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Battling breast cancer: How yoga may improve patient's quality of life

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I will be the first person to admit that I have never done yoga myself and by no means may considered well-versed in this practice, but nonetheless remain intrigued and open to any new data which may help people in the future. With such a confession aside, this article is going to focus on a new area of interest in the adjunctive treatment of stage 0-3 breast cancer: yoga. For several years now, yoga has been examined as a possible adjunctive treatment for a variety of medical conditions ranging from psychiatric issues in children to hypertension in the adult population. It became the subject of attention for such conditions due to the underlying philosophy and anecdotal success it has had in reducing stress and various stress-related pathologies.

For those readers who may have never heard of yoga or whom are unfamiliar with its practice, yoga is a very ancient practice that involves the physical, mental, and spiritual conditioning of its participants. It was developed in ancient India as a mix between religious philosophy and physical wellbeing with the goal of understanding one's own self and achieving a sense of serenity and peace within one's soul. Though there are many subtypes and subsets of yoga, the general idea is that the individual combine relaxation and meditation techniques with various physical posturing/positions and breathing exercises that allow one to tune into his/her body.

As an ancient art, humans have been practicing yoga for thousands of years and it has been used in complimentary medicine for some time now. With an increase in popularity among the western world, yoga has jumped to the forefront as a hot topic in many disciplines such as sports medicine, oncology, physical therapy, psychiatry, etc, as was mentioned earlier. Though several recent studies have described positive results with its use in helping to treat a number of conditions, many of these studies have lacked participant number and overall study design.

The more recent study in focus here was published in March of 2014 in the Journal of Clinical Oncology. Researchers were examining the use of yoga as a way to improve quality of life in breast cancer patients.

As most are familiar, breast cancer is a terrible disease that affects many women. In fact 1 in 8 women will be diagnosed with breast cancer at some point in her lifetime and even more alarming, more than 40,000 women in the United States will die from breast cancer this year. With such alarming numbers, it's obvious that diagnosing, treating and curing this disease are at the forefront of research many different realms of medicine because of how this disease can affect everything from the body to the mind to the soul.

So why look at yoga for breast cancer? Well, it's commonly accepted in medicine that radiotherapy (radiation treatments) is very often the last step in the treatment process for a women undergoing chemo/radiation for breast cancer. It is also very well described that such radiation therapy can and often does cause a number of undesirable side effects such as fatigue, pain, lymphedema, neuropathy, cardiotoxicity, sleep changes/disturbances, and cognitive problems.

With such side effects often being experienced by women receiving this treatment, researchers began examining the quality of life that these women were reporting and the kind of effects that such decreased quality of life may have on the overall morbidity and mortality of these patients.
Interestingly, but not unexpectedly, our more recent research has shown that radiation therapy has been associated with a decreased quality of life and an overall increase in the stress-related hormone, called cortisol.

Cortisol is responsible for a number of issues in the body and may contribute to elevated blood pressure, problems with glycemic control, obesity, and even increased mortality among breast cancer patients.

The current researchers decided that since previous studies using Pantajali-based yoga programs (developed by Vivekanada Yoga Anusandhana Samsthana) for patients with breast cancer have consistently shown improvements in anxiety and symptoms of stress such as nausea and vomiting, that they would examine yoga in the setting of breast cancer to specifically look at how adjunctive use of it along with standard medical regimen may affect the overall/general quality of life experience by patients with stages 0-3 breast cancer undergoing radiotherapy.
The researchers enrolled 163 patients with stage 0-3 breast cancer whom were recruited before they began their radiotherapy treatments. They had specific selection criteria that excluded any patients who had extreme mobility issues or had participated in yoga in the previous year.
They then took these women and randomized them into one of three groups. One group was the yoga group, who would attend up to three 60-minute classes per week during their 6 weeks of radiotherapy, another group was the stretching group who would alternatively attend up to three 60-minute stretching classes during their treatment period, and the last group was the “waitlist” who would just undergo their medical regimen and have the option to select yoga or stretching after the end of their 6 week treatment.

