Supportive Care in Cancer

, Volume 17, Issue 10, pp 1301–1309 | Cite as

Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial

  • James W. CarsonEmail author
  • Kimberly M. Carson
  • Laura S. Porter
  • Francis J. Keefe
  • Victoria L. Seewaldt
Original Article


Goal of work

Breast cancer survivors have limited options for the treatment of hot flashes and related symptoms. Further, therapies widely used to prevent recurrence in survivors, such as tamoxifen, tend to induce or exacerbate menopausal symptoms. The aim of this preliminary, randomized controlled trial was to evaluate the effects of a yoga intervention on menopausal symptoms in a sample of survivors of early-stage breast cancer (stages IA–IIB).

Materials and methods

Thirty-seven disease-free women experiencing hot flashes were randomized to the 8-week Yoga of Awareness program (gentle yoga poses, meditation, and breathing exercises) or to wait-list control. The primary outcome was daily reports of hot flashes collected at baseline, posttreatment, and 3 months after treatment via an interactive telephone system. Data were analyzed by intention to treat.

Main results

At posttreatment, women who received the yoga program showed significantly greater improvements relative to the control condition in hot-flash frequency, severity, and total scores and in levels of joint pain, fatigue, sleep disturbance, symptom-related bother, and vigor. At 3 months follow-up, patients maintained their treatment gains in hot flashes, joint pain, fatigue, symptom-related bother, and vigor and showed additional significant gains in negative mood, relaxation, and acceptance.


This pilot study provides promising support for the beneficial effects of a comprehensive yoga program for hot flashes and other menopausal symptoms in early-stage breast cancer survivors.


Breast cancer Hot flashes Pain Yoga Meditation 



This work was supported by a grant from the Susan G. Komen Breast Cancer Foundation.


