Waiting to Exhale: A Pilot Study of Yoga Class Participation in Vulnerable Cancer Patients

Previous research shows that yoga is associated with improvements in the overall quality of life of cancer patients (Banasik et al, 2011; Danhauer et al, 2009) including improved emotional well-being and physical outcomes such as sleep quality, mood, and stress (Bower et al, 2005). Increasingly, studies are examining the effects of yoga with multicultural cancer populations (e.g. Moadel et al, 2007), but none explore the effects of yoga on cancer patients while they wait for treatment.

The purpose of this research is to describe and evaluate an existing yoga program for vulnerable adults with cancer. The people participating in this on-going program do not usually have access to yoga classes as they are low-income, typically live in communities where yoga is not readily available or offered in their first language, and are in treatment for cancer with all of the time constraints and side effects inherent in dealing with disease treatment. Taking advantage of the time people have already set aside for cancer treatment and offering bilingual yoga classes at their cancer treatment site reduces numerous barriers to participation including time, language, and childcare.

INTRODUCTION / ABSTRACT

OBJECTIVES

Participants: Study participants (n=26) included a convenience sample of adult patients seeking cancer treatment at a County Hospital in November 2011 and January 2012. Patients who chose to attend a yoga class (n=14) were compared to a group of patients waiting for their treatment appointment who opted not to participate in a yoga class (n=12).

Design: A posttest-only design with nonequivalent groups was used to assess the effects of yoga on quality of life.

Measures: The quality of life of patients who chose to attend the yoga class was compared to patients who did not attend the class as measured by the FACT-G, and yoga class attendees were also asked to complete an Agency-specific outcome questionnaire. • The FACT-G is a 28-item self-report measure of quality of life in cancer patients measuring four dimensions: physical well-being, social/family well-being, emotional

well-being, and functional well-being (Cella, Tulsky, & Gray et al, 1993) and has established reliability and validity.• The Agency designed survey includes three sections: Attendance, Thoughts and Feelings about the Yoga Class, and Demographics. The agency survey has not been

tested for reliability or validity.

Procedures: Surveys were completed by hospital class attendees at the end of class, and data were collected from the comparison group while they waited for their treatment appointment. Informed consent was obtained from all patients, and participants received a $5 gift card in appreciation for their time completing the questionnaires.

Analysis: Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 19. A Mann-Whitney U Test for differences between two independent groups was used to test the hypothesis that patients attending a one-hour yoga class while waiting for treatment in the hospital will report a higher quality of life than patients receiving their usual course of treatment with no yoga class.

METHODS

Demographic information was self-reported by respondents. There was no significant difference between participants and non-participants on age, ethnicity, or gender. The mean age of the sample was 49.8 years (SD=14.58); the majority of study participants are Hispanic women (57%). More women than men attended the yoga class.

Health Related Quality of Life

Results of a Mann-Whitney U test revealed no significant difference in FACT-G scores (quality of life) between yoga class participants (Md=63.91, n=14) and non-participants (Md=65.01, n=12), U=67.50, z=-.26, p=.79, r=-.05.

Qualitative Component

In response to the question “What does this class give you that you haven’t found anywhere else?” participants stated:

• Tranquility, Peace, Relaxation, and Calm• “Es muy relajante y me siento bien despues” (it is very relaxing and I feel good after)• “Me ayuda a controlar la ansiedad” (it helps me with anxiety)• “Veo la vida mejor que antes” (I see life better than before)• “Mucho animo y mucho entusiasmo” (much encouragement and much enthusiasm)• “Me siento mas relajada; creo que es algo muy bueno para todas las personas” (I feel more relaxed; I think it’s a good thing for everyone)

RESULTS

CONCLUSIONS

Although class participants reported learning new skills and had high levels of satisfaction with the services they received, there was no significant difference found in the quality of life between yoga class participants and non-participants. Diverse populations appreciate the experience of the yoga classes, but results do not conclusively show that yoga positively affects quality of life.

Previous research has found yoga to be effective in improving the quality of life of cancer patients, but the most rigorous of those studies carefully implemented an ongoing 6-8 week group. Even if this study design had been more rigorous, it is likely that one yoga class in the middle of cancer treatment does not make a significant difference in the quality of life, despite attendees reporting high satisfaction with the yoga class.

