Cancer Santillán by YogaClicks


About

Yoga, meditation and mindfulness can help cancer patients in a number of ways. They can reduce the stress and anxiety that come with a cancer diagnosis. They can alleviate depression, boost mood, improve the ability to sleep and contribute to quality of life.

They can also help manage physical symptoms and the side effects of treatment – lowering blood pressure, improving immune function, impacting on pain levels, increasing energy and vitality so medication can be better handled even, according to one study, modulating DNA damage in radiotherapy.

Meditation and mindfulness can help us stay in the present moment, rather than worrying about what might, or might not be. The sense of community in class can also be a great comfort. Finding people going through the same experience, or who have been there and come out the other side, can do wonders for stress levels, and the soul.


What the clinical studies say

Yoga
  • Alleviates depression
  • Beneficial effects on physical function
  • Beneficial effects on psychological symptoms
  • Beneficial effects on somatic symptoms
  • Higher levels of acceptance
  • Higher levels of invigoration
  • Improves cognitive function
  • Improves emotional function/wellbeing
  • Improves mood
  • Improves patient's adjustment to disease
  • Improves physical fitness
  • Improves quality of life
  • Improves sleep quality
  • Improves social wellbeing
  • Improves social wellbeing
  • Improves spiritual wellbeing
  • Increases ability to relax
  • Influences levels of melatonin on breast and prostate tumors
  • Lower levels of pain
  • Lowers depression
  • Lowers tension
  • Modulates DNA damage in radiotherapy
  • Reduces anxiety
  • Reduces cancer-related distress
  • Reduces cancer-related symptoms
  • Reduces cognitive disorganization
  • Reduces confusion
  • Reduces fatigue
  • Reduces gastrointestinal symptoms
  • Reduces irritability
  • Reduces mood disturbance
  • Reduces stress
Mindfulness
  • Alleviates depression
  • Boosts vigour
  • Decreases cortisol levels
  • Improves ability to cope
  • Improves immune function
  • Improves psychosocial adjustment to disease
  • Improves quality of life
  • Improves sleep quality
  • Increases energy
  • Lowers anxiety
  • Lowers blood pressure
  • Lowers fear of recurrence
  • Lowers mood disturbance
  • Reduces anger
  • Reduces anxiety
  • Reduces confusion
  • Reduces fatigue
  • Reduces irritability
  • Reduces pro-inflammatory cytokines
  • Reduces stress symptoms

The clinical studies

Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

BACKGROUND:

Research suggests that stress-reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life. Yoga, an ancient Eastern science, incorporates stress-reduction techniques that include regulated breathing, visual imagery, and meditation as well as various postures. The authors examined the effects of the Tibetan yoga (TY) practices of Tsa lung and Trul khor, which incorporate controlled breathing and visualization, mindfulness techniques, and low-impact postures in patients with lymphoma.

METHODS:

Thirty-nine patients with lymphoma who were undergoing treatment or who had concluded treatment within the past 12 months were assigned to a TY group or to a wait-list control group. Patients in the TY group participated in 7 weekly yoga sessions, and patients in the wait-list control group were free to participate in the TY program after the 3-month follow-up assessment.

RESULTS:

Eighty nine percent of TY participants completed at least 2–3 three yoga sessions, and 58% completed at least 5 sessions. Patients in the TY group reported significantly lower sleep disturbance scores during follow-up compared with patients in the wait-list control group (5.8 vs. 8.1; P < 0.004). This included better subjective sleep quality (P < 0.02), faster sleep latency (P < 0.01), longer sleep duration (P < 0.03), and less use of sleep medications (P < 0.02). There were no significant differences between groups in terms of intrusion or avoidance, state anxiety, depression, or fatigue.

CONCLUSIONS:

The participation rates suggested that a TY program is feasible for patients with cancer and that such a program significantly improves sleep-related outcomes. However, there were no significant differences between groups for the other outcomes.
Citations

345
Authors

Lorenzo Cohen | Carla Warneke | Rachel T. Fouladi | M. Alma Rodriguez | Alejandra Chaoul-Reich
Published

2004
Journal

Cancer
Volume / Issue

100:10
Author's primary institution

The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Self-report Mindfulness as a Mediator of Psychological Well-being in a Stress Reduction Intervention for Cancer Patients—A Randomized Study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background:

There is increasing recognition of mindfulness and mindfulness training as a way to decrease stress and increase psychological functioning.

Purpose:

The aims of this study were to examine the effects of mindfulness stress reduction training on perceived stress and psychological well-being and to examine if changes in mindfulness mediate intervention effects on these outcomes.

Methods:

Seventy women and one man with a previous cancer diagnosis (mean age 51.8 years, standard deviation = 9.86) were randomized into an intervention group or a wait-list control group. The intervention consisted of an 8-week mindfulness training course.

Results:

Compared to participants in the control group, participants in the mindfulness training group had significantly decreased perceived stress and posttraumatic avoidance symptoms and increased positive states of mind. Those who participated in the intervention reported a significant increase in scores on the five-facet mindfulness questionnaire (FFMQ) when compared to controls. The increase in FFMQ score mediated the effects of the intervention on perceived stress, posttraumatic avoidance symptoms, and positive states of mind.

Conclusions:

This study indicates that the improvements in psychological well-being resulting from mindfulness stress reduction training can potentially be explained by increased levels of mindfulness as measured with the FFMQ. The importance of these findings for future research in the field of mindfulness is discussed.
Citations

113
Authors

Richard Brastrom | Pia Kvillemo | Yvonne Brandberg | Judith Tedlie Moskowitz
Published

2010
Journal

Annals of Behavioral Medicine
Volume / Issue

39:2
Author's primary institution

Department of Oncology-Pathology, Karolinska Institute, Radiumhemmet, Stockholm, Sweden
Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, and levels of cortisol, dehydroepiandrosterone-sulfate (DHEAS) and melatonin.

Methods:

Fifty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week Mindfulness-Based Stress Reduction (MBSR) program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life, mood, stress, and the hormone measures of salivary cortisol (assessed three times/day), plasma DHEAS, and salivary melatonin were assessed pre- and post-intervention.

Results:

Fifty-eight and 42 patients were assessed pre- and post-intervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality, but these improvements were not significantly correlated with the degree of program attendance or minutes of home practice. No significant improvements were seen in mood disturbance. Improvements in quality of life were associated with decreases in afternoon cortisol levels, but not with morning or evening levels. Changes in stress symptoms or mood were not related to changes in hormone levels. Approximately 40% of the sample demonstrated abnormal cortisol secretion patterns both pre- and post-intervention, but within that group patterns shifted from “inverted-V-shaped” patterns towards more “V-shaped” patterns of secretion. No overall changes in DHEAS or melatonin were found, but nonsignificant shifts in DHEAS patterns were consistent with healthier profiles for both men and women.

Conclusions:

MBSR program enrollment was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients, and resulted in possibly beneficial changes in hypothalamic-pituitary-adrenal (HPA) axis functioning. These pilot data represent a preliminary investigation of the relationships between MBSR program participation and hormone levels, highlighting the need for better-controlled studies in this area.
Citations

495
Authors

Linda E Carson | Michael Speca | Kamala Patel | Eileen Goodey
Published

2003
Journal

Psychoneuroendocrinology
Volume / Issue

29:4
Author's primary institution

Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board, 1331 29 Street NW, Calgary, Alta, Canada T2N 4N2. 
One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

This study investigated the ongoing effects of participation in a mindfulness-based stress reduction (MBSR) program on quality of life (QL), symptoms of stress, mood and endocrine, immune and autonomic parameters in early stage breast and prostate cancer patients.

Methods:

Forty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week MBSR program that incorporated relaxation, meditation, gentle yoga and daily home practice. Demographic and health behaviors, QL, mood, stress symptoms, salivary cortisol levels, immune cell counts, intracellular cytokine production, blood pressure (BP) and heart rate (HR) were assessed pre- and post-intervention, and at 6- and 12-month follow-up.

Results:

Fifty-nine, 51, 47 and 41 patients were assessed pre- and post-intervention and at 6- and 12-month follow-up, respectively, although not all participants provided data on all outcomes at each time point. Linear mixed modeling showed significant improvements in overall symptoms of stress which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (pro-inflammatory) cytokines. Systolic blood pressure (SBP) decreased from pre- to post-intervention and HR was positively associated with self-reported symptoms of stress.

Conclusions:

MBSR program participation was associated with enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure. These pilot data represent a preliminary investigation of the longer-term relationships between MBSR program participation and a range of potentially important biomarkers.
Citations

370
Authors

Linda E. Carlson | Michael Speca | Peter Faris | Kamala D. Patel
Published

2007
Journal

Brain, Behavior and Immunity
Volume / Issue

21:8
Author's primary institution

Department of Psychosocial Resources, Tom Baker Cancer Center, Alberta Cancer Board, Calgary, Alberta, Canada
Mindfulness‐Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

This study investigated the relationships between a mindfulness‐based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production.

Methods:

Forty‐nine patients with breast cancer and 10 with prostate cancer participated in an 8‐week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life (EORTC QLQ C‐30), mood (POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper, and T cytotoxic cells, as well as NK and T cell production of TNF, IFN‐γ, IL‐4, and IL‐10 were assessed pre‐ and post intervention.

