Skip to main content

Advertisement

SpringerLink
Log in

A feasibility study examining the impact of yoga on psychosocial health and symptoms in pediatric outpatients receiving chemotherapy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Pediatric cancer patients experience symptoms that negatively impact quality of life; yoga may be an effective intervention. The primary objective was to determine the feasibility of a 10-week, weekly individualized yoga intervention for children and adolescents receiving outpatient cancer therapy primarily delivered remotely using Skype. Secondary objectives were to describe depression, anxiety, anger, fatigue, quality of life, and symptoms at 5 and 10 weeks after enrollment.

Methods

We included English-speaking patients aged 10 to 18 years receiving outpatient chemotherapy for cancer. Weekly individualized yoga sessions were offered for 10 weeks. Weeks 1, 5, and 10 were in-hospital while the remaining sessions were delivered remotely using Skype. Twice weekly, homework was assigned between each session. The primary outcome was feasibility, defined as 80% of participants completing at least 60% of planned in-hospital or remote yoga sessions.

Results

Between March and November 2017, 10 patients were enrolled. Two patients discontinued the study after one and two sessions. Only six participants achieved at least 60% of planned yoga sessions and thus, the study did not meet the a priori defined feasibility threshold. Among all participants, only one homework session was performed.

Conclusions

A 10-week individualized in-person and remotely conducted yoga intervention was not feasible in children receiving cancer treatments because of failure to achieve the desired frequency of yoga sessions in a sufficient number of participants. Future research should identify approaches to improve compliance with remote yoga sessions and home practice.

Trial registration

NCT03318068.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

PROMIS:

the Patient-Reported Outcomes Measurement Information System

PedsQL:

Pediatric Quality of Life

MFS:

Multidimensional Fatigue Scale

SSPedi:

Symptom Screening in Pediatrics Tool

REDCap:

Research Electronic Data Capture

SAS:

Statistical Analysis Software

IQR:

Interquartile range

References

  1. Aldridge AA, Roesch SC (2007) Coping and adjustment in children with cancer: a meta-analytic study. J Behav Med 30(2):115–129

    Article  PubMed  Google Scholar 

  2. Hildenbrand AK, Clawson KJ, Alderfer MA, Marsac ML (2011) Coping with pediatric cancer: strategies employed by children and their parents to manage cancer-related stressors during treatment. J Pediatr Oncol Nurs 28(6):344–354

    Article  PubMed  Google Scholar 

  3. Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS, Ramesh BS, Rao N, Kumar A, Raghuram N, Hegde S, Nagendra HR, Prakash Hande M (2007) Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther 6(3):242–250

    Article  PubMed  Google Scholar 

  4. Myers RM, Balsamo L, Lu X, Devidas M, Hunger SP, Carroll WL, Winick NJ, Maloney KW, Kadan-Lottick NS (2014) A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia: a report from the children's oncology group. Cancer 120(9):1417–1425

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wechsler AM, Sanchez-Iglesias I (2013) Psychological adjustment of children with cancer as compared with healthy children: a meta-analysis. Eur J Cancer Care (Engl) 22(3):314–325

    Article  CAS  Google Scholar 

  6. Nathan PC, Nachman A, Sutradhar R, Kurdyak P, Pole JD, Lau C, Gupta S (2018) Adverse mental health outcomes in a population-based cohort of survivors of childhood cancer. Cancer 124(9):2045–2057

    Article  CAS  PubMed  Google Scholar 

  7. Diorio C, Celis Ekstrand A, Hesser T, O'Sullivan C, Lee M, Schechter T, Sung L (2016) Development of an individualized yoga intervention to address fatigue in hospitalized children undergoing intensive chemotherapy. Integr Cancer Ther 15(3):279–284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wurz A, Chamorro-Vina C, Guilcher GM, Schulte F, Culos-Reed SN (2014) The feasibility and benefits of a 12-week yoga intervention for pediatric cancer out-patients. Pediatr Blood Cancer 61(10):1828–1834

    Article  PubMed  Google Scholar 

  9. Vadiraja SH, Rao MR, Nagendra RH, Nagarathna R, Rekha M, Vanitha N, Gopinath SK, Srinath B, Vishweshwara M, Madhavi Y, B SA, Ramesh SB, Rao N (2009) Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. Int J Yoga 2(2):73–79

