Yoga for Cancer-Related Fatigue in Survivors of Hematopoietic Stem Cell Transplantation: A Mixed-Methods Feasibility Study

Abstract

Despite its potential benefits in cancer survivorship, yoga has not been tested in cancer survivors treated with hematopoietic stem cell transplantation (HSCT). The aim of this mixed-methods study is to evaluate the feasibility of a yoga intervention offered to adult HSCT survivors with cancer-related fatigue (CRF). The secondary goals are 1) to evaluate the association of baseline CRF severity with depression, sleep disturbances, and pain; 2) to evaluate the changes in CRF, depression, sleep disturbances, pain, and physical activity from baseline to postintervention; 3) to evaluate the association of CRF change with changes in depression, sleep disturbances, and pain, and physical activity; 4) to evaluate the association of yoga adherence with self-efficacy and self-regulation skills and abilities; and 5) to explore participants’ perceptions of yoga and physical activity. Twenty adult HSCT survivors were enrolled in a 6-week restorative yoga intervention, and eight of them participated in focus groups upon intervention completion. The accrual acceptance rate was 23.2% (20/86 participants). Twelve of the 20 participants who enrolled completed the study. Overall adherence was 45.4%. No adverse reactions attributable to yoga were reported. Of the five CRF dimensions (i.e., total CRF, physical CRF, general CRF, mental CRF, emotional CRF) evaluated at baseline, total CRF and emotional CRF correlated significantly with sleep disturbances (r=0.52, P=0.02; r=0.57, P=0.01, respectively). Baseline emotional CRF also correlated significantly with depression (r=0.68, P=0.02). Participants reported postintervention improvements in general CRF (d=-0.75), physical CRF (d=-0.66), vigor (d=0.63) and sleep disturbances (d=-0.81) (all Ps< 0.05). Improvements in two or more of the CRF dimensions correlated significantly with reductions in depression, sleep disturbances, and pain; correlations ranged from 0.58 to 0.86. Improvements in three CRF dimensions (general CRF, mental CRF, emotional CRF) also correlated significantly with increases in self-reported physical activity; correlations ranged from -0.58 to -0.60. Correlations between overall adherence and self-efficacy and self-regulation skills and abilities were not significant, ranging from -0.29 to 0.41. Focus group participants described a range of benefits from yoga practice, most notably stress reduction. Barriers and hurdles to practicing yoga included general time constraints, long travel distance to the intervention site, distractions during home practice, and difficult yoga poses. The most important aspects of the yoga classes from the participants’ perspective were individualized instruction style and camaraderie. Participants reported three motives for physical activity engagement: maintaining and improving general wellbeing, regaining general health, and having company to exercise with. Fear of falling and/or injury was perceived by participants as the major reason for physical activity avoidance. Yoga and walking were the most commonly preferred types of physical activity by participants. The results of this study indicate that a yoga trial in adult HSCT survivors is feasible from a safety standpoint and needs to employ strategies to improve accrual acceptance, retention, and protocol adherence rates. The reported reductions in CRF and sleep disturbances are promising and provide the foundation for hypotheses to be tested in subsequent studies. The association of CRF with depression, sleep disturbances, pain, and physical activity indicates that CRF is a multifactorial symptom partly related to concurrent symptoms and physical activity levels. The relationship between yoga adherence and self-efficacy and self-regulation skills and abilities needs to be reevaluated with larger samples. The emergent themes from the qualitative data can be used to optimize yoga and other physical activity interventions in HSCT survivors.