Results:

Fifty‐nine and 42 patients were assessed pre‐ and post intervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. Although there were no significant changes in the overall number of lymphocytes or cell subsets, T cell production of IL‐4 increased and IFN‐γ decreased, whereas NK cell production of IL‐10 decreased. These results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile.

Conclusions:

MBSR participation was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients. This study is also the first to show changes in cancer‐related cytokine production associated with program participation.
Citations

597
Authors

Linda E Carson | Michael Speca | Kamala Patel |
Published

2003
Journal

Psychosomatic Medicine
Volume / Issue

65:4
Author's primary institution

Department Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
A pilot study of yoga for breast cancer survivors: physical and psychological benefits
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background:

Physical activity provides a number of physical and psychological benefits to cancer survivors, including lessening the impact of detrimental cancer-related symptoms and treatment side-effects (e.g. fatigue, nausea), and improving overall well-being and quality of life. The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors.

Method:

Eligible participants (per-screened with PAR-Q/PAR-MED-X) were randomly assigned to either the intervention (n=20) or control group (n=18). All participants completed pre- and post-testing assessments immediately before and after the yoga program, respectively.

Results:

The yoga program participants (M age=51.18 (10.33); 92% female) included primarily breast cancer survivors, on average 55.95 (54.39) months post-diagnosis. Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial (i.e. global quality of life, emotional function, and diarrhea) variables (all p's <0.05). There were also trends for group differences, in the hypothesized directions, for the psychosocial variables of emotional irritability, gastrointestinal symptoms, cognitive disorganization, mood disturbance, tension, depression, and confusion (all p's <0.10). Finally, there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables.

Conclusions:

These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors. Future research might attempt to include a broader range of participants (e.g. other types of cancer diagnoses, male subjects), a larger sample size, and a longer program duration in an RCT
Citations

192
Authors

S. Nicole Culos-Reed | Linda E. Carlson | Lisa M/ Daroux | Susi Hately-Aldous
Published

2006
Journal

Psycho-Oncology
Volume / Issue

15:10
Author's primary institution

Faculty of Kinesiology, University of Calgary, Calgary, Canada
The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

The diagnosis of breast cancer, the most common type of cancer among American women, elicits greater distress than any other diagnosis regardless of prognosis. Therefore, the present study examined the efficacy of a stress reduction intervention for women with breast cancer. 

Methods:

As part of a larger, randomized, controlled study of the effects on measures of stress of a mindfulness-based stress reduction (MBSR) intervention for women with breast cancer, the current analyses examined the effects on sleep complaints. 

Results:

Analyses of the data indicated that both MBSR and a free choice (FC) control condition produced significant improvement on daily diary sleep quality measures though neither showed significant improvement on sleep-efficiency. Participants in the MBSR who reported greater mindfulness practice improved significantly more on the sleep quality measure most strongly associated with distress.

Conclusion:

MBSR appears to be a promising intervention to improve the quality of sleep in woman with breast cancer whose sleep complaints are due to stress.
Citations

251
Authors

Shauna L. Shapiro | Richard R Bootzin | Aurelio J Figuredo | Ana Maria Lopez | Gary E Schwartz
Published

2003
Journal

Journal of Psychosomatic Research
Volume / Issue

54:1
Author's primary institution

Department of Psychology, University of Arizona, Tuscan, USA
A Randomized, Wait-List Controlled Clinical Trial: The Effect of a Mindfulness Meditation-Based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

The objective of this study was to assess the effects of participation in a mindfulness meditation–based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients.

Methods:

A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after giving informed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice.

Results:

Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients’ mean preintervention scores on dependent measures were equivalent between groups. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress.

Conclusions:

This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages.
Citations

886
Authors

Michael Speca | Linda E Carlson | Eileen Goodey | Maureen Angen
Published

2000
Journal

Psychosomatic Medicine
Volume / Issue

62:5
Author's primary institution

Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board, Canada
Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Sleep disturbance is a very common problem for cancer patients that has largely not been addressed in the clinical intervention literature. Mindfulness meditation has demonstrated clinical benefits for a variety of patient populations in other areas of functioning. This study examined the effects of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on the sleep quality of a heterogeneous sample of 63 cancer patients.

Overall sleep disturbance was significantly reduced (p < .001) and participants reported that their sleep quality had improved (p < .001). There was also a significant reduction in stress (p < .001), mood disturbance (p = .001), and fatigue (p < .001). The associations among these changes and implications for improving quality of life of cancer patients are discussed.
Citations

338
Authors

Linda E. Carlson | Sheila N. Garland
Published

2005
Journal

International Journal of Behvaior Medicine
Volume / Issue

12:4
Author's primary institution

Department of Oncology, Department of Psychology, University of Calgary, Calgary, Alberta, Canada
The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

The goals of this work were to assess the effects of participation in a mindfulness meditation-based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients immediately after and 6 months after program completion.

A convenience sample of eligible cancer patients were enrolled after they had given informed consent. All patients completed the Profile of Mood States (POMS) and Symptoms of Stress Inventory (SOSI) both before and after the intervention and 6 months later. The intervention consisted of a mindfulness meditation group lasting 1.5 h each week for 7 weeks, plus daily home meditation practice. A total of 89 patients, average age 51, provided pre-intervention data. Eighty patients provided post-intervention data, and 54 completed the 6-month follow-up The participants were heterogeneous with respect to type and stage of cancer.

Patients' scores decreased significantly from before to after the intervention on the POMS and SOSI total scores and most subscales, indicating less mood disturbance and fewer symptoms of stress, and these improvements were maintained at the 6-month follow-up. More advanced stages of cancer were associated with less initial mood disturbance, while more home practice and higher initial POMS scores predicted improvements on the POMS between the pre- and post-intervention scores. Female gender and more education were associated with higher initial SOSI scores, and improvements on the SOSI were predicted by more education and greater initial mood disturbance.

This program was effective in decreasing mood disturbance and stress symptoms for up to 6 months in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and educational background, and with disparate ages.
Citations

328
Authors

Linda E. Carlson | Zenovia Ursuliak | Eileen Goodey | Maureen Angen | Michael Speca
Published

2001
Journal

Supportive Care in Cancer
Volume / Issue

9:2
Author's primary institution

Department of Psychosocial Resources, Tom Baker Cancer Center, Alberta Cancer Board, Calgary, Alberta, Canada
Mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients.

Methods:

Ten studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen's effect size d was computed for each category.

Results:

MBSR may indeed be helpful for the mental health of cancer patients (Cohen's effect size d=0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen's effect size d=0.18).

Conclusion:

The results suggest that MBSR may improve cancer patients' psychosocial adjustment to their disease.
Citations

231
Authors

Dianne Ledesma | Hiroaki Kumano
Published

2008
Journal

Pyscho-Oncology
Volume / Issue

18:6
Author's primary institution

Department of Stress Science and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Japan
Randomized Controlled Trial of Yoga Among a Multiethnic Sample of Breast Cancer Patients: Effects on Quality of Life
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Purpose:

This study examines the impact of yoga, including physical poses, breathing, and meditation exercises, on quality of life (QOL), fatigue, distressed mood, and spiritual well-being among a multiethnic sample of breast cancer patients.

Patients and Methods:

One hundred twenty-eight patients (42% African American, 31% Hispanic) recruited from an urban cancer center were randomly assigned (2:1 ratio) to a 12-week yoga intervention (n = 84) or a 12-week waitlist control group (n = 44). Changes in QOL (eg, Functional Assessment of Cancer Therapy) from before random assignment (T1) to the 3-month follow-up (T3) were examined; predictors of adherence were also assessed. Nearly half of all patients were receiving medical treatment.

Results:

Regression analyses indicated that the control group had a greater decrease in social well-being compared with the intervention group after controlling for baseline social well-being and covariates (P < .0001). Secondary analyses of 71 patients not receiving chemotherapy during the intervention period indicated favorable outcomes for the intervention group compared with the control group in overall QOL (P < .008), emotional well-being (P < .015), social well-being (P < .004), spiritual well-being (P < .009), and distressed mood (P < .031). Sixty-nine percent of intervention participants attended classes (mean number of classes attended by active class participants = 7.00 ± 3.80), with lower adherence associated with increased fatigue (P < .001), radiotherapy (P < .0001), younger age (P < .008), and no antiestrogen therapy (P < .02).

Conclusion:

Despite limited adherence, this intent-to-treat analysis suggests that yoga is associated with beneficial effects on social functioning among a medically diverse sample of breast cancer survivors. Among patients not receiving chemotherapy, yoga appears to enhance emotional well-being and mood and may serve to buffer deterioration in both overall and specific domains of QOL.
Citations

229
Authors

Alyson B. Moadel | Chirag Shah | Judith Wylie-Rosett | Melanie S. Harris | Sapana R. Patel | Charles B. Hall | Joseph A. Sparano
Published

2007
Journal

American Society of Clinical Oncology
Volume / Issue

25:28
Author's primary institution

Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, Columbia University, New York
Yoga for Cancer Patients and Survivors
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background:

Yoga has been practiced for thousands of years to improve physical and emotional well-being. Empirical research on yoga has been ongoing for several decades, including several recent studies conducted with cancer patients and survivors.

Methods:

This review provides a general introduction to yoga and a detailed review of yoga research in cancer.

