Supportive Care in Cancer

, Volume 20, Issue 12, pp 3055–3064 | Cite as

Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review

Review Article

Abstract

Purpose

Yoga is increasingly used as a complementary therapy to manage disease and treatment-related side effects in patients with cancer and has resulted in an increase in the number of studies exploring the effectiveness of yoga interventions. This systematic review examines whether yoga interventions provide any measurable benefit, both physically and psychologically, for women with breast cancer. The results will inform future research in this field and advance the development of yoga programmes.

Methods

We performed electronic searches of MEDLINE, PsychINFO, the Cochrane Library, Embase, CINAHL, AMED, Web of Science and Scopus for articles published up to June 2012. Only randomised controlled trials (RCTs) were included and methodological quality rating scores were determined using the PEDro (Physiotherapy Evidence Database) Scale.

Results

One hundred thirty-two studies were identified through a systematic search of eight electronic databases. Only published manuscripts that employed a RCT design were included (n = 18). The sample sizes for these studies varied widely from 18 to 164 participants and the associated PEDro scores ranged from 1 (poor) to 8 (good). All 18 studies reported positive effects for treatment-related side effects in favour of the yoga interventions, with the greatest impact on global quality of life (QoL) scores and emotional well-being.

Conclusion

Results from the few RCTs suggest there is moderate to good evidence that yoga may be a useful practice for women recovering from breast cancer treatments. Large-scale RCTs using objective measures and patient-reported outcomes with long-term follow-up are needed to substantiate whether the benefits are true and sustainable.

