Once Considered “Fringe,” Yoga Enters Mainstream Cancer Care

NEW YORK ⎯ Twenty years ago, if someone suggested that yoga would one day become a cancer care modality, most oncologists would have said…ahem….”That’s a stretch!”

But over the last decade, that’s exactly what’s happened: yoga is emerging as a preferred form of adjunctive cancer care in dozens of oncology centers, giving marked and measurable benefits to people surviving conventional treatment.

Researchers say regular yoga practice—carefully tailored to the needs and limitations of people recovering from serious illness—can alleviate anxiety, improve sleep, reduce the need for sleep meds, increase physical flexibility and balance, and reduce the burden of side-effects associated with chemotherapy.

The intercalation of this ancient self-healing discipline with conventional cancer care was a subject of considerable interest at the seventh annual meeting of the Society for Integrative Oncology.

To be sure, there are challenges in adapting yoga to the oncology ward, but oncologists, rehab specialists and yoga instructors worldwide are rising to those challenges with considerable verve.

Infusions & In-Breaths

Stephanie Sohl, PhD, of the Comprehensive Cancer Center at Wake Forest University Baptist Medical Center has been collaborating with a team at Mount Sinai School of Medicine to develop a yoga sequence for women with ovarian cancer that can actually be practiced during the patients’ chemotherapy visits.

“The primary goal of any therapy for patients who have persistent or recurrent ovarian cancer is shifted from solely pursuing a cure to the control of symptoms and overall maximization of quality of life,” said Dr. Sohl at the SIO meeting.

The program, called “Yoga Skills Training” (YST) is comprised of 15-minute sessions focused on simple, non-strenuous postures that can be done while the patient is receiving treatment. Dr. Sohl and colleagues are studying the effect of the program on parameters of anxiety, pain, fatigue, and quality of life, using standardized scales like the Cancer Behavior Inventory, the State Trait Anxiety Inventory, the Brief Pain Inventory, and the Functional Assessment of Cancer Therapy Fatigue scale.

So far, seven women have completed the trial. Not surprisingly, the yoga program resulted in measurable changes in mean scores for anxiety, relaxation, and self-efficacy in coping. However, there were no significant changes in pain and fatigue. Though it can clearly contribute to overall health, yoga is not a panacea for post-cancer malaise.

Dr. Sohl noted that there are two other studies ongoing at Wake Forest, involving more intensive yoga programs. But she believes that the brevity of the YST model and the fact that the sequences can be practiced during the patient’s treatment appointments will likely have the greatest impact. Convenience definitely improves compliance.

Recognizing, Transcending Limits

There are many different styles of yoga practiced in the US, to say nothing of the myriad forms practiced in India, some of which are thousands of years old.

There are significant logistical challenges in creating yoga forms appropriate for people undergoing cancer treatment. A good program will recognize the limitations of strength, stamina and stability in people who have undergone surgery, radiotherapy or chemotherapy.  Participants are often elderly and may be dealing with other health challenges as well.

Instructors must be specially trained in working with cancer survivors, and the interventions must be designed to fit with patients’ demanding treatment schedules. Clinicians and yoga practitioners involved in designing programs for cancer patients have shown a lot of creativity and sensitivity, and there are now programs specifically tailored for people with a diverse range of cancers.

A team at Wayne State University College of Nursing developed a program for people surviving non-small cell lung cancer. It involves a standardized yoga sequence, which patients initially learn during weekly 45-minute sessions in the clinic, but also practice at home.  In a pilot study, 9 patients who had gone through standard surgery and chemotherapy were enrolled in the yoga classes. Seven completed the full 8-week intervention and 6-week follow up.

Judi Fouladbakhsh, PhD, APRN, told SIO attendees that the patients all reported consistent and significant decreases in dyspnea and chest tension after the yoga sessions, as well as improved sleep quality, and decreased use of sleep meds. There were no adverse effects—respiratory or otherwise—related to the practice.

Dr. Fouladbakhsh added that 6 of the 7 patients were still practicing yoga at 3 months’ follow-up. That’s encouraging because yoga gives its best results when practiced daily or at least several times per week.

Asanas Aid Arthralgia

As difficult as it is to create a yoga program appropriate for cancer patients, it is even more challenging to design meaningful clinical studies. Many of the expected benefits are largely subjective, and ike any other form of exercise, it is impossible to design a “blinded” study of yoga, or to create a “placebo.”

Studies so far have been small, short-term, largely dependent on patient self-assessment, and focused on quality of life. To date, there have not been any studies of yoga’s impact on survival, disease progression, or mortality. But that could change as investigators start to look at objective clinical measures.

Mary Lou Galantino, PhD, and colleagues in the Department of Physical Therapy at Richard Stockton College of New Jersey, are assessing the effects of yoga on flexibility and balance in women with breast cancer who developed arthralgias after treatment with aromatase-inhibitors. This is a common and debilitating adverse effect associated with these drugs.

The study involved 10 post-menopausal women with stage I-III breast cancer who had severe arthralgia following drug treatment. The women participated in twice-weekly 90-minute Iyengar style yoga classes led by certified instructors and focused on flexibility, deep breathing, and meditation. Patients were encouraged to learn the sequences and to practice at home for 15 minutes per day.

Physical therapists measured Sit and Reach  (distance a person can reach beyond his/her feet while seated with legs extended) and Functional Reach (the difference between arm’s length and maximal forward reach, using a fixed base of support) following each session.

The women all showed significant changes in Sit & Reach, from a mean of 22.9 to 30.1 cm, and in the Functional Reach, from a mean of 25.4 cm to 39.1 cm) after completing a full cycle of yoga classes. “The preliminary data suggest that yoga may improve flexibility and balance in breast cancer survivors who experience aromatase inhibitor-associated arthralgia,” said Dr. Galantino.

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