Personal interviews point to unfamiliarity with yoga and waiting room culture as possible reasons cancer patients decide against participation. Further research is needed to determine why some patients choose to participate in yoga classes and others do not.

REFERENCES

Banasik, J., Williams, H., Haberman, M., Blank, S.E., & Bendel, R. (2011). Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal of the American Academy of Nurse Practitioners, 23, 135-142.

Bower, J.E. (2008). Behavioral symptoms in breast cancer patients and survivors: fatigue, insomnia, depression and cognitive disturbance. Journal of Clinical Oncology, 26(5), 768-777.

Cella D, Tulsky D, Gray G, et al. (1993). The functional assessment of cancer therapy (FACT) scale: Development and validation of the general version. Journal of Clinical Oncology, 11(3), 570–579.

Danhauer, S.C., Mihalko, S.L., Russell, G.B., Campbell, C.R., Felder, L., Daley, K., & Levine, E.A. (2009). Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psycho-Oncology, 18, 360-368.

Moadel, A.B., Shah, C., Wylie-Rosett, J., Harris, M.S., Patel, S.R., Hall, C.B., & Sparano, J.A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects on quality of life. Journal of Clinical Oncology, 25(28), 4387-4395.

ACKNOWLEDGEMENTS / CONTACTResearch reported in this publication was supported in part by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD003938 and the College of Behavioral and Social Sciences at California State University, Northridge. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. The author wishes to thank the agency where the research occurred.

Jodi Constantine Brown, MSW, PhDAssistant Professor, Department of Social Work

College of Behavioral and Social SciencesCalifornia State University, Northridge

18111 Nordhoff StreetNorthridge, CA 91330-8226

818-677-5945jodi.brown@csun.edu

Using a convenience sample of patients awaiting cancer treatment (n=26), this study seeks to describe differences between yoga class participants and non-participants by surveying non-participant’s assessment of functioning to compare between groups.

The specific objectives of this evaluation are to 1) explore participants’ reasons for attending yoga classes and their thoughts and feelings about the yoga classes, and 2) compare differences in the reported quality of life between hospital patients who participate in a yoga class and hospital patients who do not participate in a yoga class. Specifically, patients attending a one-hour yoga class while waiting for treatment at the hospital are hypothesized to report a higher quality of life than hospital patients who choose not to participate in a yoga class.

Learning Objectives:• Implement a yoga program for low-income cancer patients • Evaluate reasons attendees choose to participate in a yoga program• Discuss potential pitfalls to implementing on-site yoga for cancer patients.

Jodi Constantine Brown, Ph.D.

Variables Hospital Class Participant (n=14)

Hospital Non-Participant (n=12)

Ethnicity

African American 0 2 (5%)

Asian American 1 (3%) 2 (5%)

Caucasian 1 (3%) 3 (7%)

Hispanic 12 (32%) 5 (13%)

Gender

Male 1 (4%) 4 (14%)

Female 13 (46%) 8 (28%)

Age 45.8 (13.8) 53.1 (9.9)

Quality of Life Score 64.9 (14.2) 65.1 (15.6) Physical

ly Str

onger

Less T

ired

More Fle

xible

Mental

ly Str

onger

More Rela

xed

Manage

Stres

s0

2

4

6

8

10

12

Effects of Class

Breathing Meditation Stretching Exercise1

3

5

7

9

11

13

15

Skills Learned

AGENCY / PROGRAM DESCRIPTION

• Nonprofit 501(c)(3) whose mission is “to provide free exercise and fitness opportunities for adults living with cancer …many of our programs address the needs of medically underserved or low-income women”

• The Agency provides two weekly one-hour yoga classes to cancer patients waiting for treatment at a county hospital run by the California Department of Health Services serving the needs of society's most vulnerable members.

• Gentle chair yoga classes taught by certified instructors are held in the nurses’ break room across the hall from the treatment waiting room.

• One yoga instructor teaches the class while another remains in the waiting room listening for the names of class attendees called by nurses for their appointment. In this manner, patients do not miss their appointment, treatment, or paperwork, and are still able to participate in the yoga class.

Frequency (%) and Mean (SD) of Demographic and FACT-G Variables by Group

Class Participant Outcomes (n=14)