Study

ATLANTA—Breast cancer patients who participate in a yoga program while undergoing radiation therapy can improve their quality of life, according to a study presented here at the ASCO Annual Meeting. “This is the first study to incorporate yoga as part of the treatment plan for cancer patients,”said the lead author, Lorenzo Cohen, PhD, Associate Professor and Director of the Integrative Medicine Program at the University of Texas M. D. Anderson Cancer Center. “Cancer and its treatments are associated with considerable distress, impaired quality of life, and reduced physical function. This is particularly true for women with breast cancer who receive multimodality treatment over an extended period of time. With our studies, we think that we could help ameliorate the treatment—related side effects that accumulate in cancer patients over time.”figure: Lorenzo Cohen, PhD: “This pilot program is one of the few studies of yoga in a cancer patient population. The program was feasible, and patients found the intervention acceptable and a positive experience.”The main objective of the study, presented at an oral session, was to examine the feasibility of integrating a yoga program into the treatment care plan for women with breast cancer undergoing radiation treatment. “We wanted to determine if this is something the patients found useful and enjoyable, as well as assessing aspects of their quality of life,”Dr. Cohen said. “Because yoga deals with both mind and body, we hypothesized that cancer patients would benefit both physically and emotionally, and we found that to be the case.” Study Details Sixty—one women with breast cancer were randomly assigned either to attend yoga classes twice weekly at or around the time of their radiation appointments over six weeks or to be put on a waiting list (the control group). The controls were offered the yoga program after therapy. The patients had disease from Stage 0 to Stage 3, with the majority having Stage 2. Average age was 52; 48% of patients had undergone breast—conserving surgery, and 75% had chemotherapy. The yoga program, which included loosening and breathing exercises, postures, the deep relaxation technique of alternate nostril breathing, and meditation, was designed specifically for this patient population, emphasizing breathing and relaxation, and excluding some positions that would be difficult, given the patients' possible weakened range of motion. Each class was facilitated by a certified yoga instructor, and patients also received a CD and instruction manual for home use. After adjusting for factors such as stage of disease and time since diagnosis, the yoga group had statistically and clinically significant better physical function scores and higher general health scores, as well as marginally better social functioning scores, significantly lower levels of sleep—related daytime dysfunction, and significantly lower levels of fatigue than the control group. However, there were no differences in the levels of depression and anxiety between the two groups. “This pilot program is one of the few studies of yoga in a cancer patient population,”Dr. Cohen said. “The program was feasible and patients found the intervention acceptable and a positive experience.” Compliance Good Compliance with the program was good, he said, and 63% of the participants called the program “useful”or “very useful.”Dr. Cohen and his team also collected information about immune function for chronic stress, lung function measures, saliva for cortisol levels, and physiotherapeutic measures, which they plan to analyze next, he said. As a result of these positive findings, the M. D. Anderson team is conducting a follow—up study funded by the National Cancer Institute in breast cancer patients receiving radiation comparing the use of yoga with stretching exercises and standard care. Sleep quality will be measured via actigraphy watches, which monitor motion to help distinguish sleep from awake states, and heart—rate variability. “Cancer patients are often in need of a body holiday,”Dr. Cohen said. “As my grandmother, Vanda Scaravelli [a well—known yoga innovator and teacher], wrote in her yoga book Awakening the Spine, ‘We do it for the fun of it….To twist, stretch, and move around is pleasant and enjoyable, a body holiday.’” The moderator of an ASCO news conference that featured the study, Patricia A. Ganz, MD, Director of Cancer Prevention and Control Research at UCLA's Jonsson Comprehensive Cancer Center, commented, “With progress in treating cancer comes a new and unique challenge—ensuring the long—term health and quality of life for the growing number of cancer survivors in this country. While recent studies paint a stark picture of some of the long—term health problems faced by survivors, other research suggests that even yoga can significantly improve quality of life for both cancer survivors and those living with the disease.” Dr. Cohen noted that “if you look at the literature, there are a number of clinical trials done with yoga to benefit asthma, arthritis, hypertension, and diabetes. But there are few randomized, controlled trials with cancer patients, and there have been no published randomized trials specifically incorporating yoga as a component into the treatment plan.” The Discussant for the study, Kerry Courneya, PhD, of the Department of Physical Education at the University of Alberta, noted that studies designed to help patients cope with expected side effects help tease out the benefits in engaging in yoga during treatment. There has been a flurry of recent systematic reviews of exercise interventions, he said. ‘Gentle, Nonstrenous Exercise Acceptable during Chemotherapy’ Dr. Courneya called Dr. Cohen's study excellent: “This was a well—defined group, relevant outcome measures were assessed, and the results were promising. It was nice to see a target of radiation therapy.” He added that yoga is gaining in popularity among cancer patients. “It's a gentle exercise that is more acceptable during chemotherapy. More strenuous exercises are too difficult to do,”he said. Unanswered Questions There are some questions about the research that are still unanswered, Dr. Courneya continued: ▪ How much benefit is due to the exercise component compared with the mindfulness component? ▪ Are there changes in fitness and function outcomes? ▪ Does the group format confound the quality—of—life measures? “We're looking for slightly longer intervals and more frequency,”he said. “We need more researchers doing randomized trials using rigorous methods with large sample sizes integrated with other supportive care measures. Quality randomized controlled trials are needed to definitively show benefits. Effective behavioral interventions are needed.”

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