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Effects of Yoga on the Quality of Life in Cancer Patients

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Evidence-based Non-pharmacological Therapies for Palliative Cancer Care

Part of the book series: Evidence-based Anticancer Complementary and Alternative Medicine ((ACAM,volume 4))

Abstract

Quality of life (QoL) is a multidimensional concept that includes physical, psychological, and social aspects which can be regarded as a broad term related to the patient’s subjective evaluation of life as a whole. Patients with cancer often have to deal with symptoms and treatment-related side effects, which have ­substantial impact on their QoL. Yoga, as a main component of the mindfulness-based stress reduction and one of the most commonly utilized complementary and alternative medicine therapies, has been studied for its feasibility and effects for cancer patients. Increasing evidence indicates that yoga may be beneficial for ­people with cancer in improvements of psychological health and QoL. Nevertheless, given different methodologies of the studies, the variety of QoL measures employed, duration of the interventions, and types of yoga, the effects of yoga on QoL in cancer patients are inconclusive. The exact mechanism of yoga or ­mindfulness-based stress reduction on QoL is not clear. The researchers have proposed and investigated some plausible mechanisms, such as relaxation response, enhancing body awareness, psycho-neuro immunological aspect, and melatonin production. This chapter discusses the evidence for the effectiveness (including safety and adverse effects) of yoga for QoL of cancer patients, includes the underlying mechanisms of yoga on QoL.

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References

  • Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  • Ando M, Morita T, Akechi T, Ito S, Tanaka M, Ifuku Y et al (2009) The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with ­cancer. J Palliat Med 12:1091–1094

    Article  PubMed  Google Scholar 

  • Austin S, Laeng S (2003) Yoga. In: Carlson JL (ed) Complementary therapies and wellness: ­practice essentials for holistic health care. Prentice Hall, Upper Saddle River, pp 282–294

    Google Scholar 

  • Banasik J, Williams H, Haberman M, Blank SE, Bendel R (2011) Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract 23:135–142

    Article  PubMed  Google Scholar 

  • Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS et al (2007) Effects of an ­integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther 6:242–250

    Article  PubMed  Google Scholar 

  • Beary JF, Benson H (1974) A simple psychophysiologic technique which elicits the hypometabolic changes of the relaxation response. Psychosom Med 36:115–120

    PubMed  CAS  Google Scholar 

  • Bertschinger DR, Mendrinos E, Dosso A (2007) Yoga can be dangerous – glaucomatous visual field defect worsening due to postural yoga. Br J Ophthalmol 91:1413–1414

    Article  PubMed  Google Scholar 

  • Bower JE, Garet D, Sternlieb B (2011) Yoga for persistent fatigue in breast cancer survivors: results of a pilot study. Evid Based Complement Alternat Med 2011:623168

    Article  PubMed  Google Scholar 

  • Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R et al (2012) Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 118:3766–3775

    Article  PubMed  Google Scholar 

  • Brant JM, Beck S, Dudley WN, Cobb P, Pepper G, Miaskowski C (2011) Symptom trajectories in posttreatment cancer survivors. Cancer Nurs 34:67–77

    Article  PubMed  Google Scholar 

  • Brown RP, Gerbarg PL (2009) Yoga breathing, meditation, and longevity. Ann N Y Acad Sci 1172:54–62

    Article  PubMed  Google Scholar 

  • Carlson LE, Bultz BD (2008) Mind-body interventions in oncology. Curr Treat Options Oncol 9:127–134

    Article  PubMed  Google Scholar 

  • Carlson LE, Speca M, Patel KD, Goodey E (2003) Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 65:571–581

    Article  PubMed  Google Scholar 

  • Carlson LE, Speca M, Patel KD, Goodey E (2004) Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 29:448–474

    Article  PubMed  CAS  Google Scholar 

  • Carlson LE, Speca M, Faris P, Patel KD (2007) One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun 21:1038–1049

    Article  PubMed  CAS  Google Scholar 

  • Carmody J, Reed G, Kristeller J, Merriam P (2008) Mindfulness, spirituality, and health-related symptoms. J Psychosom Res 64:393–403

    Article  PubMed  Google Scholar 

  • Carson JW, Carson KM, Porter LS, Keefe FJ, Shaw H, Miller JM (2007) Yoga for women with metastatic breast cancer: results from a pilot study. J Pain Symptom Manage 33:331–341