Results:

Nine studies conducted with cancer patients and survivors yielded modest improvements in sleep quality, mood, stress, cancer-related distress, cancer-related symptoms, and overall quality of life. Studies conducted in other patient populations and healthy individuals have shown beneficial effects on psychological and somatic symptoms, as well as other aspects of physical function.

Conclusions:

Results from the emerging literature on yoga and cancer provide preliminary support for the feasibility and efficacy of yoga interventions for cancer patients, although controlled trials are lacking. Further research is required to determine the reliability of these effects and to identify their underlying mechanisms.
Citations

199
Authors

Julienne E. Bower | Alison Woolery | Beth Sternlieb | Deborah Garet
Published

2005
Journal

Cancer control
Volume / Issue

Author's primary institution

Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute, David Geffen School of Medicine
Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period.

Methods:

We conducted a randomized controlled trial of 84 female BC survivors (Stages 0–III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36).

Results:

Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning.

Conclusions:

Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care.
Citations

217
Authors

Cecile A. Lengacher | Versie Johnson-Mallard | Janice Post-White | Manolete S. Moscoso | Paul B. Jacobsen | Thomas W Klein | Raymond H. Widen | Shirley G. Fitzgerald | Melissa M. Shelton | Michelle Barta | Mathew Goodman | Charles E. Cox | Kevin E. Kip
Published

2009
Journal

Psycho-Oncology
Volume / Issue

18:12
Author's primary institution

University of South Florida College of Nursing, Tampa, Florida, USA
An evidence-based review of yoga as a complementary intervention for patients with cancer
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

To conduct an evidence-based review of yoga as an intervention for patients with cancer. Specifically, this paper reviewed the impact of yoga on psychological adjustment among cancer patients.

Methods:

A systematic literature search was conducted between May 2007 and April 2008. Data from each identified study were extracted by two independent raters; studies were included if they assessed psychological functioning and focused on yoga as a main intervention. Using a quality rating scale (range = 9–45), the raters assessed the methodological quality of the studies, and CONSORT guidelines were used to assess randomized controlled trials (RCTs). Effect sizes were calculated when possible. In addition, each study was narratively reviewed with attention to outcome variables, the type of yoga intervention employed, and methodological strengths and limitations.

Results:

Ten studies were included, including six RCTs. Across studies, the majority of participants were women, and breast cancer was the most common diagnosis. Methodological quality ranged greatly across studies (range = 15.5–42), with the average rating (M = 33.55) indicating adequate quality. Studies also varied in terms of cancer populations and yoga interventions sampled.

Conclusions:

This study provided a systematic evaluation of the yoga and cancer literature. Although some positive results were noted, variability across studies and methodological drawbacks limit the extent to which yoga can be deemed effective for managing cancer-related symptoms. However, further research in this area is certainly warranted. Future research should examine what components of yoga are most beneficial, and what types of patients receive the greatest benefit from yoga interventions.
Citations

127
Authors

Kelly B. Smith | Caroline F. Pukall
Published

2008
Journal

Psycho-Oncology
Volume / Issue

18:5
Author's primary institution

Department of Psychology, Queen's University, Kingston, Ont., Canada
Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

This investigation used a non-randomized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL), and coping in women recently diagnosed with breast cancer.

Early stage breast cancer patients, who did not receive chemotherapy, self-selected into an 8-week MBSR program or into an assessment only, control group. Outcomes were evaluated over time. The first assessment was at least 10 days after surgery and prior to adjuvant therapy, as well as before the MBSR start-up. Further assessments were mid-MBSR, at completion of MBSR, and at 4-week post-MBSR completion. Women with breast cancer enrolled in the control group (Non-MBSR) were assessed at similar times.

At the first assessment (i.e., before MBSR start), reductions in peripheral blood mononuclear cell NK cell activity (NKCA) and IFN-γ production with increases in IL-4, IL-6, and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breast cancer patients. Over time women in the MBSR group re-established their NKCA and cytokine production levels. In contrast, breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN-γ production with increased IL-4, IL-6, and IL-10 production. Moreover, women enrolled in the MBSR program had reduced cortisol levels, improved QOL, and increased coping effectiveness compared to the Non-MBSR group.

In summary, MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence for beneficial effects of MBSR; on immune function, QOL, and coping.
Citations

220
Authors

Linda Witek-Janusek | Kevin Albuquerue | Karen Rambo Chroniak | Ramon Durazo-Arvizu | Herbert L. Mathews
Published

2008
Journal

Brain, Behavior and Immunity
Volume / Issue

22:6
Author's primary institution

Insight Center for Stress Management and Integrative Psychotherapy, Chicago, IL 60603, USA
Mindfulness-Based Stress Reduction as supportive therapy in cancer care: systematic review
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Aim:

This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of Mindfulness-Based Stress Reduction for cancer supportive care.

Background:

The experience of cancer can have a negative impact on both psychological and physical health and on quality of life. Mindfulness-Based Stress Reduction is a therapy package that has been used with patients with a variety of conditions. In order to draw conclusions on its effectiveness for cancer patients, the evidence requires systematic assessment.

Methods:

A comprehensive search of major biomedical and specialist complementary medicine databases was conducted. Additionally, efforts were made to identify unpublished and ongoing research. Relevant research was categorized by study type and appraised according to study design. Clinical commentaries were obtained for each study and included in the review.

Results:

Three randomized controlled clinical trials and seven uncontrolled clinical trials were found. A lack of relevant qualitative research studies was identified. Studies report positive results, including improvements in mood, sleep quality and reductions in stress. A dose-response effect has been observed between practice of Mindfulness-Based Stress Reduction and improved outcome. A number of methodological limitations were identified. Modifications to the traditional Mindfulness-Based Stress Reduction programme make comparison between studies difficult and a lack of controlled studies precludes any firm conclusion on efficacy.

Conclusion:

Mindfulness-Based Stress Reduction has potential as a clinically valuable self-administered intervention for cancer patients. Further research into its efficacy, feasibility and safety for cancer patients in the nursing context is recommended.
Citations

197
Authors

Joanna E. Smith | Janet Richardson | Caroline Hoffman | Karen Pilkington
Published

2005
Journal

Journal of Advanced Nursing
Volume / Issue

52:3
Author's primary institution

Janet Richardson, Faculty of Health and Social Work, University of Plymouth, Portland Square, UK
Effects of yoga on the quality of life in cancer patients
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

This study sought to investigate the effects of yoga on the quality of life in patients with breast cancer.

Design:

Twenty patients between 30 and 50 years of age presently under treatment for breast cancer were included in the study. The physical characteristics of the patients were recorded and general physiotherapy assessments performed. Eight sessions of a yoga program including warming and breathing exercises, asanas, relaxation in supine position, and meditation were applied to participants.

Main outcome measures:

The pre- and post-yoga quality of life assessments for the patients were conducted using the Nottingham Health Profile (NHP). Patients' stress levels were assessed using the STAI-I and STAI-II anxiety inventory. Their satisfaction levels about the yoga program was evaluated using the visual analog scale (VAS).

Results:

It was found that patients' quality of life scores after the yoga program were better than scores obtained before the yoga program (p < 0.05). After sessions, there was a statistically significant decrease in their STAI-I (measuring the reactions of anxiety) scores and STAI-II (measuring the permanence of anxiety) scores (p < 0.05). It was found out that the satisfaction score concerning the yoga program was considerably increased after the yoga program (p < 0.05).

Conclusions:

It can be concluded that yoga is valuable in helping to achieve relaxation and diminish stress, helps cancer patients perform daily and routine activities, and increases the quality of life in cancer patients. This result was positively reflected in patients satisfaction with the yoga program
Citations

70
Authors

Ozlem Ulger | Naciye Vardar Yagli
Published

2010
Journal

Complementary Therapis in Clinical Practice
Volume / Issue

16:2
Author's primary institution

Hacettepe University, Faculty of Medical Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey
Yoga for women with metastatic breast cancer: results from a pilot study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Metastatic breast cancer (MBC) remains a terminal illness for which major treatment advances are slow to appear, and hence it is crucial that effective palliative interventions be developed to reduce the cancer-related symptoms of women with this condition during the remaining years of their lives.

This pilot/feasibility study examined a novel, yoga-based palliative intervention, the Yoga of Awareness Program, in a sample of women with MBC. The eight-week protocol included gentle yoga postures, breathing exercises, meditation, didactic presentations, and group interchange. Outcome was assessed using daily measures of pain, fatigue, distress, invigoration, acceptance, and relaxation during two preintervention weeks and the final two weeks of the intervention. Thirteen women completed the intervention (mean age = 59; mean time since diagnosis = 7 years; two African American, 11 Caucasian). During the study, four participants had cancer recurrences, and the physical condition of several others deteriorated noticeably.

Despite low statistical power, pre-to-post multilevel outcomes analyses showed significant increases in invigoration and acceptance. Lagged analyses of length of home yoga practice (controlling for individual mean practice time and outcome levels on the lagged days) showed that on the day after a day during which women practiced more, they experienced significantly lower levels of pain and fatigue, and higher levels of invigoration, acceptance, and relaxation.

