Robot therapy aids mental health in patients with hematological malignancy during hematopoietic stem cell transplantation in a protective isolation unit

Abstract

Patients with hematological malignancy experience physical and psychological pain, such as a sense of isolation and confinement due to intensive chemotherapy in a protective isolation unit (PIU). We examined whether the intervention of a robotic puppy, aibo (manufactured by Sony), could improve patients' mental health as an alternative therapy for pet therapy, which is not feasible in PIU. This study included 21 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (n = 16) or autologous HSCT (n = 5). The patients were randomly divided into the aibo and control groups. Psychological effects were regularly assessed by measuring the levels of salivary stress hormone chromogranin A (CgA), serum oxytocin, and serum cortisol and the quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores. The aibo group demonstrated a significant decrease in CgA level, while the control group showed the opposite trend. In addition, changes in serum oxytocin and cortisol levels indicated that aibo helped reduce stress. There was no significant difference in the QIDS-SR scores between the two groups; however, the psychomotor activity in the aibo group improved significantly. These findings suggest that aibo intervention during a stay in a PIU can improve the mental health of patients with hematological malignancies who have undergone HSCT.

Keywords: Chromogranin A; Hematopoietic stem cell transplantation; Psychiatry; Quality of life; Robot therapy.

Figure 1

(A) Percentage changes in salivary CgA levels at admission in a PIU, on the day of stem cell transplantation (day 0), and upon discharge from a PIU in the aibo and control groups. The aibo group exhibited a percentage change of 121 ± 135% on day 0, while the control group showed a percentage change of 287 ± 358% (p = 0.043, Mann–Whitney test). At discharge, the aibo group demonstrated a percentage change of 65 ± 42%, whereas the control group showed a percentage change of 218 ± 258% (p = 0.003). (B) Levels of salivary CgA in the aibo group at admission in a PIU and discharge from a PIU (0.89 ± 0.79 pmol/mL protein vs. 0.39 ± 0.30 pmol/mL protein, p = 0.004). (C) Levels of salivary CgA in the control group at admission in a PIU and discharge from a PIU (0.484 ± 0.390 pmol/mL protein vs. 0.826 ± 0.740 pmol/mL protein, p = 0.085). ]: Mann–Whitney test. }: paired t-test. *Significantly different (p < 0.05). CgA: Chromogranin A, PIU: protective isolation unit.

Figure 2

(A) Percentage changes in serum oxytocin levels at admission in a PIU, on the day of stem cell transplantation (day 0), and upon discharge from a PIU in the aibo and control groups. The percentage changes on day 0 were 95 ± 11% in the aibo group and 105 ± 31% in the control group (p = 0.349). At discharge, the aibo group showed a percentage change of 122 ± 16%, whereas the control group showed a percentage change of 86 ± 25% (p = 0.001). (B) Serum oxytocin levels in the aibo group at admission in a PIU and discharge from a PIU (388.3 ± 78.0 pg/mL vs. 468.2 ± 72.0 pg/mL, p < 0.001). (C) Serum oxytocin levels in the control group at admission in a PIU and discharge from a PIU (402.4 ± 107.3 pg/mL vs. 344.3 ± 112.6 pg/mL, p = 0.079). ]: Mann–Whitney test. }: paired t-test. *Significantly different (p < 0.05). CgA: Chromogranin A, PIU: protective isolation unit.

Figure 3

(A) Percentage changes in serum cortisol levels at admission in a PIU, on the day of stem cell transplantation (day 0), and discharge from a PIU in the aibo and control groups. The percentage changes on day 0 were 179 ± 301% in the aibo group and 380 ± 757% in the control group (p = 0.918). At discharge, the aibo group exhibited a percentage change of 91 ± 161%, whereas the control group showed a percentage change of 425 ± 491% (p = 0.024). (B) Levels of serum cortisol in the aibo group at admission in a PIU and discharge from a PIU (880.9 ± 517.5 pg/mL vs. 370.3 ± 485.3 pg/mL, p < 0.07). (C) Levels of serum cortisol in the control group at admission in a PIU and discharge from a PIU (715.96 ± 667.3 pg/mL vs. 1143.5 ± 1260 pg/mL, p = 0.389). ]: Mann–Whitney test. }: paired t-test. *Significantly different (p < 0.05). CgA: Chromogranin A, PIU: protective isolation unit.

Figure 4

Mean levels of QIDS-J across 3-time points in the aibo group and control group. (A) Mean QIDS-J scores in the aibo group at admission in a PIU, on the day of stem cell transplantation (day 0), and upon discharge from a PIU. (B) Mean QIDS-J scores in the control group at admission in a PIU, on day 0, and upon discharge from a PIU. QIDS-J: Quick Inventory of Depressive Symptomatology-Japan, PIU: protective isolation unit.

Figure 5

(A) Comparison between KPS scores at admission in a PIU, on the day of stem cell transplantation (day 0), and upon discharge from a PIU in the aibo and control groups. KPS scores were the following: at admission to PIU (84.6 ± 10.4 vs. 88.0 ± 4.2, p = 0.387), on day 0 (73.6 ± 9.2 vs. 75.0 ± 8.5, p = 0.605), and upon discharge from PIU (82.7 ± 11.9 vs. 83.0 ± 8.2, p = 0.918) in the aibo and control groups. (B) Comparison between oral intake at admission in a PIU, on day 0, and upon discharge from a PIU in the aibo and control groups. %Oral intake was the following: at admission to a PIU (83.2 ± 22.5% vs. 87.7 ± 22.3%, p = 0.557), on day 0 (45.1 ± 39.4% vs. 70.1 ± 38.3%, p = 0.223), and upon discharge from a PIU (76.6 ± 21.6% vs. 77.4 ± 20.1%, p = 0.863) in the aibo and control groups. (C) Comparison between NRS scores at admission in a PIU, on day 0, and upon discharge from PIU in the aibo and control groups. NRS scores were the following: at admission to a PIU (0.27 ± 0.47 vs. 0.10 ± 0.32, p = 0.512), on day 0 (0.45 ± 0.69 vs. 0.20 ± 0.63, p = 0.387), and upon discharge from PIU (0.27 ± 0.647 vs. 0.0 ± 0.0, p = 0.512) in the aibo and control groups. ]: Mann–Whitney test. KPS: Karnofsy Performance Scale, NRS: Numerical Rating Scale, PIU: protective isolation unit.

Figure 6

The study utilized “aibo,” a robotic device manufactured by Sony. The accompanying image was provided by Sony.