The practice of yoga began approximately 5000 years ago in India and combined physical, mental, emotional, and spiritual wellbeing.1 As a form of physical movement, yoga combines various postures and breathing techniques that are believed to improve fitness, mental clarity, reduce stress, and promote mindfulness. The practice of yoga is gaining even more popularity, and the numbers of instructors and students are rising.2

Yoga has been studied as part of an integrative approach to improving patient cancer- and treatment-related symptoms and general quality of life during and after active therapy. Most studies suggest that yoga may be beneficial for patients, and yoga is recommended by several guidelines.

For example, the American Society of Medical Oncology (ASCO) endorsed the Society for Integrative Oncology (SIO)’s guideline for integrative therapies during and after treatment for breast cancer, and included statements asserting that yoga is effective for reducing anxiety, as well as improving mood disturbances, depressive symptoms, sleep, and quality of life.3

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The National Comprehensive Cancer Network (NCCN) includes the practice of yoga in its guideline for improving some areas of survivorship and for reducing cancer-related distress and fatigue.4-6 However, many of the included studies, including randomized controlled trials (RCTs), were small, and there was no standardized design or reporting, including the details pertaining to the type of yoga practiced and the frequency or duration of sessions between studies.7

Study Results

A systematic review published in 2019 of yoga for symptoms management in patients with cancer included a total of 29 RCTs conducted during and/or after the administration of anticancer therapies.8

Most, but not all, of the studies demonstrated that, compared with placebo, the practice of yoga improved overall quality of life, fatigue, and stress/distress during treatment, and improved treatment-related cognitive impairment and sleep disturbances.

This is consistent with a results from a study published in 2017, which examined 24 studies that found that yoga significantly improved quality of life (pooled SMD, 0.22; 95% CI, 0.04-0.40), fatigue (pooled SMD, -0.48; 95% CI, -0.75 to -0.20), and sleep disturbances in the short term (pooled SMD, -0.25; 95% CI, -0.40 to -0.09) compared with no therapy.9 In the same analysis, compared with psychosocial or educational interventions, yoga significantly reduced depression (pooled SMD, -2.29; 95% CI, -3.97 to -0.67), anxiety (pooled SMD, -2.21; 95% CI, -3.90 to -0.52), and fatigue (pooled SMD, -0.90; 95% CI, -1.31 to -0.50).

Another meta-analysis of 10 RCTs published in 2018 found that yoga significantly improved fatigue during (standardized mean difference [SMD], -0.51; 95% CI, -1.01 to 0.00) and after anticancer treatment (SMD, -0.68; 95% CI, -0.93 to -0.43).10

There are have been no RCTs published that included pediatric or adolescent patients, but nonrandomized studies suggest that yoga is likely to also benefit these populations for improved physical functioning, quality of life, mobility and flexibility, reduced anxiety, sleep, mood, energy, nausea, and use of pain medication.7

Addressing Barriers to Practicing Yoga

Some barriers to practicing yoga regularly in patients with cancer included scheduling difficulties, travel, illness, and changes in symptoms.7 Therefore, yoga programs should be flexible, and patients should be aware that practicing yoga in groups at a facility or at home is effective. In a study of 8 weeks of yoga among women with breast cancer, practicing yoga with a DVD at home was effective in reducing fatigue and helped patients maintain physical activity.11

Conclusions

Yoga is beneficial for patients with cancer, helping them to improve cancer-related symptoms such as fatigue, stress/distress, mood disturbances, cognitive impairment, and quality of life.

References

  1. Yoga Alliance. What is yoga? Website. Accessed April 26, 209.
  2. Ipsos Public Affairs. 2016 yoga in America study. Published January 2016. Accessed April 26, 2019.
  3. Lyman GH, Greenlee H, Bohlke K, et al. Integrative therapies during and after breast cancer treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. 2018;36(25):2647-2655.
  4. Denlinger CS, Sanft T, Armenian S, et al. Survivorship. Version 1.2019. NCCN Clinical Practice Guidelines in Oncology. March 14, 2019.
  5. Berger AM, Mooney K, Banerjee C, et al. Cancer-related fatigue. Version 1.2019. NCCN Clinical Practice Guidelines in Oncology. March 12, 2019.
  6. Riba MB, Donovan KA, Andersen B, et al. Distress management. Version 2.2019. NCCN Clinical Practice Guidelines in Oncology. March 6, 2019.
  7. Danhauer SC, Addington EL, Sohl SJ, Chaoul A, Cohen L. Review of yoga therapy during cancer treatment. Support Care Cancer. 2017;25(4):1357-1372.
  8. Danhauer SC, Addington EL, Cohen L, et al. Yoga for symptom management in oncology: A review of the evidence base and future directions for research [published online April 1, 2019]. Cancer. doi: 10.1002/cncr.31979
  9. 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;1:CD010802.
  10. Hilfiker R, Meichtry A, Eicher M, et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J Sports Med. 2018;52(10):651-658.
  11. Winters-Stone KM, Moe EL, Perry CK, et al. Enhancing an oncologist’s recommendation to exercise to manage fatigue levels in breast cancer patients: a randomized controlled trial. Support Care Cancer. 2018;26(3):905-912.