These findings support the need for further investigation of the effects of the Yoga of Awareness Program in women with MBC.
Citations

126
Authors

James W. Carson | Kimberly M. Carson | Laura S. Porter | Fancis J. Keefe | Heather Shaw | Julie M. Miller
Published

2007
Journal

Journal of Pain and Symptom Management
Volume / Issue

33:3
Author's primary institution

Departments of Psychiatry and Behavioral Sciences (J.W.C., K.M.C., L.S.P., F.J.K., J.M.M.) and Medicine (H.S.), Duke University Medical Center, Durham, North Carolina, USA
Restorative yoga for women with breast cancer: findings from a randomized pilot study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

Restorative yoga (RY) is a gentle type of yoga that may be beneficial for cancer patients and post-treatment survivors. Study goals were: to determine the feasibility of implementing a RY intervention for women with breast cancer; and to examine group differences in self-reported emotional, health-related quality of life, and symptom outcomes.

Methods:

Women with breast cancer (n=44; mean age 55.8 years) enrolled in this study; 34% were actively undergoing cancer treatment. Study participants were randomized to the intervention (10 weekly 75-minute RY classes) or a waitlist control group. Participants completed questionnaires at Week 0 (baseline) and Week 10 (immediately post-intervention for the yoga group).

Results:

Group differences favoring the yoga group were seen for mental health, depression, positive affect, and spirituality (peace/meaning). Significant baseline*group interactions were observed for negative affect and emotional well-being. Women with higher negative affect and lower emotional well-being at baseline derived greater benefit from the yoga intervention compared to those with similar values at baseline in the control group. The yoga group demonstrated a significant within-group improvement in fatigue; no significant difference was noted for the control group.

Conclusions:

Although limited by sample size, these pilot data suggest potential benefit of RY on emotional outcomes and fatigue in cancer patients. This study demonstrates that a RY intervention is feasible for women with breast cancer; implications for study design and implementation are noted with an emphasis on program adoption and participant adherence.
Citations

124
Authors

Suzanne C. Danhauer | Shannon L. Mihalko | Gregory B. Russell | Cassie R. Campbell | Lynn Felder | Kristin Daley | Edward A. Levine
Published

2009
Journal

Journal of the Psychological, Social and Behavioral Dimensions of Cancer
Volume / Issue

18:4
Author's primary institution

Wake Forest University School of Medicine, Winston-Salem, NC, USA
Effects of an Integrated Yoga Program in Modulating Psychological Stress and Radiation-Induced Genotoxic Stress in Breast Cancer Patients Undergoing Radiotherapy
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Effects of an integrated yoga program in modulating perceived stress levels, anxiety, as well as depression levels and radiation-induced DNA damage were studied in 68 breast cancer patients undergoing radiotherapy.

Two psychological questionnaires—Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS)—and DNA damage assay were used in the study.

There was a significant decrease in the HADS scores in the yoga intervention group, whereas the control group displayed an increase in these scores. Mean PSS was decreased in the yoga group, whereas the control group did not show any change pre- and post radiotherapy. Radiation-induced DNA damage was significantly elevated in both the yoga and control groups after radiotherapy, but the post radiotherapy DNA damage in the yoga group was slightly less when compared to the control group.

An integrated approach of yoga intervention modulates the stress and DNA damage levels in breast cancer patients during radiotherapy.
Citations

118
Authors

Birendranath Banerjee | H.S. Vadiraj | Amritanshu Ram | Raghavendra Rao | Manikandan Jayapal | Kodaganur S. Gopinath | B. S. Ramesh | Nalini Rao | Ajay Kumar | Nagarathna Raghuram | Sridevi Hegde | H. R. Nagendra | M. Prakash Hande
Published

2007
Journal

Integrative Cancer Therapy
Volume / Issue

6:3
Author's primary institution

Genome Stability Laboratory, Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Meditation and prostate cancer: integrating a mind/body intervention with traditional therapies.
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

There is growing attention to the health benefits of mind/body interventions, particularly relaxation and meditation.

Biomedical research has provided undeniable evidence of the interconnectedness of the mind and body. The field of psychoneuroimmunology has defined the role of stress in reducing effectiveness of the immune system in combating infection and growth of malignant tumors.

This article explains the development of meditation practice and explores the indications that the practice of meditation is effective reducing the harmful effects of stress. In addition, there are encouraging reports of studies citing the influence of melatonin on breast and prostate tumors.

A preliminary study finds an association between meditation practice and levels of melatonin produced by the pineal gland.
Citations

85
Authors

Coker KH
Published

1999
Journal

Europe PubMed Central
Volume / Issue

17:2
Author's primary institution

Woodruff Health Sciences Center
Moderating Effects of Genetic Polymorphisms on Improvements in Cognitive Impairment in Breast Cancer Survivors Participating in a 6-Week Mindfulness-Based Stress Reduction Program
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Breast cancer (BC) survivors often report cognitive impairment, which may be influenced by single-nucleotide polymorphisms (SNPs). The purpose of this study was to test whether particular SNPs were associated with changes in cognitive function in BC survivors and whether these polymorphisms moderated cognitive improvement resulting from the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program. BC survivors recruited from Moffitt Cancer Center and the University of South Florida’s Breast Health Program, who had completed adjuvant radiation and/or chemotherapy treatment, were randomized to either the 6-week MBSR(BC) program (n = 37) or usual care (UC; n = 35) group. Measures of cognitive function and demographic and clinical history data were attained at baseline and at 6 and 12 weeks. A total of 10 SNPs from eight genes known to be related to cognitive function were analyzed using blood samples. Results showed that SNPs in four genes (ankyrin repeat and kinase domain containing 1 [ANKK1], apolipoprotein E [APOE], methylenetetrahydrofolate reductase [MTHFR], and solute carrier family 6 member 4 [SLC6A4]) were associated with cognitive impairment. Further, rs1800497 in ANKK1was significantly associated with improvements in cognitive impairment in response to MBSR(BC). These results may help to identify individuals who would be better served by MBSR(BC) or other interventions.
Citations

0
Authors

Richard R. Reich | Kevin E Kip | Carly L Paterson | Hyun Y Park | Sophia Ramesar | Heather S L Jim | Carissa B. Alinat | Jong Y. Park
Published

2015
Journal

Biological Research for Nursing
Volume / Issue

N/A
Author's primary institution

College of Nursing, University of South Florida, Tampa, Fl, USA
Yoga and cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors.

Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings.

Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.
Citations

22
Authors

S. Nicole Culos-Reed, Michael J. Mackenzie, Stephanie J. Sohl, Michelle T. Jesse, Ashley N. Ross Zahavich, Suzanne C. Danhauer
Published

2012
Journal

Evidence-Based Complementary and Alternative Medicine
Volume / Issue

Author's primary institution

Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
Yoga for breast cancer patients and survivors: a systematic review and meta-analysis
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

Many breast cancer patients and survivors use yoga to cope with their disease. The aim of this review was to systematically assess and meta-analyze the evidence for effects of yoga on health-related quality of life and psychological health in breast cancer patients and survivors.

Methods

MEDLINE, PsycInfo, EMBASE, CAMBASE, and the Cochrane Library were screened through February 2012. Randomized controlled trials (RCTs) comparing yoga to controls were analyzed when they assessed health-related quality of life or psychological health in breast cancer patients or survivors. Risk of bias was assessed using the Cochrane risk of bias tool. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results

Twelve RCTs with a total of 742 participants were included. Seven RCTs compared yoga to no treatment; 3 RCTs compared yoga to supportive therapy; 1 RCT compared yoga to health education; and 1 RCT compared a combination of physiotherapy and yoga to physiotherapy alone. Evidence was found for short-term effects on global health-related quality of life (SMD = 0.62 [95% CI: 0.04 to 1.21]; P = 0.04), functional (SMD = 0.30 [95% CI: 0.03 to 0.57), social (SMD = 0.29 [95% CI: 0.08 to 0.50]; P < 0.01), and spiritual well-being (SMD = 0.41 [95% CI: 0.08; 0.74]; P = 0.01). These effects were, however, only present in studies with unclear or high risk of selection bias. Short-term effects on psychological health also were found: anxiety (SMD = −1.51 [95% CI: -2.47; -0.55]; P < 0.01), depression (SMD = −1.59 [95% CI: -2.68 to −0.51]; P < 0.01), perceived stress (SMD = −1.14 [95% CI:-2.16; -0.12]; P = 0.03), and psychological distress (SMD = −0.86 [95% CI:-1.50; -0.22]; P < 0.01). Subgroup analyses revealed evidence of efficacy only for yoga during active cancer treatment but not after completion of active treatment.

