It is well known that the end of active cancer treatment (surgery, +/- chemotherapy, +/- radiation) is a very stressful time during which survivors report many physical and psychological concerns. In one study conducted with breast cancer survivors at the end of active treatment, participants reported that they felt abandoned and that they were on their own to manage care; however, they also reported not wanting to return to the hospital for care from providers. These women did report that they would like to be able to access information via the Internet. (xxx, xxx, Habin & Cashavelly, 2012). Further research suggests women want strategies to be vetted and/or created by their healthcare team to support wellness and healing (xxx, Wegler, xxx, Habin & xxx, 2016).
Research supports that yoga may help to reduce physical and psychological symptoms in breast cancer survivors (Chandwanti et al., 2014; Culos-Reed, Mackenzie, Sohl, Jesse, Zahavich, & Danhauer, 2012; Galantino, Desai, Greene, DeMichele, Stricker, & Mao, 2011; Kiecolt-Glaser et al., 2014; Mustain, 2013). However, there are limitations to in person yoga classes especially if they are not sensitive to the needs of breast cancer survivors.
While a web streamed video may be a self-care strategy women are seeking, research is needed to determine if this is a feasible approach, how patients perceive this strategy and what outcomes yoga may impact. The purpose of the first step in this research project was to:
- Develop a yoga video created by a multidisciplinary team of breast cancer care providers that was tailored to breast cancer survivors.
- To describe patients with breast cancer experience of using a web-streamed yoga video including, feasibility and barriers/facilitators to its use.
- To inform the next step of the efficacy trial including the choice of appropriate outcome measures.
Methods:
The study employed an open ended qualitative descriptive design using conventional content analysis.
Video development
The video was created by an interdisciplinary team of breast cancer caregivers and incorporated movements similar to stretches prescribed post-operatively.
Data collection
Patients with early stage estrogen receptor positive breast cancer within one year of initiating adjuvant endocrine therapy were recruited in routine follow-up visits by their oncology providers. Patients who were enrolled received the video by email, were asked to complete a demographic questionnaire, view the video twice a week for four weeks and complete open-ended telephone interviews at three time points to determine how the video was used and perceived.
Data analysis
Conventional content analysis was used to understand the feasibility and patient experience of using the video.
Results:
Fourteen women who had ended active treatment and were on adjuvant therapy participated in this study. The participants reported they were easily able to access the video, but only one described using the video as instructed (2 times per week for 4 weeks). The participants were interested in making some healthy lifestyle changes but implementation of change was challenging. Several participants did not understand this to be a mindfulness practice and instead expected it to be an exercise video. Therefore, they found it “boring”. Others described feeling the need for more education on self-care strategies, but reported being overwhelmed by taking on self-care as they were also returning to usual life responsibilities.
Conclusion:
The web streamed intervention was an acceptable way to provide this intervention. Our findings indicate more education about yoga as a mindfulness based self-care strategy is needed. Further, mindfulness strategies (as opposed to exercise) should be practiced daily so it is not reasonable to assume that twice weekly would yield desirable results.
Persons with breast cancer who were not on adjuvant therapy expressed an interest in being enrolled in this study, but basing this work on previous work we did not include all breast cancer survivors ending active treatment and going forward we should. When we initiated this study, we were not sure what outcomes – physical or psychological may be impacted by a yoga video. The findings from this study have informed the outcome measures we will use in that they will be sensitive to a mindfulness based strategy such as well-being and anxiety as opposed to physical function. This study findings are limited in that the sample was a well-educated, all Caucasian sample.