disorder (GAD),
post-traumatic stress disorder (PTSD), claustrophobia, or panic disorder
- This is a phase II feasibility clinical trial with a single arm experimental design. The
VR intervention and all patient-reported outcome measures (PROs) will be done remotely
- Study will include collection of self-reported PROs for distress, anxiety, mood
disturbance, symptom burden/interference, quality of life, cognitive function,
loneliness, and financial toxicity, as well as optional salivary stress biomarkers.
These measures will be collected at baseline and immediately after a brief VR relaxation
intervention to determine acute effects on distress, anxiety, and biological stress
measures. Repeat post-intervention assessments will be done approximately 1 week and 1
month following the initial intervention to determine sub-acute effects on distress and
anxiety, as well as impact on other symptoms and stress biomarkers. A semi-structured
qualitative interview will also be conducted 1 week after the initial intervention to
assess participant satisfaction with the intervention and how the pandemic has affected
their psychological symptoms.
- Descriptive statistics, T-tests, Wilcoxon rank sum tests, and multiple logistic
regression models will be used to evaluate the feasibility of the VR intervention.
Linear mixed models and effect size calculations will be used to evaluate the acute and
sub-acute effects of the VR intervention on self- reported PROs. Pearson or Spearman
correlations will be used to evaluate the relationship between the biological stress
measures and self-reported PROs.
- A total of 120 PBT patients will participate in this study.
Trial Phase Phase II
Trial Type Treatment
National Cancer Institute
Terri Sue Armstrong
- Primary ID 200065
- Secondary IDs NCI-2020-01753, 20-C-0065
- Clinicaltrials.gov ID NCT04301089