Skip to main content

Advertisement

Log in

Review of yoga therapy during cancer treatment

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Reviews of yoga research that distinguish results of trials conducted during (versus after) cancer treatment are needed to guide future research and clinical practice. We therefore conducted a review of non-randomized studies and randomized controlled trials of yoga interventions for children and adults undergoing treatment for any cancer type.

Methods

Studies were identified via research databases and reference lists. Inclusion criteria were the following: (1) children or adults undergoing cancer treatment, (2) intervention stated as yoga or component of yoga, and (3) publication in English in peer-reviewed journals through October 2015. Exclusion criteria were the following: (1) samples receiving hormone therapy only, (2) interventions involving meditation only, and (3) yoga delivered within broader cancer recovery or mindfulness-based stress reduction programs.

Results

Results of non-randomized (adult n = 8, pediatric n = 4) and randomized controlled trials (adult n = 13, pediatric n = 0) conducted during cancer treatment are summarized separately by age group. Findings most consistently support improvement in psychological outcomes (e.g., depression, distress, anxiety). Several studies also found that yoga enhanced quality of life, though further investigation is needed to clarify domain-specific efficacy (e.g., physical, social, cancer-specific). Regarding physical and biomedical outcomes, evidence increasingly suggests that yoga ameliorates sleep and fatigue; additional research is needed to advance preliminary findings for other treatment sequelae and stress/immunity biomarkers.

Conclusions

Among adults undergoing cancer treatment, evidence supports recommending yoga for improving psychological outcomes, with potential for also improving physical symptoms. Evidence is insufficient to evaluate the efficacy of yoga in pediatric oncology. We describe suggestions for strengthening yoga research methodology to inform clinical practice guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. WHO (2015) Fact sheet No. 297: Cancer. Retrieved from: http://www.who.int/mediacentre/factsheets/fs297/en/

  2. Thomson CA, McCullough ML et al (2014) Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the Women's Health Initiative. Cancer Prev Res 7:42–53. doi:10.1158/1940-6207.CAPR-13-0258

    Article  Google Scholar 

  3. Vergnaud AC, Romaguera D et al (2013) Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European prospective investigation into nutrition and cancer cohort study1,4. Am J Clin Nutr 97:1107–1120. doi:10.3945/ajcn.112.049569

    Article  CAS  PubMed  Google Scholar 

  4. Lutgendorf SK, Sood AK (2011) Biobehavioral factors and cancer progression: physiological pathways and mechanisms. Psychosom Med 73:724–730. doi:10.1097/PSY.0b013e318235be76

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thaker PH, Han LY et al (2006) Chronic stress promotes tumor growth and angiogenesis in a mouse model of ovarian carcinoma. Nat Med 12:939–944. doi:10.1038/nm1447

    Article  CAS  PubMed  Google Scholar 

  6. Armaiz-Pena GN, Cole SW et al (2013) Neuroendocrine influences on cancer progression. Brain Behav Immun 30:S19–S25. doi:10.1016/j.bbi.2012.06.005

    Article  CAS  PubMed  Google Scholar 

  7. 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(1):E7–E15. doi:10.1188/10.ONF.E7-E15

    Article  PubMed  Google Scholar 

  8. Mao JJ, Palmer CS et al (2011) Complementary and alternative medicine use among cancer survivors: a population-based study. J Cancer Surviv 5:8–17. doi:10.1007/s11764-010-0153-7

    Article  PubMed  Google Scholar 

  9. van Uden-Kraan CF, Chinapaw MJ et al (2013) Cancer patients' experiences with and perceived outcomes of yoga: results from focus groups. Support Care Cancer 21:1861–1870. doi:10.1007/s00520-013-1728-4

    Article  PubMed  Google Scholar 

  10. Chrousos GP, Gold PW (1992) The concepts of stress and stress system disorders: overview of physical and behavioral homeostasis. JAMA 267:1244–1252

    Article  CAS  Google Scholar 

  11. Bower JE, Lamkin DM (2013) Inflammation and cancer-related fatigue: mechanisms, contributing factors, and treatment implications. Brain Behav Immun 30:S48–S57. doi:10.1016/j.bbi.2012.06.011

    Article  CAS  PubMed  Google Scholar 

  12. Epel ES, Blackburn EH et al (2004) Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A 101:17312–17315. doi:10.1073/pnas.0407162101