  1. 1.
    Banerjee B, Vadiraj HS, Ram A 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. doi: 10.1177/1534735407306214 PubMedCrossRefGoogle Scholar
  2. 2.
    Berger BG, Owen DR (1992) Mood alteration with yoga and swimming: aerobic exercise may not be necessary. Percept Mot Skills 75:1331–1343. doi: 10.2466/PMS.75.8.1331–1343 PubMedCrossRefGoogle Scholar
  3. 3.
    Booth-LaForce C, Thurston RC, Taylor MR (2007) A pilot study of a Hatha yoga treatment for menopausal symptoms. Maturitas 57:286–295. doi: 10.1016/j.maturitas.2007.01.012 PubMedCrossRefGoogle Scholar
  4. 4.
    Borkovec TD, Nau SD (1972) Credibility check of analogue therapy rationales. J Behav Ther Exp Psychiatry 3:257–260. doi: 10.1016/0005–7916(72)90045–6 CrossRefGoogle Scholar
  5. 5.
    Carpenter JS, Storniolo AM, Johns S et al (2007) Randomized, double-blind, placebo-controlled crossover trials of venlafaxine for hot flashes after breast cancer. Oncologist 12:124–135. doi: 10.1634/theoncologist.12–1–124 PubMedCrossRefGoogle Scholar
  6. 6.
    Carson JW, Carson KM, Gil KM et al (2004) Mindfulness-based relationship enhancement. Behav Ther 35:471–494. doi: 10.1016/S0005–7894(04)80028–5 CrossRefGoogle Scholar
  7. 7.
    Carson JW, Carson KM, Porter LS et al (2007) Yoga for women with metastatic breast cancer: results from a pilot study. J Pain Symptom Manage 33:331–341. doi: 10.1016/j.jpainsymman.2006.08.009 PubMedCrossRefGoogle Scholar
  8. 8.
    Carson JW, Keefe FJ, Affleck G et al (2006) A comparison of conventional pain coping skills training and pain coping skills training with a maintenance training component: a daily diary analysis of short- and long-term treatment effects. J Pain 7:615–625. doi: 10.1016/j.jpain.2006.02.008 PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen BE, Kanaya AM, Macer JL et al (2007) Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas 56:198–204. doi: 10.1016/j.maturitas.2006.08.003 PubMedCrossRefGoogle Scholar
  10. 10.
    Cohen L, Warneke C, Fouladi RT et al (2004) Psychological adjustment and sleep quality in a randomized controlled trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 100:2253–2260. doi: 10.1002/cncr.20236 PubMedCrossRefGoogle Scholar
  11. 11.
    Culos-Reed SN, Carlson LE, Daroux LM et al (2006) A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology 15:891–897. doi: 10.1002/pon.1021 PubMedCrossRefGoogle Scholar
  12. 12.
    Elavsky S, McAuley E (2007) Physical activity and mental health outcomes during menopause: a randomized controlled trial. Ann Behav Med 33:132–142. doi: 10.1007/BF02879894 PubMedCrossRefGoogle Scholar
  13. 13.
    Freedman RR (2005) Hot flashes: behavioral treatments, mechanisms, and relation to sleep. Am J Med 118:124–130. doi: 10.1016/j.amjmed.2005.09.046 PubMedCrossRefGoogle Scholar
  14. 14.
    Freedman RR (2005) It’s all in your head. Menopause 12:483. doi: 10.1097/01.gme.0000172272.10219.90 PubMedCrossRefGoogle Scholar
  15. 15.
    Freedman RR, Woodward S (1992) Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol 167:436–439PubMedGoogle Scholar
  16. 16.
    Garfinkel MS, Schumacher HR Jr, Husain A et al (1994) Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol 21:2341–2343PubMedGoogle Scholar
  17. 17.
    Garfinkel MS, Singhal A, Katz WA et al (1998) Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA 280:1601–1603. doi: 10.1001/jama.280.18.1601 PubMedCrossRefGoogle Scholar
  18. 18.
    Gross JJ (2002) Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 39:281–291. doi: 10.1017/S0048577201393198 PubMedCrossRefGoogle Scholar
  19. 19.
    Keefe FJ, Caldwell DS, Baucom D et al (1999) Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. Arthritis Care Res 12:101–11 1999:101–111PubMedCrossRefGoogle Scholar
  20. 20.
    Kronenberg F (1990) Hot flashes: epidemiology and physiology. Ann N Y Acad Sci 592:52–86. doi: 10.1111/j.1749–6632.1990.tb30316.x PubMedCrossRefGoogle Scholar
  21. 21.
    Lee MM, Lin SS, Wrensch MR et al (2000) Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 92:42–47. doi: 10.1093/jnci/92.1.42 PubMedCrossRefGoogle Scholar
  22. 22.
    MacLennan A, Lester S, Moore V (2001) Oral oestrogen replacement therapy versus placebo for hot flushes (Cochrane Review). Cochrane Database Syst Rev 1. CD002978.Google Scholar
  23. 23.
    McCracken LM, Carson JW, Eccleston C et al (2004) Acceptance and change in the context of chronic pain. Pain 109:4–7. doi: 10.1016/j.pain.2004.02.006 PubMedCrossRefGoogle Scholar
  24. 24.
    Moadel AB, Shah C, Wylie-Rosett J 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. doi: 10.1200/JCO.2006.06.6027 PubMedCrossRefGoogle Scholar
  25. 25.
    Morales L, Neven P, Timmerman D et al (2004) Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients. Anticancer Drugs 15:753–760. doi: 10.1097/00001813–200409000–00003 PubMedCrossRefGoogle Scholar
  26. 26.
    National Institutues of Health (2005) National Institutes of Health State-of-the-Science Conference Statement: management of menopause-related symptoms. Ann Intern Med 143:1003–1014Google Scholar
  27. 27.
    Oken BS, Kishiyama S, Zajdel D et al (2004) Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology 62:2058–2064PubMedGoogle Scholar
  28. 28.
    Raghavendra RM, Nagarathna R, Nagendra HR 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. doi: 10.1111/j.1365–2354.2006.00739.x CrossRefGoogle Scholar
  29. 29.
    Schwartz JE, Stone AA (1998) Strategies for analyzing ecological momentary assessment data. Health Psychol 17:6–16. doi: 10.1037/0278–6133.17.1.6 PubMedCrossRefGoogle Scholar
  30. 30.
    Sloan JA, Loprinzi CL, Novotny PJ et al (2001) Methodologic lessons learned from hot flash studies. J Clin Oncol 19:4280–4290PubMedGoogle Scholar
  31. 31.
    Telles S, Naveen KV (1997) Yoga for rehabilitation: an overview. Indian J Med Sci 51:123–127PubMedGoogle Scholar
  32. 32.
    Vempati RP, Telles S (2002) Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep 90:487–494. doi: 10.2466/PR0.90.2.487–494 PubMedCrossRefGoogle Scholar
  33. 33.
    Williams KA, Petronis J, Smith D et al (2005) Effect of Iyengar yoga therapy for chronic low back pain. Pain 115:107–117. doi: 10.1016/j.pain.2005.02.016 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • James W. Carson
    • 1
    Email author
  • Kimberly M. Carson
    • 2
  • Laura S. Porter
    • 3
  • Francis J. Keefe
    • 3
  • Victoria L. Seewaldt
    • 4
  1. 1.Department of Anesthesiology and Peri-operative MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.PortlandUSA
  3. 3.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  4. 4.Department of MedicineDuke University Medical CenterDurhamUSA

Personalised recommendations