Yoga Therapies for Breast Cancer

 Yoga Therapy for Post-Diagnosis Breast Cancer Care

1. Yoga Therapy During Chemotherapy for Early-Stage and Locally Advanced Breast Cancer-

Purpose: The aim of this trial was to determine the feasibility of personalized yoga therapy in women receiving treatment for early-stage or locally advanced breast cancer and assess its impact on weight gain.

Methods: Thirty women were randomized 1:1 to receive yoga therapy by a certified yoga therapist during treatment or a control group. Participants in the yoga arm were asked to complete three 30 minute yoga sessions weekly (which included movement, breath work, mindfulness, and relaxation) throughout adjuvant or neoadjuvant chemotherapy (N = 29) or endocrine (N = 1); the control arm received breast cancer treatment without yoga. For comparability between participants randomized to yoga therapy, the single patient treated with endocrine therapy was excluded from the analysis. Primary outcomes were feasibility and weight change. Additional outcomes were mood, fatigue, QOL, serum tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP) as immune mediator biomarkers.

Results: Mean age was 51.6 years, 75.9% were white and 24.1% were people of color, reflecting the cancer center population. 80% had stage II-III disease. Enrollment was completed in 9 months. Compliance was lower than predicted; however, participants participated in on average 1.7 yoga sessions/week for a mean 15.6 weeks duration. There were no adverse events. Control arm participants gained on average 2.63% body weight during treatment while yoga participants lost 0.14% body weight (weight change = -0.36 in yoga arm vs. 2.89 in standard of care arm, Wilcoxon rank sum test P = .024). Control participants reported increased fatigue and decreased QOL, while yoga participants reported no change in QOL. No significant change in TNF-alpha or CRP was noted in either arm.

2. Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with early stage breast cancer: a case series-

Purpose: To identify the impact of yoga on measures of cognition, functional outcomes, and quality of life (QOL) for breast cancer survivors (BCS).

Methods: Four women with a diagnosis of early-stage breast cancer prior to chemotherapy treatment were administered the following physiologic measures at baseline, 6, and 12 weeks during chemotherapy, and at one and three months after the conclusion of the study: Functional Reach test (balance) and Sit and Reach test (flexibility), and QOL, POMS (Mood) and FACT-B (QOL), at baseline. Primary outcomes of cognition were measured with the Perceived Cognition Questionnaire (PCQ) and CogState, a computerized measurement of cognition. Women attended an Iyengar-inspired yoga program twice a week for 12 weeks. Qualitative questionnaires were administered after the completion of the study to determine perceived benefits and challenges of the yoga program.

Results: Four women with Stage II breast cancer ranged in age from 44-65 years. CogState computerized testing showed changes in varying domains of cognition through treatment and follow-up. Improved balance, flexibility, and QOL were also noted over time. No adverse events were observed. Analysis of qualitative data revealed the yoga classes were helpful and subjects continued the practice elements of yoga including relaxation, breathing, and stretching. The most challenging aspect of the study was physical limitations due to various medical complications and included fatigue, decreased range of motion, and pain.

3. Mindful Yoga for women with metastatic breast cancer: design of a randomized controlled trial-

Purpose: This randomized controlled trial examines the feasibility and initial efficacy of a Mindful Yoga program, compared with a social support condition that controls for attention, on measures of disease-related symptoms such as pain and fatigue.

Methods: The study will be completed by December 2017. Sixty-five women with MBC age ≥ 18 are being identified and randomized with a 2:1 allocation to Mindful Yoga or a support group control intervention. The 120-min intervention sessions take place weekly for 8 weeks. The study is conducted at an urban tertiary care academic medical center located in Durham, North Carolina. The primary feasibility outcome is attendance at intervention sessions. Efficacy outcomes include pain, fatigue, sleep quality, psychological distress, mindfulness and functional capacity at post-intervention, 3-month follow-up, and 6-month follow-up.

Results: The consensus conclusion across the reviews was that there is moderate to good evidence that, at least in the short-term, yoga has a positive impact on psychological health in early stage breast cancer patients and survivors. Effect sizes for psychosocial outcomes (e.g., emotional distress, anxiety, depression, global quality of life) were moderate to large, whereas for functional well-being effect sizes were small. Fatigue improved in approximately 50% of studies where assessed. Only one RCT—which was conducted by the authors of this paper—assessed pain, which improved in that study. None of the studies reported serious adverse events.

4. Feasibility of a mindful yoga program for women with metastatic breast cancer: results of a randomized pilot study-

Purpose: This study examined the acceptability of a comprehensive yoga program for MBC and the feasibility of conducting a randomized trial testing the intervention.

