Yoga As Possible Non-Medical Intervention to Improve Quality of Life of Patients with Myelodysplastic Syndromes - a Feasibility Report

Background Despite significant progress in the management of myelodysplastic syndromes (MDS), symptom-burden remains significant and patients report on impaired quality of life (QoL) [Stauder, Leukemia 2018]. There is an ongoing need to explore non-pharmacologic approaches for managing MDS symptom burden. Yoga has proved an effective method to improve various physical and psychosocial outcomes, such as fatigue, anxiety, and sleep disturbances, in patients diagnosed with solid cancers.

Aims (1) To examine the practicality of an in-person 8-week yoga class; (2) To explore the feasibility of an 8-week group online yoga within an observational study; (3) Preliminary assessment of QoL parameters.

Methods MDS patients from 9 medical centers in Israel were invited to participate in a yoga program, consisting of 8 one hour in-person classes (once weekly). The classes were given by certified Kundalini yoga teachers, who delivered a mild-medium intensity program combining deep breathing, physical movements, and mantras, specifically designed for this patient population. Each medical center hosted its own course. All the exercises were done while the patients were seated on a chair. All MDS patients were invited, regardless of disease risk or performance status. In the second part, patients were offered a further 8-week online program, in which a one-hour weekly session was given via zoom, within an observational study. Symptom-burden was assessed using a modified Edmonton Symptom Self-Assessment Scale (ESAS), a 10-item rating scale (0-10, with 10 being the highest degree), which has been previously recommended by the National Comprehensive Cancer Network to assess QoL in all cancer populations. Patient-reported outcomes included fatigue, sleepiness, depression, nausea, pain and other QoL measures. Questionnaires were filled out by patients before and after each meeting.

Results Overall, 120 patients from 9 centers participated in at least one in-person yoga class. Participating patients, including those with poor performance status, were able to engage and complete most exercises throughout the class. Many of the patients were able to return to consequent classes, but some of them encountered barriers, mainly difficulty in commuting. Twenty-three patients signed up for the online yoga live zoom session. Of those, 11 patients were high-risk MDS and 12 were low-risk MDS, 7 were transfusion dependent. During the 8 weeks of study, 3 patients experienced disease progression. Sixteen patients participated in the online program. The main reasons for not participating included video-conferencing installing and enabling issues. Most patients filled out the questionnaires before and after each online lesson. The QoL analysis will be reported separately, but preliminary data suggests a substantial increase in general well-being and decrease in fatigue, after a class.

Conclusion This in-person and live online Kundalini yoga program was well-tolerated by many MDS patients of all risk groups. Preliminary analysis suggests improved well-being after completing each class. However, we did encounter some barriers, mainly challenging transportation and software operating difficulties. Despite theses challenges, patients managed to adhere to schedule. We suggest developing a hybrid plan (in-person and live online lessons) for further exploring the benefits of yoga among MDS patients. In the future we will evaluate the effect on QoL, as well as possible effect on disease outcomes.

Zuckerman:Cellect Biotechnology: Honoraria, Speakers Bureau; BioSight Ltd: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Orgenesis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Ofran:Abbvie: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Medison: Consultancy, Honoraria; Astellas: Honoraria; Janssen: Honoraria; Novartis: Consultancy; BMS: Consultancy, Honoraria.