Keywords

Breast cancer Yoga Randomised controlled trial Quality of life 

References

  1. 1.
    Breast cancer-UK incidence statistics. Cancer Research UK. http://info.cancerresearchuk.org/cancerstats/types/breast/incidence/#world. Accessed 13 Jun 2012
  2. 2.
    Fallowfield L (2002) Quality of life: a new perspective for cancer patients. Nat Rev Cancer 2:873–879PubMedCrossRefGoogle Scholar
  3. 3.
    Kissane DW, Grabsch B, Love A, Clarke DM, Blosch S, Smith GC (2004) Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust NZ J Psychiat 38:320–326CrossRefGoogle Scholar
  4. 4.
    Molassiotis A, Scott JA, Kearney N, Pud D, Magri M, Selvekerova S, Bruyns I, Patiraki E (2006) Complementary and alternative medicine use in breast cancer patients in Europe. Support Care Cancer 14:260–267PubMedCrossRefGoogle Scholar
  5. 5.
    Smith KB, Pukall CF (2009) An evidence-based review of yoga as a complementary intervention for patients with cancer. Psycho-Oncol 18:465–475CrossRefGoogle Scholar
  6. 6.
    Lin K-Y, Hu Y-T, K-Jen C, Lin H-F, Tsauo J-Y (2011) Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evid-based Compl Alt. doi:10.1155/2011/659876
  7. 7.
    PEDro scale. Physiotherapy evidence database. http://www.pedro.org.au/english/downloads/pedro-scale/. Accessed 21 Feb 2012
  8. 8.
    Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721PubMedGoogle Scholar
  9. 9.
    de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55:29–33Google Scholar
  10. 10.
    Salter KL, Teasell RW, Foley NC, Jutai JW (2007) Outcome assessment in randomized controlled trials of stroke rehabilitation. Am J Phys Med Rehab 86:1007–1012CrossRefGoogle Scholar
  11. 11.
    Vadiraja SH, Rao MR, Nagendra RH, Nagarathna R, Rekha M, Vanitha N, Gopinath SK, Srinath B, Vishweshwara M, Madhavi Y, Ajaikumar SB, Ramesh SB, Rao N (2009) Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. Int J Yoga 2:73–79PubMedCrossRefGoogle Scholar
  12. 12.
    Vadiraja HS, Rao MR, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, Gopinath KS, Srinath BS, Vishweshwara MS, Madhavi YS, Ajaikumar BS, Bilimagga SR, Rao N (2009) 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 17:274–280PubMedCrossRefGoogle Scholar
  13. 13.
    Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, Gopinath KS, Srinath BS, Vishweshwara MS, Madhavi YS, Ajaikumar BS, Ramesh BS, Nalini R, Kumar V (2009) 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 8:37–46PubMedCrossRefGoogle Scholar
  14. 14.
    Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, Diwakar RB, Patil S, Bilimagga SR, Rao N, Varambally S (2009) Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complement Ther Med 17:1–8PubMedCrossRefGoogle Scholar
  15. 15.
    Rao RM, Nagendra HR, Raghuram N, Vinay C, Chandrashekara S, Gopinath KS, Srinath BS (2008) Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Int J Yoga 1:33–41PubMedCrossRefGoogle Scholar
  16. 16.
    Rao MR, Nagendra HR, Raghuram N, Vinay C, Chandrashekara S, Gopinath KS, Srinath BS (2008) Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery. Int J Yoga 1:11–20PubMedCrossRefGoogle Scholar
  17. 17.
    Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, Ravi BD, Patil S, Ramesh BS, Nalini R (2007) Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care 16:462–474CrossRefGoogle Scholar
  18. 18.
    Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G (2011) Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer. doi:10.1002/cncr.26702
  19. 19.
    Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J, McGregor B, McTiernan A (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 20:267–277PubMedCrossRefGoogle Scholar
  20. 20.
    Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, Daley K, Levine EA (2009) Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psycho-Oncol 18:360–368CrossRefGoogle Scholar
  21. 21.
    Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL (2009) Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer 17:1301–1309PubMedCrossRefGoogle Scholar
  22. 22.
    Blank SE, Kittel J, Haberman MR (2003) Active practice of Iyengar yoga as an intervention for breast cancer survivors. Int J Yoga Ther 13:51–59Google Scholar
  23. 23.
    Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, Sparano JA (2007) Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 25:4387–4395PubMedCrossRefGoogle Scholar
  24. 24.
    Kovacic T, Kovacic M (2011) Impact of relaxation training according to Yoga in Daily Life® system on perceived stress after breast cancer surgery. Integr Cancer Ther 10:16–26PubMedCrossRefGoogle Scholar
  25. 25.
    Banerjee B, Vadiraja HS, Ram A, Raghavendra R, Jayapal M, Gopinath KS, Ramesh BS, Rao N, Kumar A, Raghuram N, Hedge S, Nagendra HR, Hande P (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 6:242–250PubMedCrossRefGoogle Scholar
  26. 26.
    Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S (2006) A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psycho-Oncol 15:891–897CrossRefGoogle Scholar
  27. 27.
    Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, Nagendra HR, Wei Q, Cohen L (2010) Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 8:43–55PubMedGoogle Scholar
  28. 28.
    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 23:135–142PubMedCrossRefGoogle Scholar
  29. 29.
    Minton O, Stone P (2008) How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Breast Cancer Res Tr 112:5–13CrossRefGoogle Scholar
  30. 30.
    Morgan WP, Dishman RK (2001) Adherence to exercise and physical activity. Quest 53:277–278CrossRefGoogle Scholar
  31. 31.
    Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM, Proulx C, Lane K, Ladha AB, Vallance JK, McKenzie DC (2008) Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc 40:1180–1187PubMedCrossRefGoogle Scholar
  32. 32.
    Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenreich CM, Ladha AB, Proulx C, Lane K, Vallance JK, Segal RJ (2008) Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med 35:116–122PubMedGoogle Scholar
  33. 33.
    Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS (2012) Predictors of adherence to an Iyengar yoga program in breast cancer. Int J Yoga 5:3–9PubMedCrossRefGoogle Scholar
  34. 34.
    Ganz PA, Bower JE (2007) Cancer related fatigue: a focus on breast cancer and Hodgkin's disease survivors. Acta Oncol 46:474–479PubMedCrossRefGoogle Scholar
  35. 35.
    Mustian KM, Palesh O, Sprod L, Peppone LJ, Heckler CE, Yates JS, Reddy PS, Melnik M, Giguere JK, Morrow GR (2010) Effect of YOCAS yoga on sleep, fatigue, and quality of life: a URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. J Clin Oncol 28:15sGoogle Scholar
  36. 36.
    Jenkins V, Zammit C, Grant M, Rees D, Paine D, Langridge C, Fallowfield L (2010) Development of a structured yoga DVD for women following breast and axillary surgery. Eur J Cancer Suppl 8:80CrossRefGoogle Scholar
  37. 37.
    Haddad R, Chandwani K, Perkins G, Spelman A, Johnson K, Fortier A, Nagendra HR, Nagarathna R, Raghuram NV, Arun B, Wei Q, Kirschbaum C, Cohen L (2011) Randomized, controlled trial of yoga for women with breast cancer undergoing radiotherapy. Psychosom Med 73:A119–A120Google Scholar
  38. 38.
    Isabell UB, Maja R (2010) Yoga supports physical and mental well-being after breast cancer surgery. J Psychosom Obst Gyn 31:0167–482XGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical SchoolUniversity of SussexBrightonUK

Personalised recommendations