    Article  PubMed  PubMed Central  Google Scholar 

  10. Oberoi S, Robinson PD, Cataudella D, Culos-Reed SN, Davis H, Duong N, Gibson F, Gotte M, Hinds P, Nijhof SL, Tomlinson D, van der Torre P, Cabral S, Dupuis LL, Sung L (2018) Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: a systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol 122:52–59. https://doi.org/10.1016/j.critrevonc.2017.12.011

    Article  PubMed  Google Scholar 

  11. Robinson PD, Oberoi S, Tomlinson D, Duong N, Davis H, Cataudella D, Culos-Reed N, Gibson F, Götte M, Hinds P, Nijhof SL, van der Torre P, Cabral S, Dupuis LL, Sung L (2018) Management of fatigue in children and adolescents with cancer and in paediatric recipients of haemopoietic stem-cell transplants: a clinical practice guideline. Lancet Child Adolesc Health 2(5):371–378

    Article  PubMed  Google Scholar 

  12. Agarwal RP, Maroko-Afek A (2018) Yoga into cancer care: a review of the evidence-based research. Int J Yoga 11(1):3–29

    PubMed  PubMed Central  Google Scholar 

  13. Stinson JN, Lalloo C, Harris L, Isaac L, Campbell F, Brown S, Ruskin D, Gordon A, Galonski M, Pink LR, Buckley N, Henry JL, White M, Karim A (2014) iCanCope with pain: user-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs. Pain Res Manag 19(5):257–265

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schulz-Heik RJ, Meyer H, Mahoney L, Stanton MV, Cho RH, Moore-Downing DP, Avery TJ, Lazzeroni LC, Varni JM, Collery LM, Bayley PJ (2017) Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga. BMC Complement Altern Med 17(1):198

    Article  PubMed  PubMed Central  Google Scholar 

  15. Movavi (2017) Screen capture studio

  16. Arnold DM, Burns KE, Adhikari NK, Kho ME, Meade MO, Cook DJ, McMaster Critical Care Interest G (2009) The design and interpretation of pilot trials in clinical research in critical care. Crit Care Med 37(1 Suppl):S69–S74

    Article  PubMed  Google Scholar 

  17. Hinds PS, Nuss SL, Ruccione KS, Withycombe JS, Jacobs S, DeLuca H, Faulkner C, Liu Y, Cheng YI, Gross HE, Wang J, DeWalt DA (2013) PROMIS pediatric measures in pediatric oncology: valid and clinically feasible indicators of patient-reported outcomes. Pediatr Blood Cancer 60(3):402–408

    Article  PubMed  Google Scholar 

  18. Irwin DE, Gross HE, Stucky BD, Thissen D, DeWitt EM, Lai JS, Amtmann D, Khastou L, Varni JW, DeWalt DA (2012) Development of six PROMIS pediatrics proxy-report item banks. Health Qual Life Outcomes 10:22

    Article  PubMed  PubMed Central  Google Scholar 

  19. Irwin DE, Stucky B, Langer MM, Thissen D, Dewitt EM, Lai JS, Varni JW, Yeatts K, DeWalt DA (2010) An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Qual Life Res 19(4):595–607

    Article  PubMed  PubMed Central  Google Scholar 

  20. Irwin DE, Stucky BD, Langer MM, Thissen D, DeWitt EM, Lai JS, Yeatts KB, Varni JW, DeWalt DA (2012) PROMIS pediatric anger scale: an item response theory analysis. Qual Life Res 21(4):697–706

    Article  PubMed  Google Scholar 

  21. Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P (2002) The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life inventory generic core scales, Multidimensional Fatigue Scale, and cancer module. Cancer 94(7):2090–2106

    Article  PubMed  Google Scholar 

  22. Hyslop S, Dupuis LL, Baggott C, Dix D, Gibson P, Kuczynski S, Johnston DL, Orsey A, Portwine C, Price V, Spiegler B, Tomlinson D, Vanan M, Tomlinson GA, Sung L (2018) Validation of the proxy version of Symptom Screening in Pediatrics Tool (SSPedi) in children receiving cancer treatments. J Pain Symptom Manag 56:107–112. https://doi.org/10.1016/j.jpainsymman.2018.03.025