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Wu Y, Antony S et al (2014) Molecular mechanisms underlying chronic inflammation-associated cancers. Cancer Lett 345:164–173. doi:10.1016/j.canlet.2013.08.014

    Article  CAS  PubMed  Google Scholar 

  14. Satin JR, Linden W et al (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115:5349–5361. doi:10.1002/cncr.24561

    Article  CAS  PubMed  Google Scholar 

  15. Kiecolt-Glaser JK, Bennett JM et al (2014) Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol 32:1040–1049. doi:10.1200/JCO.2013.51.8860

    Article  PubMed  PubMed Central  Google Scholar 

  16. Buffart LM, van Uffelen JG et al (2012) Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 12:559. doi:10.1186/1471-2407-12-559

    Article  PubMed  PubMed Central  Google Scholar 

  17. Harder H, Parlour L et al (2012) Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review. Support Care Cancer 20:3055–3064. doi:10.1007/s00520-012-1611-8

    Article  CAS  PubMed  Google Scholar 

  18. Lin KY, Hu YT et al (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 Retrieved from PM:21437197

    Article  Google Scholar 

  19. Cramer H, Lange S et al (2012) Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer 12:412. doi:10.1186/1471-2407-12-412

    Article  PubMed  PubMed Central  Google Scholar 

  20. Speed-Andrews AE, Stevinson C et al (2012) Predictors of adherence to an Iyengar yoga program in breast cancer survivors. Int J Yoga 5:3–9 http://doi.org/10.4103/0973-6131.91693

    Article  Google Scholar 

  21. Carson JW, Carson KM et al (2007) Yoga for women with metastatic breast cancer: results from a pilot study. J Pain Symptom Manag 33:331–341. doi:10.1016/j.jpainsymman.2006.08.009

    Article  Google Scholar 

  22. Danhauer SC, Tooze JA et al (2008) Restorative yoga for women with ovarian or breast cancer: findings from a pilot study. J Soc Integr Oncol 6(2):47–58

    PubMed  Google Scholar 

  23. Duncan MD, Leis A et al (2008) Impact and outcomes of an Iyengar yoga program in a cancer centre. Curr Oncol 15:s109–s108

    Article  Google Scholar 

  24. Galantino ML, Greene L et al (2012) Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with early stage breast cancer: a case series. Explore-NY 8:127–135. doi:10.1016/j.explore.2011.12.001

    Article  PubMed  Google Scholar 

  25. Kumar A, Balkrishna A (2009) To study the effect of the sequence of seven pranayama by Swami Ramdev on gene expression in leukaemia patients and rapid interpretation of gene expression. J Clin Path 62:1052–1053

    Article  CAS  Google Scholar 

  26. McCall M, McDonald M et al (2015) Yoga for health-related quality of life in adult cancer: a randomized controlled feasibility study. Evid Based Compl Alt:816–820. doi:10.1155/2015/816820

    Article  Google Scholar 

  27. Milbury K, Chaoul A et al (2014) Couple-based Tibetan yoga program for lung cancer patients and their caregivers. Psycho-Oncology. doi:10.1002/pon.3588

    Article  PubMed  PubMed Central  Google Scholar 

  28. Milbury K, Mallaiah S et al (2015) Vivekananda yoga program for patients with advanced lung cancer and their family caregivers. Integr Cancer Ther 14(5):446–451

    Article  CAS  Google Scholar 

  29. Sohl SJ, Danhauer SC et al (2012) Feasibility of a brief yoga intervention during chemotherapy for persistent or recurrent ovarian cancer. Explore-NY 8:197–198. doi:10.1016/j.explore.2012.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cohen J (1992) A power primer. Psychol Bull 112:155–159

    Article  CAS  Google Scholar 

  31. Culos-Reed SN, Mackenzie MJ et al (2012) Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors. Evid-Based Compl Alt. doi:10.1155/2012/642576

    Article  Google Scholar 

  32. Diorio C, Schechter T et al (2015) A pilot study to evaluate the feasibility of individualized yoga for inpatient children receiving intensive chemotherapy. BMC Complement Altern Med 15(1):19–30

    Article  Google Scholar 

  33. Geyer R, Lyons A et al (2011) Feasibility study: the effect of therapeutic yoga on quality of life in children hospitalized with cancer. Pediatr Phys Ther 23:375–379. doi:10.1097/PEP.0b013e318235628c