Conclusions

This systematic review found evidence for short-term effects of yoga in improving psychological health in breast cancer patients. The short-term effects on health-related quality of life could not be clearly distinguished from bias. Yoga can be recommended as an intervention to improve psychological health during breast cancer treatment.
Citations

57
Authors

Holger Cramer
Published

2012
Journal

BMC Cancer
Volume / Issue

12
Author's primary institution

University of Duisburg-Essen, Knappschafts-Krankenhaus, Am Deimelsberg 34a, 45276, Essen, Germany
Effects of yoga interventions on fatigue in cancer patients and survivors: a systematic review of randomized controlled trials
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

Fatigue is one of the most frequently reported, distressing side effects reported by cancer survivors and often has significant long-term consequences. Research indicates that yoga can produce invigorating effects on physical and mental energy, and thereby may improve levels of fatigue. The objective of this systematic review was to examine the literature that reports the effects of randomized, controlled yoga interventions on self-reported fatigue in cancer patients and survivors. The online electronic databases, PubMed and PsycINFO, were used to search for peer-reviewed research articles studying the effects of yoga interventions on fatigue in cancer survivors. Combinations of yoga, cancer, and fatigue-related search terms were entered simultaneously to obtain articles that included all three elements. Studies were included if they met the following inclusion criteria: participants were male or female cancer patients or survivors participating in randomized, controlled yoga interventions. The main outcome of interest was change in fatigue from pre- to post-intervention. Interventions of any length were included in the analysis. Risk of bias using the format of the Cochrane Collaboration's tool for assessing risk of bias was also examined across studies.

Results

Ten articles met inclusion criteria and involved a total of 583 participants who were predominantly female, breast cancer survivors. Four studies indicated that the yoga intervention resulted in significant reductions in self-reported fatigue from pre- to post-intervention. Three of the studies reported that there were significant reductions of fatigue among participants who attended a greater number of yoga classes. Risk of bias was high for areas of adequate selection, performance, detection, and patient-reported bias and mixed for attrition and reporting bias. Risk of bias was uniformly low for other forms of bias, including financial conflicts of interest.

Conclusions

Results of the studies included in this review suggest that yoga interventions may be beneficial for reducing cancer-related fatigue in women with breast cancer; however, conclusions should be interpreted with caution as a result of levels of bias and inconsistent methods used across studies. More well-constructed randomized controlled trials are needed to determine the impact of yoga interventions on fatigue in cancer patients and survivors.Background

Fatigue is one of the most frequently reported, distressing side effects reported by cancer survivors and often has significant long-term consequences. Research indicates that yoga can produce invigorating effects on physical and mental energy, and thereby may improve levels of fatigue. The objective of this systematic review was to examine the literature that reports the effects of randomized, controlled yoga interventions on self-reported fatigue in cancer patients and survivors. The online electronic databases, PubMed and PsycINFO, were used to search for peer-reviewed research articles studying the effects of yoga interventions on fatigue in cancer survivors. Combinations of yoga, cancer, and fatigue-related search terms were entered simultaneously to obtain articles that included all three elements. Studies were included if they met the following inclusion criteria: participants were male or female cancer patients or survivors participating in randomized, controlled yoga interventions. The main outcome of interest was change in fatigue from pre- to post-intervention. Interventions of any length were included in the analysis. Risk of bias using the format of the Cochrane Collaboration's tool for assessing risk of bias was also examined across studies.

Results

Ten articles met inclusion criteria and involved a total of 583 participants who were predominantly female, breast cancer survivors. Four studies indicated that the yoga intervention resulted in significant reductions in self-reported fatigue from pre- to post-intervention. Three of the studies reported that there were significant reductions of fatigue among participants who attended a greater number of yoga classes. Risk of bias was high for areas of adequate selection, performance, detection, and patient-reported bias and mixed for attrition and reporting bias. Risk of bias was uniformly low for other forms of bias, including financial conflicts of interest.

Conclusions

Results of the studies included in this review suggest that yoga interventions may be beneficial for reducing cancer-related fatigue in women with breast cancer; however, conclusions should be interpreted with caution as a result of levels of bias and inconsistent methods used across studies. More well-constructed randomized controlled trials are needed to determine the impact of yoga interventions on fatigue in cancer patients and survivors.
Citations

17
Authors

Julie Sadja, Paul J. Mills
Published

2013
Journal

EXPLORE: The journal of Science and Healing
Volume / Issue

9 : 4
Author's primary institution

University of California, San Diego (UCSD), Joint Doctoral Program in Clinical Psychology, San Diego, CA
Effects of yoga on psychologic function and quality of life in women with breast cancer: a meta-analysis of randomized controlled trials
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

The aim of this meta-analysis was to evaluate the effects of yoga on psychologic function and quality of life (QoL) in women with breast cancer.

Design:

A systematic search of PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database, and the Chinese Digital Journals Full-text Database was carried out. Randomized control trials (RCTs) examining the effects of yoga, versus a control group receiving no intervention, on psychologic functioning and QoL in women with breast cancer were included. Methodological quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1, and data were analyzed using the Cochrane Collaboration's Review Manager 5.1.

Results:

Six (6) studies involving 382 patients were included. The meta-analysis showed that yoga can improve QoL for women with breast cancer. A statistically significant effect favoring yoga for the outcome of QoL was found (standard mean difference=0.27, 95% confidence interval [0.02, 0.52], p=0.03). Although the effects of yoga on psychologic function outcomes—such as anxiety, depression, distress and sleep—were in the expected direction, these effects were not statistically significant (p>0.05). Fatigue showed no significant difference (p>0.05).

Conclusions:

The present data provided little indication of how effective yoga might be when they were applied by women with breast cancer except for mildly effective in QOL improvement. The findings were based on a small body of evidence in which methodological quality was not high. Further well-designed RCTs with large sample size are needed to clarify the utility of yoga practice for this population.Objective:

The aim of this meta-analysis was to evaluate the effects of yoga on psychologic function and quality of life (QoL) in women with breast cancer.

Design:

A systematic search of PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database, and the Chinese Digital Journals Full-text Database was carried out. Randomized control trials (RCTs) examining the effects of yoga, versus a control group receiving no intervention, on psychologic functioning and QoL in women with breast cancer were included. Methodological quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1, and data were analyzed using the Cochrane Collaboration's Review Manager 5.1.

Results:

Six (6) studies involving 382 patients were included. The meta-analysis showed that yoga can improve QoL for women with breast cancer. A statistically significant effect favoring yoga for the outcome of QoL was found (standard mean difference=0.27, 95% confidence interval [0.02, 0.52], p=0.03). Although the effects of yoga on psychologic function outcomes—such as anxiety, depression, distress and sleep—were in the expected direction, these effects were not statistically significant (p>0.05). Fatigue showed no significant difference (p>0.05).

Conclusions:

The present data provided little indication of how effective yoga might be when they were applied by women with breast cancer except for mildly effective in QOL improvement. The findings were based on a small body of evidence in which methodological quality was not high. Further well-designed RCTs with large sample size are needed to clarify the utility of yoga practice for this population.
Citations

19
Authors

Jun Zhang, Ke-hu Yang, Chun-mei Wang
Published

2012
Journal

The Journal of Alternative and Complementary Medicine
Volume / Issue

18 : 11
Author's primary institution

Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Purpose

Yoga is increasingly used as a complementary therapy to manage disease and treatment-related side effects in patients with cancer and has resulted in an increase in the number of studies exploring the effectiveness of yoga interventions. This systematic review examines whether yoga interventions provide any measurable benefit, both physically and psychologically, for women with breast cancer. The results will inform future research in this field and advance the development of yoga programmes.

Methods

We performed electronic searches of MEDLINE, PsychINFO, the Cochrane Library, Embase, CINAHL, AMED, Web of Science and Scopus for articles published up to June 2012. Only randomised controlled trials (RCTs) were included and methodological quality rating scores were determined using the PEDro (Physiotherapy Evidence Database) Scale.

Results

One hundred thirty-two studies were identified through a systematic search of eight electronic databases. Only published manuscripts that employed a RCT design were included (n = 18). The sample sizes for these studies varied widely from 18 to 164 participants and the associated PEDro scores ranged from 1 (poor) to 8 (good). All 18 studies reported positive effects for treatment-related side effects in favour of the yoga interventions, with the greatest impact on global quality of life (QoL) scores and emotional well-being.

Conclusion

Results from the few RCTs suggest there is moderate to good evidence that yoga may be a useful practice for women recovering from breast cancer treatments. Large-scale RCTs using objective measures and patient-reported outcomes with long-term follow-up are needed to substantiate whether the benefits are true and sustainable.Purpose

Yoga is increasingly used as a complementary therapy to manage disease and treatment-related side effects in patients with cancer and has resulted in an increase in the number of studies exploring the effectiveness of yoga interventions. This systematic review examines whether yoga interventions provide any measurable benefit, both physically and psychologically, for women with breast cancer. The results will inform future research in this field and advance the development of yoga programmes.

Methods

We performed electronic searches of MEDLINE, PsychINFO, the Cochrane Library, Embase, CINAHL, AMED, Web of Science and Scopus for articles published up to June 2012. Only randomised controlled trials (RCTs) were included and methodological quality rating scores were determined using the PEDro (Physiotherapy Evidence Database) Scale.

Results

One hundred thirty-two studies were identified through a systematic search of eight electronic databases. Only published manuscripts that employed a RCT design were included (n = 18). The sample sizes for these studies varied widely from 18 to 164 participants and the associated PEDro scores ranged from 1 (poor) to 8 (good). All 18 studies reported positive effects for treatment-related side effects in favour of the yoga interventions, with the greatest impact on global quality of life (QoL) scores and emotional well-being.

Conclusion

Results from the few RCTs suggest there is moderate to good evidence that yoga may be a useful practice for women recovering from breast cancer treatments. Large-scale RCTs using objective measures and patient-reported outcomes with long-term follow-up are needed to substantiate whether the benefits are true and sustainable.
Citations

29
Authors

H. Harder, L. Parlour, V. Jenkins
Published

2012
Journal

Supportive Care in Cancer
Volume / Issue

20 : 12
Author's primary institution

Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

This study aimed to systematically review the evidence from randomized controlled trials (RCTs) and to conduct a meta-analysis of the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors.