    Article  PubMed  Google Scholar 

  • Cassileth BR, Deng GE, Gomez JE, Johnstone PA, Kumar N, Vickers AJ (2007) Complementary therapies and integrative oncology in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:340S–354S

    Article  PubMed  Google Scholar 

  • Cella DF (1994) Quality of life: concepts and definition. J Pain Symptom Manage 9:186–192

    Article  PubMed  CAS  Google Scholar 

  • Cella DF, Cherin EA (1988) Quality of life during and after cancer treatment. Compr Ther 14:69–75

    PubMed  CAS  Google Scholar 

  • Cella DF, Tulsky DS (1993) Quality of life in cancer: definition, purpose, and method of measurement. Cancer Invest 11:327–336

    Article  PubMed  CAS  Google Scholar 

  • Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579

    PubMed  CAS  Google Scholar 

  • Chang BH, Casey A, Dusek JA, Benson H (2010) Relaxation response and spirituality: pathways to improve psychological outcomes in cardiac rehabilitation. J Psychosom Res 69:93–100

    Article  PubMed  Google Scholar 

  • Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A (2004) Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 100:2253–2260

    Article  PubMed  Google Scholar 

  • Collins C (1998) Yoga: intuition, preventive medicine, and treatment. J Obstet Gynecol Neonatal Nurs 27:563–568

    Article  PubMed  CAS  Google Scholar 

  • Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S (2006) A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology 15:891–897

    Article  PubMed  Google Scholar 

  • Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, Daley K et al (2009) Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psychooncology 18:360–368

    Article  PubMed  Google Scholar 

  • Dapueto JJ, Servente L, Francolino C, Hahn EA (2005) Determinants of quality of life in patients with cancer. Cancer 103:1072–1081

    Article  PubMed  Google Scholar 

  • Daubenmier JJ (2005) The relationship of yoga, body awareness, and body responsiveness to ­self-objectification and disordered eating. Psychol Women Quart 29:207–219

    Article  Google Scholar 

  • de Haes JC, van Knippenberg FC, Neijt JP (1990) Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer 62:1034–1038

    Article  PubMed  Google Scholar 

  • Deng GE, Frenkel M, Cohen L, Cassileth BR, Abrams DI, Capodice JL et al (2009) Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. J Soc Integr Oncol 7:85–120

    PubMed  Google Scholar 

  • Deutsch JE, Anderson EZ (2008) Complementary therapies for physical therapy: a clinical ­decision-making approach. Saunders/Elsevier, St. Louis

    Google Scholar 

  • DiStasio SA (2008) Integrating yoga into cancer care. Clin J Oncol Nurs 12:125–130

    Article  PubMed  Google Scholar 

  • Duncan MD, Leis A, Taylor-Brown JW (2008) Impact and outcomes of an Iyengar yoga program in a cancer centre. Curr Oncol 15(Suppl 2):s109, es172–108

    PubMed  Google Scholar 

  • Felce D, Perry J (1995) Quality of life: its definition and measurement. Res Dev Disabil 16:51–74

    Article  PubMed  CAS  Google Scholar 

  • Ferrans CE (2010) Advances in measuring quality-of-life outcomes in cancer care. Semin Oncol Nurs 26:2–11

    Article  PubMed  Google Scholar 

  • Fouladbakhsh JM, Stommel M (2010) Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Oncol Nurs Forum 37:E7–E15

    Article  PubMed  Google Scholar 

  • Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ (2011) Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With Aromatase Inhibitor-Associated Arthralgias. Integr Cancer Ther 11:313–320

    Google Scholar 

  • Garfinkel M, Schumacher HR Jr (2000) Yoga. Rheum Dis Clin North Am 26:125–132

    Article  PubMed  CAS  Google Scholar 

  • Grossman P, Niemann L, Schmidt S, Walach H (2004) Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 57:35–43

    Article  PubMed  Google Scholar 

  • Gunnars B, Nygren P, Glimelius B (2001) Assessment of quality of life during chemotherapy. Acta Oncol 40:175–184

    Article  PubMed  CAS  Google Scholar 

  • Hoffman JW, Benson H, Arns PA, Stainbrook GL, Landsberg GL, Young JB et al (1982) Reduced sympathetic nervous system responsivity associated with the relaxation response. Science 215:190–192

    Article  PubMed  CAS  Google Scholar 

  • Honea N, Brant J, Beck SL (2007) Treatment-related symptom clusters. Semin Oncol Nurs 23:142–151

    Article  PubMed  Google Scholar 

  • Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M (2012) How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther 11(3):187–203