    Article  PubMed  Google Scholar 

  34. Thygeson MV, Hooke MC et al (2010) Peaceful play yoga: serenity and balance for children with cancer and their parents. J Pediatr Oncol Nurs 27(5):276–284. doi:10.1177/1043454210363478

    Article  PubMed  Google Scholar 

  35. Wurz A, Chamorro-Vina C et al (2014) The feasibility and benefits of a 12-week yoga intervention for pediatric cancer out-patients. Pediatr Blood Cancer. doi:10.1002/pbc.25096

    Article  PubMed  Google Scholar 

  36. Archer S, Phillips E et al (2015) “I’m 100% for it! I’m a convert!”: Women's experiences of a yoga programme during treatment for gynaecological cancer; an interpretative phenomenological analysis. Complement Ther Med 23(1):55–62

    Article  CAS  Google Scholar 

  37. Archer S, Forshaw MJ (2015) Using a randomised controlled trial (RCT) methodology in CAM research with gynaecological cancer patients: a commentary on the perks and pitfalls. Complement Ther Clin Pract 21(1):11–18

    Article  Google Scholar 

  38. Banerjee B, Vadiraj HS 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

    Article  PubMed  Google Scholar 

  39. Chakrabarty J, Vidyasagar M et al (2015) Effectiveness of pranayama on cancer-related fatigue in breast cancer patients undergoing radiation therapy: a randomized controlled trial. Int J Yoga 8(1):47–53. doi:10.4103/0973-6131.146062

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chandwani KD, Thornton B et al (2010) Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 8(2):43–55

    PubMed  Google Scholar 

  41. Cohen L, Warneke C et al (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. doi:10.1002/cncr.20236

    Article  PubMed  Google Scholar 

  42. Danhauer SC, Mihalko SL et al (2009) Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psycho-Oncol 18:360–368. doi:10.1002/pon.1503

    Article  Google Scholar 

  43. Dhruva A, Miaskowski C (2012) Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial. J Altern Complement Med 18:473–479. doi:10.1089/acm.2011.0555

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kovacic T, Kovacic M (2011b) Impact of relaxation training according to yoga in daily life(R) system on self-esteem after breast cancer surgery. J Altern Complement Med 17:1157–1164. doi:10.1089/acm.2010.0653

    Article  PubMed  Google Scholar 

  45. Kovacic T, Kovacic M (2011a) 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. doi:10.1177/1534735410387418

    Article  PubMed  Google Scholar 

  46. Kovacic T, Zagoricnik M et al (2013) Impact of relaxation training according to the yoga in daily life(R) system on anxiety after breast cancer surgery. J Complement Integr Med 10. doi:10.1515/jcim-2012-0009 [doi];/j/jcim.2013.10.issue-1/jcim-2012-0009/jcim-2012-0009.xml

  47. Moadel AB, Shah C 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

    Article  PubMed  Google Scholar 

  48. Raghavendra RM, Nagarathna R et al (2007) Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care 16:462–474. doi:10.1111/j.1365-2354.2006.00739.x

    Article  CAS  Google Scholar 

  49. Rao MR, Raghuram N 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. doi:10.1016/j.ctim.2008.05.005

    Article  PubMed  Google Scholar 

  50. Rao RM, Telles S et al (2008c) Effects of yoga on natural killer cell counts in early breast cancer patients undergoing conventional treatment. Comment to: recreational music-making modulates natural killer cell activity, cytokines, and mood states in corporate employees Masatada Wachi, Masahiro Koyama, Masanori Utsuyama, Barry B. Bittman, Masanobu Kitagawa, Katsuiku Hirokawa med Sci Monit, 2007. Med Sci Monit Basic Res 13(2):CR57–CR70 LE3-LE4. doi:734742

    Google Scholar 

  51. Rao RM, Nagendra HR et al (2008a) Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery. Int J Yoga 1:11–20. doi:10.4103/0973-6131.36789 [doi];IJY-01-11

    Article  PubMed  PubMed Central  Google Scholar 

  52. Rao RM, Nagendra HR et al (2008b) Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Int J Yoga 1:33–41. doi:10.4103/0973-6131.36795 [doi];IJY-01-33

    Article  PubMed  PubMed Central  Google Scholar 

  53. Rao R, Raghuram N et al (2015) Effects of an integrated yoga program on self-reported depression scores in breast cancer patients undergoing conventional treatment: a randomized controlled trial. Indian J Palliat Care 21(2):174–181

