Virtual yoga, music therapy — cancer patients find support online amid COVID-19

In a soft, melodic voice, music therapist Mary Kauffman teaches viewers breathing, stress-reducing exercises to the beat of a Hapi drum. What’s more, you can watch her relaxing video from the comfort of your own home.

Turn to another video program and you can learn how to make a loom with directions from art therapist Elia Khalaf or do yoga sitting on a chair thanks to wellness instructor Sari Velar.

These are just a few of the classes offered online through the Sylvester Comprehensive Cancer Center’s Support Services programs that are free and open to the community. Other classes cover nutrition and cooking demonstrations, spiritual counseling, advice for hair loss and even a virtual session called “A Dog’s Story” about the life of a therapy pooch. There are also sessions in Spanish.

Sylvester, part of the University of Miami Health System, is among many medical institutions offering an increasing number of online services, which shifted into high gear when shutdowns began due to the coronavirus pandemic.

“It’s one way we can still connect emotionally with our patients at this time,” said Dr. Christina Pozo-Kaderman, a clinical psychologist and director of cancer support services at Sylvester. “It’s a whole new way of providing healthcare.”

“One impact of this trend is that telemedicine is here to stay,” said Dr. Brian Hunis, medical director of oncology and associate medical director, Memorial Cancer Institute. “One of the few good things about this pandemic is that it has helped move telemedicine ahead by five to 10 years.”

Hunis said the Institute, part of the Memorial Healthcare System, had to work quickly to switch “an average of 80 plus appointments per week per doctor to about a third of that in-person and the rest to telemedicine.”

These unprecedented circumstances have shown that telemedicine “is one, doable; two, efficient; and three, provided it continues to be reimbursed, an adequate alternative to an in-face encounter,” said Hunis.

There are exceptions when an in-person visit is more vital, he said. Those cases might involve seeing a new cancer patient — particularly one about to undergo chemotherapy, cases where a physical exam is needed or situations that could have a severe emotional impact.

“The question I pose to my colleagues when they have to decide whether to do telemedicine versus an in-person encounter is, ‘What would happen if I don’t see this person?’ If the answer is probably nothing, then it would be OK to use telemedicine.“

But sometimes patients do need a “face-to-face, personal touch,” he said.

Aside from oncologists moving about two-thirds of their practice to telehealth, Memorial shifted its integrated medicine practice, including psychologists, dietitians, cancer navigators and others to serve oncology patients via telehealth.

While institutions had to move quickly to create a wide spectrum of virtual programs, it paid off, said Pozo-Kaderman.

“Telehealth has opened a lot of opportunities,” said Raul Pino-Lay, a retired Miami pharmacist who was diagnosed with lymphoma in 2017. “For me, it’s great.”

Before the coronavirus, Pino-Lay had looked forward to his practices and performances with Sylvester’s Survivorship Choir, which sang at numerous University of Miami events, including games.

While disappointed that he can’t meet with his fellow choir members in person, Pino-Lay has practiced with the group via Zoom thanks to Sylvester music therapist Kauffman.

He’s also taken virtual yoga lessons, exercise classes and met virtually with the chaplain.

“I love it,” said Pinot-Lay. “I’m so glad I can do a lot of the things I had to stop because of the coronavirus. Oh my God, I’m forever thankful.”

Dr. Maria Teresa Maidana Giret has found both virtual medicine and classes helpful. She’s an assistant scientist in the radiology oncology department at Sylvester who discovered she had breast cancer on Christmas Eve 2017.

Giret attends a virtual support group with one of her three daughters, tried music therapy and has had four virtual medical appointments, which have helped with lipedema issues.

“Now I have exercises and a routine,” she said. “It’s saving me time.”

For Stephany Goyla, virtual programming has allowed her to continue sessions with a personal trainer arranged through the cancer patient survivorship program at the Miami Cancer Institute, part of Baptist Health South Florida.

“I’m so grateful for this,” said Goyla, who was diagnosed with cervical cancer last year. “This costs me $100 for 10 weeks. I couldn’t afford this on my own.”

Twice a week, after finishing work at home, she switches to her personal computer and begins her virtual training with James Cleary, oncology exercise physiologist at the Miami Cancer Institute.

“It keeps your health up and your energy up,” said Goyla.

Boosting physical and mental health is a key component of virtual programming, said Dr. M. Beatriz Currier, chief of psychiatric oncology and medical director of the Cancer Patient Support Center at the Miami Cancer Institute.

“We really thought it was important because of the uncertainty for patients and providers feeling the stress of not really having the normal way of life we’re used to,” said Currier. “We want to empower patients to have self-care practices available to them so they can have some control over some of the emotional and physical symptoms” caused by COVID-19.

Fear, depression and irritability can be even more severe for a patient during a crisis like this pandemic. Physical symptoms can include insomnia, fatigue, headaches and loss of appetite as well as increased alcohol or substance abuse.

Physical exercise and activity — about 150 minutes per week — is among the crucial factors in fighting stress and fostering health, she said. So the cancer center’s programming includes a wide range of exercise classes. Some are straightforward like chair yoga, weights, stretching and Pilates but there’s also Zumba, hip-hop, family workouts and a Friday night dance party.

“Our patients are part of a family and kids are struggling, too,” said Currier, so many classes involve kids and teens.

The Miami Cancer Institute also offers classes in daily relaxation, meditation and mindfulness, deep breathing.

”Patients start meditating for two minutes, twice a day. Gradually build up to 10 minutes of meditation twice a day,” said Currier. “This can really dampen many of the emotional and physical symptoms related to stress.”

There are also classes on stopping smoking, diet and nutrition, cooking demonstrations and one called “Sleep in the time of COVID-19.”

“We know that sleep is ground zero for mental health,” Currier said. “It’s very important for patients to maintain good sleep habits.”

Those habits, she said, include trying to maintain the same sleep schedule, not reading or watching TV in bed, avoiding alcohol to help sleep because it disrupts the sleep cycle and minimizing exposure to blue light on electronic screens.

During a crisis like a pandemic, “everything that you know is changed and different,” said Michelle Rodewald, a registered nurse in hematology/oncology in the Maroone Cancer Center at Cleveland Clinic Weston. “The oncology patient often feels isolated.”

The hospital has launched virtual classes that include yoga, art and music therapy, nutrition, cooking demonstrations, a book club and esthetics (skin care, dealing with hair and eyebrow loss), said Rodewald, who oversees support services. The classes are for patients only and some services, such as art therapy, are available for patients’ families. During the summer, an art therapy program is available for the children of cancer patients.

When measures were put in place to limit social distancing, Mavis Swann attended the new patient orientation at Cleveland Clinic virtually.

“It was in real time and it was very informative,” said Swann, a Delray Beach resident who was diagnosed with breast cancer in February. She also learned about nutrition and where to get a wig.

“For me, it was really, really good. I look forward to going to art therapy to see what I can draw.”

Being able to interact, even in a virtual class, “brings some calmness,” said Rodewald. “You can see it on their faces after a session. They might not be talking about their diagnosis. They might be playing music or dancing. It brings a lot of joy.”

How to connect to online classes

▪ Sylvester Comprehensive Cancer Center: The public can access classes at the Sylvester Comprehensive Cancer Center at the University of Miami at umiamihealth.org/en/Sylvester-Comprehensive-Cancer-Center/Classes-and-Events

▪ Miami Cancer Institute: To get the list of upcoming programs, subscribe to the weekly eblasts with program/event information via Miamicancerinstitute.com and click on “subscribe now” or sign up on https://baptisthealth.net/Cancer-Care/joinTheCommunity