The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on integrative and complementary therapies sometimes used by patients with cancer. In this installment, Jun J. Mao, MD, MSCE, and Jyothirmai Gubili, MS, focus on the role of virtual integrative and supportive care in the face of the challenges posed by the coronavirus.
The global crisis due to COVID-19 continues unabated, causing extensive disruption of societal life. It has also been detrimental to psychological health worldwide. The toll is especially great on patients with cancer because the pandemic has exacerbated their preexisting distress associated with the disease, its treatments, and fear of cancer progression or recurrence.
Jun J. Mao, MD, MSCE
Jyothirmai Gubili, MS
In a large survey of 6,213 patients, 23.4% reported being depressed, and 17.7% were anxious. In addition, 36.6% of those surveyed indicated barriers to continuing cancer treatment, citing inconveniences caused by COVID-19.1 Fear of delays in diagnosis and treatment, greater susceptibility to infections, and disruption of ongoing treatments and supportive care are among the factors that contribute to stress and anxiety.2-4
Consequently, the need to address this psychological burden has never been greater.
Mind-body practices include those with ancient roots, such as meditation, yoga, and tai chi, as well as newer techniques such as guided imagery, music therapy, and biofeedback. They all focus on mind-body-behavior interactions to affect stress reduction, physical relaxation, and psychological well-being. A large body of research supports the benefits of these therapies in alleviating the anxiety and stress associated with cancer and its treatments.5,6 Many cancer centers incorporate them as part of a multidisciplinary approach to patient care through the cancer continuum.
The Society for Integrative Oncology7 and ASCO8 recommend mind-body practices as safe, nonpharmacologic techniques to mitigate psychological symptoms and to improve the quality of life. However, due to COVID-19–imposed restrictions, patients cannot avail such therapies in person.
Remote Delivery of Mind-Body Services: Meeting Patient Needs During the Pandemic
At the peak of the first wave of COVID-19 in New York City, the integrative medicine service at Memorial Sloan Kettering Cancer Center rapidly developed and implemented a virtual integrative medicine-at-home program for patients with cancer. Therapies offered included fitness, meditation, yoga, dance, tai chi, and music. The sessions, 30 to 45 minutes long, were led by an integrative medicine practitioner via Zoom video conferencing. To inform program evaluation and continued process improvement, at the end of each session, participants completed a 3-item questionnaire on satisfaction with the class session, reduction in stress/anxiety, and the likelihood of recommending the class to others. Participants answered these questions using a 5-point Likert scale and could also comment about the session through the chat function available on Zoom.
Data showed fitness classes to be the most popular (n = 2,513, 42.2%), followed by meditation (n = 1,176, 19.8%), yoga (n = 909, 15.3%), music (n = 513, 8.6%), dance (n = 424, 7.1%), and tai chi (n = 413, 6.9%). Of the 3,902 participants who completed the questionnaire, the majority indicated they were extremely satisfied with the sessions (n = 3,733, 95.7%); had significant reductions in anxiety/stress (n = 3,268, 83.8%); and were very likely to recommend the class to others (n = 3,605, 92.4%). Using the real-time chat function, participants expressed gratitude and feelings of love and connection during the classes, despite attending them remotely.9
Given the uncertainty surrounding COVID-19 and subsequently the restrictions to in-person care, virtual services can be valuable in oncology settings. Mind-body therapies are safe and effective interventions for managing stress and anxiety. They can be especially useful in coping with the pandemic-inflicted psychological burden and contribute to overall well-being and resilience.
We demonstrated the feasibility of remotely delivering mind-body services to patients with cancer. The high rates of usage and acceptance of these offerings are promising. As we continue to face the challenges of COVID-19, helping patients access virtual integrative and supportive care is important to address their psychosocial needs.
Future research should evaluate whether virtual mind-body programing integrated into oncology care can improve patient experience and outcomes.
DISCLOSURE: Dr. Mao has received institutional research funding from Tibet Cheezheng Tibetan Medicine Co. Ltd. and Zhongke Health International LLC. Ms. Gubili reported no conflicts of interest.
1. Wang Y, Duan Z, Ma Z, et al: Epidemiology of mental health problems among patients with cancer during COVID-19 pandemic. Transl Psychiatry 10:263, 2020.
2. Miaskowski C, Paul SM, Snowberg K, et al: Stress and symptom burden in oncology patients during the COVID-19 pandemic. J Pain Symptom Manage 60:e25-e34, 2020.
3. Kuderer NM, Choueiri TK, Shah DP, et al: Clinical impact of COVID-19 on patients with cancer (CCC19): A cohort study. Lancet 395:1907-1918, 2020.
4. Gregucci F, Caliandro M, Surgo A, et al: Cancer patients in COVID-19 era: Swimming against the tide. Radiother Oncol 149:109-110, 2020.
5. Carlson LE, Zelinski E, Toivonen K, et al: Mind-body therapies in cancer: What is the latest evidence? Curr Oncol Rep 19:67, 2017.
6. Stout NL, Baima J, Swisher AK, et al: A systematic review of exercise systematic reviews in the cancer literature (2005–2017). PM R 9:S347-S384, 2017.
7. Greenlee H, Balneaves LG, Carlson LE, et al: Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014:346-358, 2014.
8. Lyman GH, Greenlee H, Bohlke K, et al: Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO Clinical Practice Guideline. J Clin Oncol 36:2647-2655, 2018.
9. Trevino KM, Raghunathan N, Latte-Naor S, et al: Rapid deployment of virtual mind-body interventions during the COVID-19 outbreak: Feasibility, acceptability, and implications for future care. Support Care Cancer. September 9, 2020 (early release online).