    Article  PubMed  Google Scholar 

  • Impett EA, Daubenmier JJ, Hirschman AL (2006) Minding the body: yoga, embodiment, and well-being. Sex Res Soc Policy 3:39–48

    Article  Google Scholar 

  • Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300

    Article  PubMed  Google Scholar 

  • Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  • Karabulu N, Erci B, Ozer N, Ozdemir S (2010) Symptom clusters and experiences of patients with cancer. J Adv Nurs 66:1011–1021

    Article  PubMed  Google Scholar 

  • Karasek M (2004) Melatonin, human aging, and age-related diseases. Exp Gerontol 39:1723–1729

    Article  PubMed  CAS  Google Scholar 

  • Kiecolt-Glaser JK, Christian L, Preston H, Houts CR, Malarkey WB, Emery CF et al (2010) Stress, inflammation, and yoga practice. Psychosom Med 72:113–121

    Article  PubMed  CAS  Google Scholar 

  • Kieviet-Stijnen A, Visser A, Garssen B, Hudig W (2008) Mindfulness-based stress reduction training for oncology patients: patients’ appraisal and changes in well-being. Patient Educ Couns 72:436–442

    Article  PubMed  Google Scholar 

  • Kovacic T, Kovacic M (2011) Impact of relaxation training according to Yoga In Daily Life(R) system on perceived stress after breast cancer surgery. Integr Cancer Ther 10:16–26

    Article  PubMed  Google Scholar 

  • Kulkarni DD, Bera TK (2009) Yogic exercises and health – a psycho-neuro immunological approach. Indian J Physiol Pharmacol 53:3–15

    PubMed  CAS  Google Scholar 

  • Landesman S (1986) Quality of life and personal life satisfaction: definition and measurement issues. Ment Retard 24:141–143

    PubMed  CAS  Google Scholar 

  • Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H (2000) Functional brain ­mapping of the relaxation response and meditation. Neuroreport 11:1581–1585

    Article  PubMed  CAS  Google Scholar 

  • Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW et al (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology 18:1261–1272

    Article  PubMed  Google Scholar 

  • Lieberman HR, Waldhauser F, Garfield G, Lynch HJ, Wurtman RJ (1984) Effects of melatonin on human mood and performance. Brain Res 323:201–207

    Article  PubMed  CAS  Google Scholar 

  • Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY (2011) Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evid Based Complement Alternat Med 2011:659876

    PubMed  Google Scholar 

  • Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J, McGregor B et al (2012) Randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: effects on quality of life and anthropometric measures. Support Care Cancer 20:267–277

    Article  PubMed  Google Scholar 

  • Lutgendorf SK, Sood AK (2011) Biobehavioral factors and cancer progression: physiological pathways and mechanisms. Psychosom Med 73:724–730

    Article  PubMed  Google Scholar 

  • Massion AO, Teas J, Hebert JR, Wertheimer MD, Kabat-Zinn J (1995) Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data. Med Hypotheses 44:39–46

    Article  PubMed  CAS  Google Scholar 

  • Matousek RH, Pruessner JC, Dobkin PL (2011) Changes in the cortisol awakening response (CAR) following participation in mindfulness-based stress reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract 17:65–70

    Article  PubMed  Google Scholar 

  • Mehling WE, Wrubel J, Daubenmier JJ, Price CJ, Kerr CE, Silow T et al (2011) Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. Philos Ethics Humanit Med 6:6

    Article  PubMed  Google Scholar 

  • Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR (2008) Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26:971–982

    Article  PubMed  CAS  Google Scholar 

  • Mills E, Wu P, Seely D, Guyatt G (2005) Melatonin in the treatment of cancer: a systematic review of randomized controlled trials and meta-analysis. J Pineal Res 39:360–366

    Article  PubMed  CAS  Google Scholar 

  • Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB et al (2007) Randomized ­controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 25:4387–4395

    Article  PubMed  Google Scholar 

  • Musial F, Bussing A, Heusser P, Choi KE, Ostermann T (2011) Mindfulness-based stress reduction for integrative cancer care: a summary of evidence. Forsch Komplementmed 18:192–202

    Article  PubMed  Google Scholar 

  • Padilla GV, Presant C, Grant MM, Metter G, Lipsett J, Heide F (1983) Quality of life index for patients with cancer. Res Nurs Health 6:117–126

    Article  PubMed  CAS  Google Scholar 

  • Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH (2011) Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev 20:1996–2005