Methods: Sixty-three women with MBC were randomized with a 2:1 allocation to yoga or a support group comparison condition. Both interventions involved eight weekly group sessions. Feasibility was quantified using rates of accrual, attrition, and session attendance. Acceptability was assessed with a standardized self-report measure. Pain, fatigue, sleep quality, psychological distress, mindfulness, and functional capacity were assessed at baseline, post-intervention, and 3 and 6 months post-intervention.

Results: Eighty percent of participants in the yoga condition and 65% in the support group indicated that they were highly satisfied with the intervention. Following treatment, women in the yoga intervention had modest improvements in some outcomes; however, overall symptom levels were low for women in both conditions. Findings suggest that the yoga intervention content was highly acceptable to patients with MBC.

5. Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer-

Purpose: Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer.

Methods: Sixty-four women with MBC completed baseline questionnaires of mindfulness (Five Facet Mindfulness Questionnaire-Short Form [FFMQ-SF]) and symptoms of pain severity and interference, fatigue, psychological distress, and sleep disturbance as part of a randomized controlled trial of a Mindful Yoga intervention. 

Results: Overall, higher mindfulness was associated with lower symptom levels including lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance. However, degree of association varied by mindfulness facet. Nonreactivity, nonjudging, and describing showed the most frequent associations and largest effect sizes across symptoms, while observing showed the least frequent associations and lowest effect sizes. Mindfulness-and in particular nonreactivity, nonjudging, and describing-may be a personal resource for women with MBC in coping with complex symptoms of this life-threatening illness.

6. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer-

Purpose: To assess effects of yoga on health-related quality of life, mental health and cancer-related symptoms among women with a diagnosis of breast cancer who are receiving active treatment or have completed treatment.

Methods: Study of Randomized control trials of 24 studies with 2166 participants. Randomized controlled trials were eligible when they (1) compared yoga interventions versus no therapy or versus any other active therapy in women with a diagnosis of non-metastatic or metastatic breast cancer, and (2) assessed at least one of the primary outcomes on patient-reported instruments, including health-related quality of life, depression, anxiety, fatigue or sleep disturbances.

Results: Seventeen studies that compared yoga versus no therapy provided moderate-quality evidence showing that yoga improved health-related quality of life, reduced fatigue and reduced sleep disturbances in the short term. 

Summary of my Findings: Women with Breast Cancer may find relief of Cancer symptoms with Yoga Therapies of Yoga asanas and mindfulness. Studies show improvement in symptoms such as reduced fatigue, better sleep, less pain, less psychological distress, improved balance, improved flexibility, improved quality of life and better weight management. Evidence suggests that yoga therapies may improve health-related quality of life and provide relief of some cancer related symptoms. 

Reference List:

Greaney SK, Amin N, Prudner BC, Compernolle M, Sandell LJ, Tebb SC, Weilbaecher KN, Abeln P, Luo J, Tao Y, Hirbe AC, Peterson LL. Yoga Therapy During Chemotherapy for Early-Stage and Locally Advanced Breast Cancer. Integr Cancer Ther. 2022 Jan-Dec;21:15347354221137285. doi: 10.1177/15347354221137285. PMID: 36412916; PMCID: PMC9706042.

Galantino ML, Greene L, Daniels L, Dooley B, Muscatello L, O'Donnell L. Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with early stage breast cancer: a case series. Explore (NY). 2012 Mar-Apr;8(2):127-35. doi: 10.1016/j.explore.2011.12.001. PMID: 22385567.

Carson JW, Carson KM, Olsen MK, Sanders L, Porter LS. Mindful Yoga for women with metastatic breast cancer: design of a randomized controlled trial. BMC Complement Altern Med. 2017 Mar 13;17(1):153. doi: 10.1186/s12906-017-1672-9. PMID: 28288595; PMCID: PMC5348886.

Porter LS, Carson JW, Olsen M, Carson KM, Sanders L, Jones L, Westbrook K, Keefe FJ. Feasibility of a mindful yoga program for women with metastatic breast cancer: results of a randomized pilot study. Support Care Cancer. 2019 Nov;27(11):4307-4316. doi: 10.1007/s00520-019-04710-7. Epub 2019 Mar 15. PMID: 30877596; PMCID: PMC6745290.

Zimmaro LA, Carson JW, Olsen MK, Sanders LL, Keefe FJ, Porter LS. Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer. Psycho Oncology. 2020 Feb;29(2):263-270. doi: 10.1002/pon.5223. Epub 2019 Oct 17. PMID: 31509614; PMCID: PMC7002241.

Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017 Jan 3;1(1):CD010802. doi: 10.1002/14651858.CD010802.pub2. PMID: 28045199; PMCID: PMC6465041.