    Article  Google Scholar 

  54. Vadiraja HS, Raghavendra RM 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. doi:10.1177/1534735409331456

    Article  CAS  PubMed  Google Scholar 

  55. Vadiraja HS, Rao MR 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. doi:10.1016/j.ctim.2009.06.004

    Article  CAS  PubMed  Google Scholar 

  56. Vadiraja SH, Rao MR et al (2009c) Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. Int J Yoga 2:73–79. doi:10.4103/0973-6131.60048

    Article  PubMed  PubMed Central  Google Scholar 

  57. Taso CJ, Lin HS et al (2014) The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: a randomized controlled trial. J Nurs Res 22:155–164. doi:10.1097/jnr.0000000000000044 [doi];00134372-201409000-00004

    Article  PubMed  Google Scholar 

  58. Chandwani KD, Perkins G et al (2014) Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. J Clin Oncol 32:1058–1065. doi:10.1200/JCO.2012.48.2752

    Article  PubMed  PubMed Central  Google Scholar 

  59. Cohen L, Cole SW et al (2012) Depressive symptoms and cortisol rhythmicity predict survival in patients with renal cell carcinoma: role of inflammatory signaling. PLoS One 7:e42324. doi:10.1371/journal.pone.0042324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Sephton SE, Sapolsky RM et al (2000) Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 92:994–1000

    Article  CAS  Google Scholar 

  61. Greenlee H, Balneaves LG et al (2014) Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 50:346–358. doi:10.1093/jncimonographs/lgu041

    Article  Google Scholar 

  62. Sherman KJ (2012) Guidelines for developing yoga interventions for randomized trials. Evid-Based Compl Alt. doi:10.1155/2012/143271

    Article  Google Scholar 

  63. MacPherson H, Altman DG et al (2010) Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. Acupunct Med 28:83–93. doi:10.1136/aim.2009.001370

    Article  PubMed  PubMed Central  Google Scholar 

  64. Jacobsen PB, Muchnick S et al (2015) Pilot study of Iyengar yoga for management of aromatase inhibitor-associated arthralgia in women with breast cancer. Psycho-Oncology 24(11):1578–1580. doi:10.1002/pon.3756

    Article  PubMed  PubMed Central  Google Scholar 

  65. Wang C, Schmid CH et al (2010) A randomized trial of tai Chi for fibromyalgia. N Engl J Med 363:743–754. doi:10.1056/NEJMoa0912611

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Kligler B, Homel P (2011) Cost savings in inpatient oncology through an integrative medicine approach. Am J Manag Care 17:779–784 doi:53468

    PubMed  Google Scholar 

  67. Andersen BL, Yang HC et al (2008) Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113:3450–3458. doi:10.1002/cncr.23969

    Article  PubMed  PubMed Central  Google Scholar 

  68. Ornish D, Weidner G et al (2005) Intensive lifestyle changes may affect the progression of prostate cancer. J Urol 174:1065–1069. doi:10.1097/01.ju.0000169487.49018.73

    Article  PubMed  Google Scholar 

  69. Giese-Davis J, Collie K et al (2011) Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol 29:413–420. doi:10.1200/JCO.2010.28.4455

    Article  PubMed  Google Scholar 

  70. Danhauer SC, Addington EL et al (2015) Evidence supports incorporating yoga alongside conventional cancer treatment for women with breast cancer. Breast Dis 26:189–193. doi:10.1016/j.breastdis.2015.07.036

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Addington is currently supported by NIH/NCI training grant CA193193 at Northwestern University Feinberg School of Medicine. Partial support for Dr. Cohen was provided by the Richard E. Haynes Distinguished Professorship in Clinical Cancer Prevention. Dr. Sohl was supported by the National Center For Complementary & Integrative Health of the National Institutes of Health under Award Number K01AT008219. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Suzanne C. Danhauer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Note: An earlier version of this manuscript was published in 2016 as a chapter in The Principles and Practice of Yoga in Health Care by Handspring Publishing Limited.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Danhauer, S.C., Addington, E.L., Sohl, S.J. et al. Review of yoga therapy during cancer treatment. Support Care Cancer 25, 1357–1372 (2017). https://doi.org/10.1007/s00520-016-3556-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3556-9

Keywords

Navigation