Abstract
Introduction: Polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF) are myeloproliferative neoplasms (MPNs) with impact on patients that include cytopenias, vascular risk, and disease specific symptom burden. Fatigue is the most commonly reported symptom among MPN patients, contributing to a reduced overall quality of life (QoL). Fatigue and reduced QoL are often left unresolved with current pharmacologic therapy. Our prior work has demonstrated the feasibility of online-streamed yoga and its preliminary effects for improving total symptom burden (including fatigue) in MPN patients. The purpose of this study was to further examine the effects of a 12-wk online yoga intervention for fatigue and QoL in MPN patients as compared to a wait-list control group as well as the feasibility of collecting remote blood samples, for remote assessment of corresponding biomarkers, in a national sample of MPN patients.
Methods: MPN patients were recruited nationally using social media and MPN patient group partners. Participants were randomized to either an intervention (i.e., yoga) group or a wait-list control group. The intervention group was asked to complete 60 min/wk of online yoga (via Udaya.com, an online yoga streaming platform) for 12 wks as well as a blood draw (complete blood cell count (CBC), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-a)) at both wk 0 and post-intervention wk 12. Those in the control group were asked to maintain their normal level of activity for 16 wks. All study participants were asked to complete online self-report surveys administered via Qualtrics. Survey measures included demographics, MPN Symptom Assessment Form (MPN SAF) as well as National Institutes of Health Patient Reported Outcomes Measurement Information System (NIH PROMIS). Surveys were administered at baseline (wk 0), mid-point (wk 7), and post-intervention (wk 12). Weekly yoga minutes were collected with online self-report and objectively with an online web analytics tool (i.e., Clicky). The feasibility of the remote blood draw was defined as a ≥70% completion rate at both wk 0 and wk 12. Questionnaire outcomes were compared between groups at 12 wks using analysis of covariance adjusting for baseline and changes in blood draw variables were analyzed using dependent t-tests.
Results: Patients: Two hundred and sixty MPN patients completed the eligibility survey, of which 96 were eligible, 62 completed the informed consent, and 48 MPN patients completed the 12-wk intervention. There were no significant differences in demographic variables or outcome variables (i.e., fatigue and QoL) between the intervention group (n=27) and the control group (n=21) at baseline. Table 1 describes study participant demographics.
Yoga Participation: Over the course of the 12-wk intervention, objective yoga participation averaged 40.8 min/wk whereas self-report yoga participation averaged 56.1 min/wk. Figure 1 depicts the trends in objective and self-report yoga participation throughout the 12-wk intervention.
Impact of Yoga Intervention: There were no significant differences at wk 12 in MPN SAF fatigue (ES=0.18; p=0.72) or MPN SAF QoL (ES=-0.53; p=0.19), however, NIH PROMIS QoL was significantly better in the yoga group at wk 12 (ES=0.7; p=0.03) when compared to the control group. Table 2 describes the changes in fatigue and QoL throughout the 12-wk intervention.
Blood Draw Feasibility: At baseline, 92.6% (n=25/27) of yoga group participants completed the blood draw and 70.4% (n=19/27) completed the blood draw at post-intervention. There was a significant decrease in TNF-a from wk 0 to wk 12 (-1.3±1.5; p=0.005) but no significant differences in CBC or IL-6 from wk 0 to wk 12.
Conclusions: This study builds upon our prior work demonstrating the feasibility of online yoga as well as its preliminary effects for improving symptom burden in MPN patients. In light of the improvements in QoL compared to the control group and significant decreases in TNF-a as well as the feasibility of remote blood draws in the present study, a future randomized controlled trial is warranted. It is possible that we did not see significant improvements in fatigue due to small sample sizes; therefore, a larger, more representative (i.e., more men) sample size is warranted in order to further investigate the effectiveness of online yoga on MPN patient symptom burden, QoL, and pro-inflammatory biomarkers.
Mesa: Ariad: Consultancy; Incyte Corporation: Research Funding; Gilead Sciences, Inc.: Research Funding; CTI BioPharma Corp.: Research Funding; Celgene Corporation: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; Galena Biopharma, Inc.: Consultancy; Promedico: Research Funding.