Methods

A systematic literature search in ten databases was conducted in November 2011. Studies were included if they had an RCT design, focused on cancer patients or survivors, included physical postures in the yoga program, compared yoga with a non-exercise or waitlist control group, and evaluated physical and/or psychosocial outcomes. Two researchers independently rated the quality of the included RCTs, and high quality was defined as >50% of the total possible score. Effect sizes (Cohen’s d) were calculated for outcomes studied in more than three studies among patients with breast cancer using means and standard deviations of post-test scores of the intervention and control groups.

Results

Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer. The median quality score was 67% (range: 22–89%). The included studies evaluated 23 physical and 20 psychosocial outcomes. Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression (d = −0.69 to −0.75), moderate reductions in fatigue (d = −0.51), moderate increases in general quality of life, emotional function and social function (d = 0.33 to 0.49), and a small increase in functional well-being (d = 0.31). Effects on physical function and sleep were small and not significant.

Conclusion

Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.Background

This study aimed to systematically review the evidence from randomized controlled trials (RCTs) and to conduct a meta-analysis of the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors.

Methods

A systematic literature search in ten databases was conducted in November 2011. Studies were included if they had an RCT design, focused on cancer patients or survivors, included physical postures in the yoga program, compared yoga with a non-exercise or waitlist control group, and evaluated physical and/or psychosocial outcomes. Two researchers independently rated the quality of the included RCTs, and high quality was defined as >50% of the total possible score. Effect sizes (Cohen’s d) were calculated for outcomes studied in more than three studies among patients with breast cancer using means and standard deviations of post-test scores of the intervention and control groups.

Results

Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer. The median quality score was 67% (range: 22–89%). The included studies evaluated 23 physical and 20 psychosocial outcomes. Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression (d = −0.69 to −0.75), moderate reductions in fatigue (d = −0.51), moderate increases in general quality of life, emotional function and social function (d = 0.33 to 0.49), and a small increase in functional well-being (d = 0.31). Effects on physical function and sleep were small and not significant.

Conclusion

Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.
Citations

52
Authors

Laurien M Buffart, Janniquer GZ van Uffelen, Ingrid I Riphagen, Johannes Brug, Willem van Mechelen, Wendy J Brown, Mai JM Chinapaw
Published

2012
Journal

BMC Cancer
Volume / Issue

12 : 559
Author's primary institution

EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands
Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Yoga is one of the most widely used complementary and alternative medicine therapies to manage illness. This meta-analysis aimed to determine the effects of yoga on psychological health, quality of life, and physical health of patients with cancer. Studies were identified through a systematic search of seven electronic databases and were selected if they used a randomized controlled trial design to examine the effects of yoga in patients with cancer. The quality of each article was rated by two of the authors using the PEDro Scale. Ten articles were selected; their PEDro scores ranged from 4 to 7.

The yoga groups compared to waitlist control groups or supportive therapy groups showed significantly greater improvements in psychological health: anxiety (P=0.009), depression (P=.002), distress (P=.003), and stress (P=0.006). However, due to the mixed and low to fair quality and small number of studies conducted, the findings are preliminary and limited and should be confirmed through higher-quality, randomized controlled trials.Yoga is one of the most widely used complementary and alternative medicine therapies to manage illness. This meta-analysis aimed to determine the effects of yoga on psychological health, quality of life, and physical health of patients with cancer. Studies were identified through a systematic search of seven electronic databases and were selected if they used a randomized controlled trial design to examine the effects of yoga in patients with cancer. The quality of each article was rated by two of the authors using the PEDro Scale. Ten articles were selected; their PEDro scores ranged from 4 to 7.

The yoga groups compared to waitlist control groups or supportive therapy groups showed significantly greater improvements in psychological health: anxiety (P=0.009), depression (P=.002), distress (P=.003), and stress (P=0.006). However, due to the mixed and low to fair quality and small number of studies conducted, the findings are preliminary and limited and should be confirmed through higher-quality, randomized controlled trials.
Citations

86
Authors

Kuan-Yin Lin, Yu-Ting Hu, King-Jen Chang, Heui-Fen Lin
Published

2011
Journal

Evidence-Based Complementary and Alternative Medicine
Volume / Issue

2011
Author's primary institution

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Purpose

To evaluate yoga’s impact on inflammation, mood, and fatigue.

Patients and Methods

A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale.

Results

Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF-α (P = .027), and IL-1β (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1β (P = .03) production but not in TNF-α production (P > .05).

Conclusion

Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.Purpose

To evaluate yoga’s impact on inflammation, mood, and fatigue.

Patients and Methods

A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale.

Results

Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF-α (P = .027), and IL-1β (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1β (P = .03) production but not in TNF-α production (P > .05).

Conclusion

Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.
Citations

39
Authors

Janice K. Kiecolt-Glaser, Jeanette M. Bennett, Rebecca Andridge, Juan Peng, Charles L. Shapiro, William B. Malarkey, Charles F. Emery, Rachel Laymna, Ewa E. Mrozek, Ronald Glaser
Published

2014
Journal

Journal of Clinical Oncology
Volume / Issue

Author's primary institution

Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
Yoga reduces inflammatory signaling in fatigued breast cancer survivors: a randomized controlled trial
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

Yoga is a popular mind–body therapy that has demonstrated beneficial effects on psychological, behavioral, and functional outcomes. However, few studies have investigated effects on inflammatory processes. This study tested the hypothesis that an Iyengar yoga intervention specifically designed for fatigued breast cancer survivors would lead to decreases in inflammation-related gene expression and circulating markers of proinflammatory cytokine activity.

Methods

Breast cancer survivors with persistent cancer-related fatigue were randomized to a 12-week Iyengar yoga intervention (n = 16) or a 12-week health education control condition (n = 15). Blood samples were collected at baseline, post-intervention, and at a 3-month follow-up for genome-wide transcriptional profiling and bioinformatic analyses. Plasma inflammatory markers and salivary cortisol were also assessed.

Results

In promoter-based bioinformatics analyses, the yoga group showed reduced activity of the pro-inflammatory transcription factor nuclear factor kappa B (NF-κB), increased activity of the anti-inflammatory glucocorticoid receptor, and reduced activity of cAMP response element-binding protein (CREB) family transcription factors relative to controls (all ps < .05). There was also a significant intervention effect on the soluble tumor necrosis factor receptor type II (sTNF-RII), a marker of TNF activity; plasma levels of sTNF-RII remained stable in the yoga group, whereas levels of this marker increased in the health education group (p = .028). A similar, non-significant trend was observed for the interleukin 1 receptor antagonist (p = .16). No significant changes in C reactive protein (CRP), interleukin 6 (IL-6), or diurnal cortisol measures were observed.

Conclusions

A 12-week restorative Iyengar yoga intervention reduced inflammation-related gene expression in breast cancer survivors with persistent fatigue. These findings suggest that a targeted yoga program may have beneficial effects on inflammatory activity in this patient population, with potential relevance for behavioral and physical health.Background

Yoga is a popular mind–body therapy that has demonstrated beneficial effects on psychological, behavioral, and functional outcomes. However, few studies have investigated effects on inflammatory processes. This study tested the hypothesis that an Iyengar yoga intervention specifically designed for fatigued breast cancer survivors would lead to decreases in inflammation-related gene expression and circulating markers of proinflammatory cytokine activity.

Methods

Breast cancer survivors with persistent cancer-related fatigue were randomized to a 12-week Iyengar yoga intervention (n = 16) or a 12-week health education control condition (n = 15). Blood samples were collected at baseline, post-intervention, and at a 3-month follow-up for genome-wide transcriptional profiling and bioinformatic analyses. Plasma inflammatory markers and salivary cortisol were also assessed.

Results

In promoter-based bioinformatics analyses, the yoga group showed reduced activity of the pro-inflammatory transcription factor nuclear factor kappa B (NF-κB), increased activity of the anti-inflammatory glucocorticoid receptor, and reduced activity of cAMP response element-binding protein (CREB) family transcription factors relative to controls (all ps < .05). There was also a significant intervention effect on the soluble tumor necrosis factor receptor type II (sTNF-RII), a marker of TNF activity; plasma levels of sTNF-RII remained stable in the yoga group, whereas levels of this marker increased in the health education group (p = .028). A similar, non-significant trend was observed for the interleukin 1 receptor antagonist (p = .16). No significant changes in C reactive protein (CRP), interleukin 6 (IL-6), or diurnal cortisol measures were observed.

Conclusions

A 12-week restorative Iyengar yoga intervention reduced inflammation-related gene expression in breast cancer survivors with persistent fatigue. These findings suggest that a targeted yoga program may have beneficial effects on inflammatory activity in this patient population, with potential relevance for behavioral and physical health.
Citations

16
Authors

Julienne E Bower, Gail Greendale, Alexandra D. Crosswell, Deborah Garet, Beth Sternlieb, Patricia A. Ganz, Michael R. Irwin. Richard Olmstead
Published

2014
Journal

Psychoneuroendocrinology
Volume / Issue

43
Author's primary institution

UCLA Department of Psychology, Los Angeles, CA, United States
Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Purpose

Previous research incorporating yoga (YG) into radiotherapy (XRT) for women with breast cancer finds improved quality of life (QOL). However, shortcomings in this research limit the findings.