    Article  PubMed  Google Scholar 

  • Philippot P, Chapelle G, Blairy S (2002) Respiratory feedback in the generation of emotion. Cognition Emotion 16:605–627

    Article  Google Scholar 

  • Pierpaoli W, Maestroni GJ (1987) Melatonin: a principal neuroimmunoregulatory and anti-stress hormone: its anti-aging effects. Immunol Lett 16:355–361

    Article  PubMed  CAS  Google Scholar 

  • Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, Ravi BD et al (2007) Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care (Engl) 16:462–474

    Article  CAS  Google Scholar 

  • Rakel D, Faass N (2006) Complementary medicine in clinical practice: integrative practice in American healthcare. Jones and Bartlett, Sudbury

    Google Scholar 

  • Rani NJ, Rao PVK (1994) Body awareness and yoga training. Percept Mot Skills 79:1103–1106

    Article  Google Scholar 

  • Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, Diwakar RB et al (2009) Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complement Ther Med 17:1–8

    Article  PubMed  Google Scholar 

  • Reiche EMV, Nunes SOV, Morimoto HK (2004) Stress, depression, the immune system, and ­cancer. Lancet Oncol 5:617–625

    Article  PubMed  CAS  Google Scholar 

  • Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG et al (2010) Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 11:165–173

    Article  PubMed  Google Scholar 

  • Sarang PS, Telles S (2006) Oxygen consumption and respiration during and after two yoga r­elaxation techniques. Appl Psychophysiol Biofeedback 31:143–153

    Article  PubMed  Google Scholar 

  • Schag CA, Ganz PA, Heinrich RL (1991) CAncer Rehabilitation Evaluation System – short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument. Cancer 68:1406–1413

    Article  PubMed  CAS  Google Scholar 

  • Schipper H, Clinch J, McMurray A, Levitt M (1984) Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation. J Clin Oncol 2:472–483

    PubMed  CAS  Google Scholar 

  • Shapiro SL, Bootzin RR, Figueredo AJ, Lopez AM, Schwartz GE (2003) The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer – An exploratory study. J Psychosom Res 54:85–91

    Article  PubMed  Google Scholar 

  • Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS (2010) Pilot evaluation of an Iyengar yoga program for breast cancer survivors. Cancer Nurs 33:369–381

    Article  PubMed  Google Scholar 

  • Srinivasan V, Pandi-Perumal SR, Brzezinski A, Bhatnagar KP, Cardinali DP (2011) Melatonin, immune function and cancer. Recent Pat Endocr Metab Immune Drug Discov 5:109–123

    Article  PubMed  CAS  Google Scholar 

  • Stein KD, Syrjala KL, Andrykowski MA (2008) Physical and psychological long-term and late effects of cancer. Cancer 112:2577–2592

    Article  PubMed  Google Scholar 

  • Tooley GA, Armstrong SM, Norman TR, Sali A (2000) Acute increases in night-time plasma melatonin levels following a period of meditation. Biol Psychol 53:69–78

    Article  PubMed  CAS  Google Scholar 

  • Ulger O, Yagli NV (2010) Effects of yoga on the quality of life in cancer patients. Complement Ther Clin Pract 16:60–63

    Article  PubMed  Google Scholar 

  • Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N et al (2009a) Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther 8:37–46

    Article  PubMed  CAS  Google Scholar 

  • Vadiraja HS, Rao MR, Nagarathna R, Nagendra HR, Rekha M, Vanitha N et al (2009b) Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Complement Ther Med 17:274–280

    Article  PubMed  CAS  Google Scholar 

  • Vallath N (2010) Perspectives on yoga inputs in the management of chronic pain. Indian J Palliat Care 16:1–7

    Article  PubMed  Google Scholar 

  • Velikova G, Stark D, Selby P (1999) Quality of life instruments in oncology. Eur J Cancer 35:1571–1580

    Article  PubMed  CAS  Google Scholar 

  • Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL (2008) Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun 22:969–981

    Article  PubMed  Google Scholar 

  • Yabroff KR, Lund J, Kepka D, Mariotto A (2011) Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev 20:2006–2014

    Article  PubMed  Google Scholar 

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Lin, KY., Tsauo, JY. (2013). Effects of Yoga on the Quality of Life in Cancer Patients. In: Cho, W. (eds) Evidence-based Non-pharmacological Therapies for Palliative Cancer Care. Evidence-based Anticancer Complementary and Alternative Medicine, vol 4. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5833-9_6

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