A feasibility study examining the impact of yoga on psychosocial health and symptoms in pediatric outpatients receiving chemotherapy
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.
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.
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.
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.
KeywordsPediatric oncology Chemotherapy Yoga therapy Yoga Symptoms
the Patient-Reported Outcomes Measurement Information System
Pediatric Quality of Life
Multidimensional Fatigue Scale
Symptom Screening in Pediatrics Tool
Research Electronic Data Capture
Statistical Analysis Software
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 from this study was provided by the Pediatric Oncology Group of Ontario (POGO) Seed Funding Grant.
Compliance with ethical standards
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 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.
- 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):242–250CrossRefGoogle 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):1417–1425CrossRefGoogle 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 CrossRefGoogle 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):371–378CrossRefGoogle Scholar
- 12.Agarwal RP, Maroko-Afek A (2018) Yoga into cancer care: a review of the evidence-based research. Int J Yoga 11(1):3–29Google 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):257–265CrossRefGoogle 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):198CrossRefGoogle Scholar
- 15.Movavi (2017) Screen capture studioGoogle 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):402–408CrossRefGoogle 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 CrossRefGoogle 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):1750–1755CrossRefGoogle 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):661–668CrossRefGoogle Scholar