Patients and Methods

Patients with stages 0 to III breast cancer were recruited before starting XRT and were randomly assigned to YG (n = 53) or stretching (ST; n = 56) three times a week for 6 weeks during XRT or waitlist (WL; n = 54) control. Self-report measures of QOL (Medical Outcomes Study 36-item short-form survey; primary outcomes), fatigue, depression, and sleep quality, and five saliva samples per day for 3 consecutive days were collected at baseline, end of treatment, and 1, 3, and 6 months later.

Results

The YG group had significantly greater increases in physical component scale scores compared with the WL group at 1 and 3 months after XRT (P = .01 and P = .01). At 1, 3, and 6 months, the YG group had greater increases in physical functioning compared with both ST and WL groups (P < .05), with ST and WL differences at only 3 months (P < .02). The group differences were similar for general health reports. By the end of XRT, the YG and ST groups also had a reduction in fatigue (P < .05). There were no group differences for mental health and sleep quality. Cortisol slope was steepest for the YG group compared with the ST and WL groups at the end (P = .023 and P = .008) and 1 month after XRT (P = .05 and P = .04).

Conclusion

YG improved QOL and physiological changes associated with XRT beyond the benefits of simple ST exercises, and these benefits appear to have long-term durability.
Citations

27
Authors

Kavita D. Chandwani, George Perkins, Hongasandra Ramarao Nagendra, Nelamangala V. Raghuram, Amy Spelman, Raghuram Nagarathna, Kayla Johnson, Adoneca Fortier, Banu Arun, Qi Wei, Clemens Kirschbaum, Robin Haddad, G. Stephen Morris, Janet Scheetz, Alejandro Chaoul, Lorenzo Cohen
Published

2014
Journal

American Society of Clinical Oncology
Volume / Issue

32 : 10
Author's primary institution

The University of Texas MD Anderson Cancer Center, Houston, TX 77030
The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

Women who develop secondary arm lymphoedema subsequent to treatment associated with breast cancer require life-long management for a range of symptoms including arm swelling, heaviness, tightness in the arm and sometimes the chest, upper body impairment and changes to a range of parameters relating to quality of life. While exercise under controlled conditions has had positive outcomes, the impact of yoga has not been investigated. The aim of this study is to determine the effectiveness of yoga in the physical and psycho-social domains, in the hope that women can be offered another safe, holistic modality to help control many, if not all, of the effects of secondary arm lymphoedema.

Methods and design

A randomised controlled pilot trial will be conducted in Hobart and Launceston with a total of 40 women receiving either yoga intervention or current best practice care. Intervention will consist of eight weeks of a weekly teacher-led yoga class with a home-based daily yoga practice delivered by DVD. Primary outcome measures will be the effects of yoga on lymphoedema and its associated symptoms and quality of life. Secondary outcome measures will be range of motion of the arm and thoracic spine, shoulder strength, and weekly and daily physical activity. Primary and secondary outcomes will be measured at baseline, weeks four, eight and a four week follow up at week twelve. Range of motion of the spine, in a self-nominated group, will be measured at baseline, weeks eight and twelve. A further outcome will be the women’s perceptions of the yoga collected by interview at week eight.

Discussion

The results of this trial will provide information on the safety and effectiveness of yoga for women with secondary arm lymphoedema from breast cancer treatment. It will also inform methodology for future, larger trials.
Citations

15
Authors

Annette Loudon, Tony Barnett, Neil Piller, Maarten A Immink, Denis Visentin, Andrew D Williams
Published

2012
Journal

BMC Complementary and Alternative Medicine
Volume / Issue

12 : 66
Author's primary institution

University Department of Rural Health, University of Tasmania, Launceston, TAS, 7250, Australia
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background:

Many debilitating symptoms arise from cancer and its treatment that are often unrelieved by established methods. Pranayama, a series of yogic breathing techniques, may improve cancer-related symptoms and quality of life, but it has not been studied for this purpose.

Objectives:

A pilot study was performed to evaluate feasibility and to test the effects of pranayama on cancer-associated symptoms and quality of life.

Design:

This was a randomized controlled clinical trial comparing pranayama to usual care.

Setting:

The study was conducted at a university medical center.

Subjects:

Patients receiving cancer chemotherapy were randomized to receive pranayama immediately or after a waiting period (control group).

Interventions:

The pranayama intervention consisted of four breathing techniques taught in weekly classes and practiced at home. The treatment group received pranayama during two consecutive cycles of chemotherapy. The control group received usual care during their first cycle, and received pranayama during their second cycle of chemotherapy.

Outcome measures:

Feasibility, cancer-associated symptoms (fatigue, sleep disturbance, anxiety, depression, stress), and quality of life were the outcomes.

Results:

Class attendance was nearly 100% in both groups. Sixteen (16) participants were included in the final intent-to-treat analyses. The repeated-measures analyses demonstrated that any increase in pranayama dose, with dose measured in the number of hours practiced in class or at home, resulted in improved symptom and quality-of-life scores. Several of these associations—sleep disturbance (p=0.04), anxiety (p=0.04), and mental quality of life (p=0.05)—reached or approached statistical significance.

Conclusions:

Yoga breathing was a feasible intervention among patients with cancer receiving chemotherapy. Pranayama may improve sleep disturbance, anxiety, and mental quality of life. A dose–response relationship was found between pranayama use and improvements in chemotherapy-associated symptoms and quality of life. These findings need to be confirmed in a larger study.
Citations

27
Authors

Anand Dhruva, Christine Miaskowski, Donald Abrams, Micahel Acree, Bruce Cooper, Steffanie Goodman, Frederick M. Hecht
Published

2012
Journal

The Journal of Alternative and Complementary Medicine
Volume / Issue

18 : 5
Author's primary institution

Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA
Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Purpose

Thirty percent to 90% of cancer survivors report impaired sleep quality post-treatment, which can be severe enough to increase morbidity and mortality. Lifestyle interventions, such as exercise, are recommended in conjunction with drugs and cognitive behavioral therapy for the treatment of impaired sleep. Preliminary evidence indicates that yoga—a mind-body practice and form of exercise—may improve sleep among cancer survivors. The primary aim of this randomized, controlled clinical trial was to determine the efficacy of a standardized yoga intervention compared with standard care for improving global sleep quality (primary outcome) among post-treatment cancer survivors.

Patients and Methods

In all, 410 survivors suffering from moderate or greater sleep disruption between 2 and 24 months after surgery, chemotherapy, and/or radiation therapy were randomly assigned to standard care or standard care plus the 4-week yoga intervention. The yoga intervention used the Yoga for Cancer Survivors (YOCAS) program consisting of pranayama (breathing exercises), 16 Gentle Hatha and Restorative yoga asanas (postures), and meditation. Participants attended two 75-minute sessions per week. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index and actigraphy pre- and postintervention.

Results

In all, 410 survivors were accrued (96% female; mean age, 54 years; 75% had breast cancer). Yoga participants demonstrated greater improvements in global sleep quality and, secondarily, subjective sleep quality, daytime dysfunction, wake after sleep onset, sleep efficiency, and medication use at postintervention (all P ≤ .05) compared with standard care participants.

Conclusion

Yoga, specifically the YOCAS program, is a useful treatment for improving sleep quality and reducing sleep medication use among cancer survivors.
Citations

39
Authors

Karen M. Mustian, Lisa K. Sprod, Michelle Janelsins, Luke J. Peppone, Oxana G. Palesh, Kavita Chandwani, Pavan S. Reddy, Marianne K. Melnik, Charles Heckler, Gary R. Morrow
Published

2013
Journal

Journal of Clinical Oncology
Volume / Issue

33 : 19
Author's primary institution

University of Rochester Medical Center, 265 Crittenden Blvd, CU 420658, Rochester, NY
Yoga in addition to standard care for patients with haematological malignancies
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

Haematological malignancies are malignant neoplasms of the myeloid or lymphatic cell lines including leukaemia, lymphoma and myeloma. In order to manage physical and psychological aspects of the disease and its treatment, complementary therapies like yoga are coming increasingly into focus. However, the effectiveness of yoga practice for people suffering from haematological malignancies remains unclear.

Objectives

To assess the effects of yoga practice in addition to standard cancer treatment for people with haematological malignancies.

Search methods

Our search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to 4th February 2014), databases of ongoing trials (controlled-trials.com; clinicaltrials.gov), conference proceedings of the American Society of Clinical Oncology, the American Society of Hematology, the European Haematology Association, the European Congress for Integrative Medicine, and Global Advances in Health and Medicine. We handsearched references of these studies from identified trials and relevant review articles. Two review authors independently screened the search results.

Selection criteria

We included randomised controlled trials (RCTs) of yoga in addition to standard care for haematological malignancies compared with standard care only. We did not restrict this to any specific style of yoga.

Data collection and analysis

Two review authors independently extracted data for eligible studies and assessed the risk of bias according to predefined criteria. We evaluated distress, fatigue, anxiety, depression and quality of sleep. Further outcomes we planned to assess were health-related quality of life (HRQoL), overall survival (OS) and adverse events (AE), but data on these were not available.