    Article  Google Scholar 

  23. Johnston DL, Hyslop S, Tomlinson D, Baggott C, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Dupuis LL, Sung L (2018) Describing symptoms using the Symptom Screening in Pediatrics Tool in hospitalized children with cancer and hematopoietic stem cell transplant recipients. Cancer Med 7(5):1750–1755

    Article  PubMed  PubMed Central  Google Scholar 

  24. O'Sullivan C, Dupuis LL, Gibson P, Johnston DL, Baggott C, Portwine C, Spiegler B, Kuczynski S, Tomlinson D, de Mol Van Otterloo S, Tomlinson GA, Sung L (2014) Refinement of the Symptom Screening in Pediatrics Tool (SSPedi). Br J Cancer 111(7):1262–1268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. O'Sullivan C, Lee Dupuis L, Gibson P, Johnston DL, Baggott C, Portwine C, Spiegler B, Kuczynski S, Tomlinson D, Tomlinson GA, Sung L (2018) Evaluation of the electronic self-report Symptom Screening in Pediatrics Tool (SSPedi). BMJ Support Palliat Care 8(1):110–116

    Article  PubMed  Google Scholar 

  26. Dupuis LL, Johnston DL, Baggott C, Hyslop S, Tomlinson D, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Sung L (2017) Validation of the Symptom Screening in Pediatrics Tool in children receiving cancer treatments. J Natl Cancer Inst 110(6):661–668

    Article  PubMed Central  Google Scholar 

  27. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed  Google Scholar 

  28. Diorio C, Schechter T, Lee M, O'Sullivan C, Hesser T, Tomlinson D, Piscione J, Armstrong C, Tomlinson G, Sung L (2015) A pilot study to evaluate the feasibility of individualized yoga for inpatient children receiving intensive chemotherapy. BMC Complement Altern Med 15:2

    Article  PubMed  PubMed Central  Google Scholar 

  29. Carlson LE, Speca M, Patel KD, Goodey E (2003) Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 65(4):571–581

    Article  PubMed  Google Scholar 

  30. Curtis K, Kuluski K, Bechsgaard G, Ridgway J, Katz J (2016) Evaluation of a specialized yoga program for persons admitted to a complex continuing care hospital: a pilot study. Evid Based Complement Alternat Med 2016:6267879

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We wish to thank the volunteer yoga instructors, Robin Hurlow and Jeff Goodman, for sharing their time and expertise with the participants involved in this study.

Funding

Funding from this study was provided by the Pediatric Oncology Group of Ontario (POGO) Seed Funding Grant.

Author information

Authors and Affiliations

  1. Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada

    Eliana Stein, Shannon Hyslop, Erin Plenert & Lillian Sung

  2. Department of Pediatrics, University of British Columbia, 4480 Oak Street, B318A, Vancouver, BC, V6H 3V4, Canada

    Meera Rayar

  3. Division of Child & Youth Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada

    Upasana Krishnadev

  4. SickKids Centre for Community Mental Health, 114 Maitland Street, Toronto, Ontario, M4Y 1E1, Canada

    Upasana Krishnadev

  5. Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada

    Abha Gupta, Tal Schechter-Finkelstein & Lillian Sung

Authors
  1. Eliana Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meera Rayar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Upasana Krishnadev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abha Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shannon Hyslop
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erin Plenert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tal Schechter-Finkelstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lillian Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lillian Sung.

Ethics declarations

Ethical approval

Research Ethics Board approval was obtained from SickKids (REB#1000054681). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

There are no financial or non-financial conflicts of interest for any of the authors involved in this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Eliana Stein and Meera Rayar are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stein, E., Rayar, M., Krishnadev, U. et al. A feasibility study examining the impact of yoga on psychosocial health and symptoms in pediatric outpatients receiving chemotherapy. Support Care Cancer 27, 3769–3776 (2019). https://doi.org/10.1007/s00520-019-04673-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-04673-9

Keywords

Search

Navigation