Transcript Waiting to Exhale: A Pilot Study of Yoga Class Participation in Vulnerable Cancer Patients Jodi Constantine Brown, Ph.D. INTRODUCTION / ABSTRACT Previous research shows.

Waiting to Exhale: A Pilot Study of Yoga Class Participation in
Vulnerable Cancer Patients
Jodi Constantine Brown, Ph.D.
INTRODUCTION / ABSTRACT
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 ongoing program do not usually have access to yoga classes as they are lowincome, 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.
METHODS
CONCLUSIONS
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).
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 nonparticipants. Diverse populations appreciate the experience of the yoga classes,
but results do not conclusively show that yoga positively affects quality of life.
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.
OBJECTIVES
Using a convenience sample of patients awaiting cancer treatment (n=26), this
study seeks to describe differences between yoga class participants and nonparticipants 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.
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.
Variables
Hospital Class Participant Hospital Non-Participant
(n=14)
(n=12)
African American
0
2 (5%)
Asian American
1 (3%)
2 (5%)
Caucasian
1 (3%)
3 (7%)
12 (32%)
5 (13%)
Hispanic
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.
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.
Skills Learned
Effects of Class
15
12
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.
13
11
8
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.
9
6
7
4
Gender
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.
Class Participant Outcomes (n=14)
10
Ethnicity
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
RESULTS
Frequency (%) and Mean (SD) of Demographic and FACT-G
Variables by Group
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.
5
Male
Female
Age
Quality of Life Score
1 (4%)
4 (14%)
13 (46%)
8 (28%)
45.8 (13.8)
53.1 (9.9)
64.9 (14.2)
65.1 (15.6)
2
3
0
Physically
Stronger
Less Tired
More
Flexible
Mentally
Stronger
More
Relaxed
Manage
Stress
1
Breathing
Meditation
Stretching
Exercise
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 / CONTACT
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 nonparticipants (Md=65.01, n=12), U=67.50, z=-.26, p=.79, r=-.05.
Qualitative Component
Research 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.
In response to the question “What does this class give you that you haven’t found anywhere else?” participants stated:
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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)
Jodi Constantine Brown, MSW, PhD
Assistant Professor, Department of Social Work
College of Behavioral and Social Sciences
California State University, Northridge
18111 Nordhoff Street
Northridge, CA 91330-8226
818-677-5945
[email protected]