Main results

Our search strategies led to 149 potentially relevant references, but only a single small study met our inclusion criteria. The included study was published as a full text article and investigated the feasibility and effect of Tibetan Yoga additional to standard care (N = 20; 1 person dropped out before attending any classes and no data were collected) compared to standard care only (N = 19). The study included people with all stages of Hodgkin and non-Hodgkin's lymphoma, with and without current cancer treatment. The mean age was 51 years.

We judged the overall risk of bias as high as we found a high risk for performance, detection and attrition bias. Additionally, potential outcome reporting bias could not be completely ruled out. Following the recommendations of GRADE, we judged the overall quality of the body of evidence for all predefined outcomes as 'very low', due to the methodical limitations and the very small sample size.

The influence of yoga on HRQoL and OS was not reported. There is no evidence that yoga in addition to standard care compared with standard care only can improve distress in people with haematological malignancies (mean difference (MD) -0.30, 95% confidence interval (CI) -5.55 to 4.95; P = 0.91). Similarly, there is no evidence of a difference between either group for fatigue (MD 0.00, 95% CI -0.94 to 0.94; P = 1.00), anxiety (MD 0.30, 95% CI -5.01 to 5.61; P = 0.91) or depression (MD -0.70, 95% CI -3.21 to 1.81; P = 0.58).

There is very low quality evidence that yoga improves the overall quality of sleep (MD -2.30, 95% CI -3.78 to -0.82; P = 0.002). The yoga groups' total score for the Pittsburgh Sleep Quality Index (PSQI) was 5.8 (± 2.3 SD) and better than the total score (8.1 (± 2.4 SD)) of the control group. A PSQI total score of 0 to 5 indicates good sleep whereas PSQI total score 6 to 21 points towards significant sleep disturbances. The occurrence of AEs was not reported.

Authors' conclusions

The currently available data provide little information about the effectiveness of yoga interventions for people suffering from haematological malignancies. The finding that yoga may be beneficial for the patients' quality of sleep is based on a very small body of evidence. Therefore, the role of yoga as an additional therapy for haematological malignancies remains unclear. Further high-quality randomised controlled trials with larger numbers of participants are needed to make a definitive statement.
Citations

3
Authors

Steffen Felbel, Joerg J Meerpohl, Ina Monsef, Andreas Engert, Nicole Skoetz
Published

2014
Journal

Cochrane Library
Volume / Issue

Author's primary institution

University Hospital of Cologne, Cochrane Haematological Malignancies Group, Department I of Internal Medicine, Cologne, Germany
Mindfulness meditation for oncology patients: a discussion and critical review
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

The purpose of this article is to (1) provide a comprehensive over view and discussion of mindfulness meditation and its clinical applicability in oncology and (2) report and critically evaluate the existing and emerging research on mindfulness meditation as an intervention for cancer patients. Using relevant keywords, a comprehensive search of MEDLINE, PsycInfo, and Ovid was completed along with a review of published abstracts from the annual conferences sponsored by the Center for Mindfulness in Medicine, Health Care, and Society and the American Psychosocial Oncology Society. Each article and abstract was critiqued and systematically assessed for purpose statement or research questions, study design, sample size, characteristics of subjects, characteristics of mindfulness intervention, outcomes, and results. The search produced 9 research articles published in the past 5 years and 5 conference abstracts published in 2004. Most studies were conducted with breast and prostate cancer patients, and the mindfulness intervention was done in a clinic-based group setting. Consistent benefits—improved psychological functioning, reduction of stress symptoms, enhanced coping and well-being in cancer outpatients—were found. More research in this area is warranted: using randomized, controlled designs, rigorous methods, and different cancer diagnoses and treatment settings; expanding outcomes to include quality of life, physiological, health care use, and health-related outcomes; exploring mediating factors; and discerning dose effects and optimal frequency and length of home practice. Mindfulness meditation has clinically relevant implications to alleviate psychological and physical suffering of persons living with cancer. Use of this behavioral intervention for oncology patients is an area of burgeoning interest to clinicians and researchers.
Citations

166
Authors

Mary Jone, Rebecca L. Norris, Susan M. Bauer-Wu
Published

2006
Journal

Ingeral Cancer Therapy
Volume / Issue

5 : 2
Author's primary institution

Dana-Farber Cancer Institute, Boston, Massachusetts.
Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective

To investigate the effects of meditation on anxiety, depression, fatigue, and quality of life in women who are receiving radiation therapy for breast cancer.

Design

Randomized, non-program controlled, parallel intervention clinical trial.

Setting

The ASAN Cancer Center located in Seoul, Korea.

Intervention

The subjects of this study included 102 female breast cancer patients who had undergone breast-conserving surgery; these female patients were randomized into equally assigned meditation control groups, with each group consisting of 51 patients. The test group received a total of 12 meditation therapy sessions during their 6-week radiation therapy period, and the control group underwent only a conventional radiation therapy.

Outcome

The tools used to evaluate the effects of meditation were Hospital Anxiety and Depression scale, Revised Piper Fatigue scale, and European Organization for Research and Treatment of Cancer-Quality of Life Core-30. The results were analyzed based on the principles of intention-to-treat analysis, and, as a corollary analysis, per-protocol analysis was conducted.

Results

The breast cancer patients who received meditation therapy compared with the non-intervention group saw improvements in reduction of anxiety (p=.032), fatigue (p=.030), and improvement in global quality of life (p=0.028).

Conclusions

Based on the results of this study, an affirmation can be made that meditation can be used as a non-invasive intervention treatment for improving fatigue, anxiety, quality of life, and emotional faculties of women with breast cancer.
Citations

14
Authors

Yeon Hee Kim, Hwa Jung Kim, Seung Do Ahn, Yun Jeong Seo, So Hee Kim
Published

2013
Journal

Complementary Therapies in Medicine
Volume / Issue

21 : 4
Author's primary institution

Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
Using yoga in breast cancer-related lymphoedema
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

The aim of this article is to explore the research findings that can inform the use of yoga for women with breast cancer-related lymphoedema (BCRL). Women with this condition may need lifelong treatment and have to self-manage the affected area. A growing body of research has led to the development of guidelines for the inclusion of exercise as part of self-management. Supervised exercise monitored for its effects, using slow warm ups, cool downs and gradual progression, is known to improve both physical and mental wellbeing. Women are also exploring complementary and alternative therapies, such as yoga, as an adjunct to the mainstream management of lymphoedema. Research has demonstrated positive outcomes from yoga including physical benefits derived from slow breathing and gentle, progressive movement, and psychological benefits from relaxation and meditation. While there is some evidence of the benefit of yoga for lymphoedema of the lower limbs, additional research is required to establish the efficacy and safety of yoga as a viable option in the self-management of BCRL. Subsequent to this, guidelines for practitioners and women can be established.
Citations

3
Authors

Annette Loudon, Tony Barnett, Neil Piller, Andrew Williams, Maarten Immink
Published

2012
Journal

Journal of Lymphoedema
Volume / Issue

7 : 1
Author's primary institution

HumanLife Sciences, University of Tasmania, Australia
Yoga management of breast cancer-related yoga
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

Secondary arm lymphoedema continues to affect at least 20% of women after treatment for breast cancer requiring lifelong professional treatment and self-management. The holistic practice of yoga may offer benefits as an adjunct self-management option. The aim of this small pilot trial was to gain preliminary data to determine the effect of yoga on women with stage one breast cancer-related lymphoedema (BCRL). This paper reports the results for the primary and secondary outcomes.

Methods

Participants were randomised, after baseline testing, to receive either an 8-week yoga intervention (n = 15), consisting of a weekly 90-minute teacher-led class and a 40-minute daily session delivered by DVD, or to a usual care wait-listed control group (n = 13). Primary outcome measures were: arm volume of lymphoedema measured by circumference and extra-cellular fluid measured by bioimpedance spectroscopy. Secondary outcome measures were: tissue induration measured by tonometry; levels of sensations, pain, fatigue, and their limiting effects all measured by a visual analogue scale (VAS) and quality of life based on the Lymphoedema Quality of Life Tool (LYMQOL). Measurements were conducted at baseline, week 8 (post-intervention) and week 12 (four weeks after cessation of the intervention).

Results

At week 8, the intervention group had a greater decrease in tissue induration of the affected upper arm compared to the control group (p = 0.050), as well as a greater reduction in the symptom sub-scale for QOL (p = 0.038). There was no difference in arm volume of lymphoedema or extra-cellular fluid between groups at week 8; however, at week 12, arm volume increased more for the intervention group than the control group (p = 0.032).

Conclusions

An 8-week yoga intervention reduced tissue induration of the affected upper arm and decreased the QOL sub-scale of symptoms. Arm volume of lymphoedema and extra-cellular fluid did not increase. These benefits did not last on cessation of the intervention when arm volume of lymphoedema increased. Further research trials with a longer duration, higher levels of lymphoedema and larger numbers are warranted before definitive conclusions can be made.
Citations

7
Authors

Annette Loudon, Tony Barnett, Neil Piller, Andrew D Williams, Maarten Immink
Published

2014
Journal

Complementary and Alternative Medicine
Volume / Issue

14 : 214
Author's primary institution

University of Tansmania, Launceston, Australia


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