The researchers then assessed the quality of life by using a 36-item survey form called the SF-36, which assessed their pain, vitality, social functioning, emotional functioning, and mental health among other outcomes. The survey was completed before and after the radiotherapy treatment period so as to have a baseline to compare things to.

They also looked at fatigue, sleep disturbances, depression, and cortisol levels (via 3 consecutive days of saliva sampling).

The yoga program that was used was considered and integrated program and was held in a large conference style room. It was typically a one-to-one scenario between the patient and instructor and the patient received a CD to help practice and learn the program at home.

The integrated yoga program consisted of the following aspects:

  1. Warm-up/breathing exercises
  2. Forward, backward, side bending (sitting and standing), cobra posture, crocodile, and half-shoulder stand.
  3. Supine deep relaxation
  4. Nostril breathing using alternating nostrils
  5. Meditation

So what did they find? Well, they were able to show that there were significantly greater increases in the SF-36 (Quality of Life) inventories for the yoga group when compared to the wait-list group at both 1 and 3 month marks after the treatment. There was not, however, any statistical differences between the yoga group and the stretching group in terms of the SF-36 score at these follow-ups.

Though the quality of life inventories did not display a very impressive improvement, patient’s who’d participated in the yoga group during their radiotherapy reported decreased fatigue in comparison to the stretching and wait-list counterparts at the end of the treatment and at one month.

Additionally, patients in the yoga group also displayed steeper cortisol slopes in comparison to the stretching group and waitlist group at the end of treatment and at month 1 as well.
What does this all mean? This was essentially the first study to look at yoga and compare the effects it might have in a cancer population to another active group and the simple standard of care. They were able to show a correlation with the yoga group and improvements in several of the parameters that they were measuring, which may suggest that yoga could serve as a successful adjunctive treatment in breast cancer patients.

The thought underlying this whole concept is that higher levels of cortisol and decreased quality of life have been linked to earlier and increased mortality among breast cancer patients. The researchers here wanted to further evaluate the pilot studies looking at yoga and breast cancer.
Overall, the study is promising and offers great data that suggests that there may be serious role for using yoga adjunctively with radiotherapy to reduce some of the unpleasant side effects and improve the overall treatment process.

It does, however, lack in several areas. It is critical to understand that this study only examined the patients at the very end of the treatment, and then again at months 1, 3, and 6 after the completion of the treatment. The significant findings that they reported were only significant at the end of therapy and at months 1 and 3 when looking at some parameters. This suggests that further examination of the long term effects of yoga is necessary before making any broad statements about its use, efficacy, and application in breast cancer patients.

With that being said, improving the side effects and quality of life in these patients is critical. It’s a debilitating and life-changing disease process that we must continue to fight. While researchers push to find better drugs and a cure at the cellular level, we must not forget about the other aspects of any disease process that may play a role in overall recovery. This study certainly offers an interesting look into the combination of current standard of care medical treatments with a complimentary medical practice involving the training of both the mind and body in attempts to optimize our treatment protocols.

Please feel free to leave me any comments, feedback, concerns, or insight on this page or email me at c_meltsakos@nymc.edu. Also, if you like what you've read subscribe to the feed to get my articles sent directly to your inbox!

Resources:

1. Cohen, L. et al. Randomized, Controlled Trial of Yoga in Women With Breast Cancer Undergoing Radiotherapy. Journal of Clinical Oncology. 2014; 32(10): 1058-65.

2. Cramer H, Lauche R, Langhorst J, et al. Quality of life and mental health in patients with chronic disease who regularly practice yoga and those who do not: A case-control study. Evid Based Complement Alternat Med 2013.

3. Danhauer SC, Mihalko SL, Russel GB, et al. Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psychooncology. 2009; 18: 360-68.

4. Littman AJ, Bertram LC, Ceballos R, et al. Randomized controlled pilot trial of yoa in overweight and oese breast cancer survivors: Effects on quality of life and anthropometric measures. Support Care Cancer 2012; 20: 267-77.

5. http://www.nationalbreastcancer.org/breast-cancer-facts

6. Pew Internet Post-Election Survey, November 14 – December 09, 2012. N=2,261 adults ages 18+. Margin of error is +/- 2.3 percentage points. American Society for Hypertension, Inc.

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