CHICAGO—A customized yoga program reduced fatigue and improved sleep and overall quality of life in cancer survivors in a study reported at the ASCO Annual Meeting.
The four-week program, which combines aspects of gentle Hatha and restorative yoga, was also associated with a reduction in use of sleep medication.
Karen Mustian, PhD, MPH, Assistant Professor at the University of Rochester Medical Center James P. Wilmot Cancer Center Departments of Radiation Oncology and Community and Preventive Medicine and the Susan B. Anthony Institute for Women and Gender Studies, URMC Center for Future Health, presented the findings at a presscast held in advance of the meeting.
Sleep problems and fatigue are among the most common problems experienced by cancer survivors, and can significantly affect quality of life, Dr. Mustian noted. Approximately 80% and 95% of patients report fatigue during and after treatment, respectively, and as many as 80% and 65% have sleep problems during and after therapy.
The new study, which Dr. Mustian said is the largest randomized controlled study to examine the value of yoga specifically designed for cancer survivors, involved 410 people who reported sleep problems and fatigue two months to two years after completing chemotherapy, radiation, and/or surgical treatment for early-stage cancer.
Most participants were female (93%), with a mean age of 54, and 75% had a diagnosis of breast cancer. None had distant metastatic disease or sleep apnea at baseline.
A total of 204 patients were randomized to usual follow-up care and 206, to usual care plus yoga.
Breathing Exercises, Gentle Hatha and Restorative Yoga, and ‘Mindfulness'
For the NCI-funded study, Dr. Mustian and colleagues designed a specialized program known as YOCAS—Yoga for Cancer Survivors—which includes breathing exercises, gentle Hatha and restorative yoga postures, and mindfulness exercises.
Participants attended two 75-minute classes a week, for four weeks.
The instructors, all of whom were certified by the Yoga Alliance, received special training for the YOCAS program.
At the start of the study, both the yoga and no-yoga group had poor sleep quality, as evidenced by a mean score of 9.0 and 9.2 points, respectively, on a 21-point sleep impairment scale, in which higher scores correspond to worse sleep.
After four weeks, the scores had dropped to an average of 7.2 and 7.9 points, respectively. This corresponds to a 22% improvement in sleep quality in the yoga group vs a 12% improvement in the no-yoga group, Dr. Mustian reported.
At baseline, 84% of the yoga group and 83% of the control group had clinically impaired sleep quality, with scores of 5 or greater on the Pittsburgh Sleep Quality Index.
After four weeks, 31% of the yoga group had recovered and no longer had clinically impaired sleep quality (index of less than 5), whereas only 16% of patients in the control group experienced recovery, a significant difference.
Yoga participants also fared better on every other measure looked at:
- Their average scores on a questionnaire commonly used to measure fatigue in cancer patients dropped by 42% vs 12% in the no-yoga group.
- Their average scores on a scale used to measure daytime sleepiness dropped by 29% vs 5% in the no-yoga group.
- The average scores on a questionnaire commonly used to measure quality of life improved by 6% while there was no change in the no-yoga group.
- They reduced their use of over-the-counter and prescription sleep medications by an average of 21% while those in the no-yoga group used 5% more sleep medication on average.
All the differences reached statistical significance.
“In conclusion, we can state that it is possible that Hatha yoga classes and restorative yoga classes might be useful to cancer survivors in communities across the United States in helping these side effects that impair quality of life,” Dr. Mustian said.
Not Yet Available
The customized yoga program used in the study is not yet available to yoga instructors, though, Dr. Mustian said.
“Cancer survivors looking for this kind of benefit should probably look for gentle Hatha or restorative yoga taught by a well-qualified instructor registered with the Yoga Alliance.”
As for other forms of yoga, “we can't say they are safe or effective for cancer survivors,” she said.
Probably Reduces Stress & Inflammation
Yoga must likely exerts its benefits by reducing stress and inflammation, said Janice Kiecolt-Glaser, PhD, Distinguished University Professor and S. Robert Davis Chair of Medicine in the Department of Psychiatry at Ohio State Medical Center.
Dr. Kiecolt-Glaser, who was not involved with this work, is conducting a study designed to examine the effects of yoga on fatigue, immune function, and mood in breast cancer survivors.
Adjunct, Not Replacement, Of Course
ASCO 2009–2010 President Douglas W. Blayney, MD, stressed that yoga is an adjunct, not a replacement, for usual care.
Cancer survivors, particularly women, often turn to complementary medicine such as yoga, Dr. Blayney said. YOCAS is “a creative application of scientific technique to complementary and alternative medicine approaches. This is a readily applicable approach that improves quality of life and reduces medicine intake in cancer survivors. This is a real positive.
“Physicians frequently have trouble discussing these approaches with patients, but this study applies real science to the issue,” he continued.
“This emphasizes the increasing importance of ameliorating complications of therapy in long-term cancer survivors, as there are literally millions of patients to whom this might be applicable in the United States.”