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Most cancer patients experience some level of cancer-related fatigue (CRF) during treatments. Approximately one third of them will continue to experience moderate to severe CRF as survivors for months and years after treatment. The experience of CRF is a “distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning” (1). Fatigue generally presents in symptom clusters that include sleep disturbance, pain and distress and negatively affect survivors’ recovery by impairing physical and mental function, interfering with recovery and resumption of normal life activities and reducing overall survival (2).
Yoga therapy, a relatively new, evidence-based therapeutic discipline of clinical application of yoga in medicine, aims to help cancer patients find relief from a spectrum of symptoms, including fatigue. Yoga therapists provide individual and group sessions after completing pertinent patient assessments. Personalized protocols are designed specific to the patient’s cancer history, chief complaints and everyday challenges she/he may experience. The main goals are to help mitigate side effects of cancer or cancer treatments and to enhance health and wellness in general.
The compelling evidence supports the use of yoga therapy. For example, in a 2019 nationwide, multicenter, phase III randomized clinical trial (RCT) conducted by Lin and colleagues, yoga therapy’s effect on fatigue in cancer survivors (N=410) was evaluated. The results of the study showed that the patients randomized into yoga therapeutic intervention demonstrated significantly greater improvements in CRF compared with participants in the usual survivorship care at post-intervention. This 22% to 37% improvement in CRF of the ‘yoga therapy for cancer survivor’ participants was also associated with improved sleep quality and decreased daytime dysfunction (e.g., excessive napping).
Another, more recent RCT (N= 173) of breast cancer survivors, also demonstrated that yoga therapy is useful to reduce cancer-related fatigue, along with decreased depression and improved quality of life (3). It is, therefore, not surprising that The Society for Integrative Oncology guidelines for integrative therapies during and after breast cancer include mind-body practices, such as yoga. These guidelines were endorsed by the American Society of Clinical Oncology (4). In addition, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for management of CRF and distress include yoga therapy as an effective intervention for managing these symptoms in oncology patients (e.g., Level 1 evidence) (5).
Yoga is an ancient system of healing that includes using postures to stretch and breath in unison, and other mindfulness techniques, such as meditation. Modern, high-tech approaches demonstrated that these age-tested techniques help manage internal and external stressors and emotional responses, which ultimately could help change behaviors in a positive way. Often patients say they value the feeling of control that yoga provides, and that this counteracts the hopelessness they may feel when confronting the adversities of cancer.
At UC Health, Yoga Therapy in cancer treatment doesn’t look quite like a typical yoga session where the physical postures are the focus. Instead, yoga therapy interventions include breathing practices connected with gentle movements, guided imagery, and a deep relaxation practice called Yoga Nidra (which means ‘sleep with awareness’ in Sanskrit). Because of its adaptability, yoga fits well within the comprehensive cancer exercise programs and represents a good choice for a patient whose stamina is too low to engage in a more intense physical activity.
Therapeutic yoga interventions reach beyond the physical (e.g., gentle movement-based practices to help improve stiffness from the treatments or help mitigate lymphedema) and address the whole person, including emotional (e.g., stress relief in the face of a cancer diagnosis or anxiety prior to a surgery) and cognitive (e.g., managing habitual patterns of thought associated with fear of cancer recurrence) domains, among others.
The high-quality evidence from RCTs and national guidelines for CRF treatments support yoga as a therapeutic option to help improve physical and psychosocial symptoms in cancer patients, including CRF and thus the overall quality of life. For additional information on virtual yoga therapy classes or registration information, please, call the Center for Integrative Health and Wellness at 513-475-9567 or visithttps://www.uchealth.com/wp-content/uploads/sites/57/2020/12/Yoga-For-Cancer-Class-Flyer-Updated-08DEC20.pdf
1. National Comprehensive Cancer Network [NCCN], 2018.
2. Lin, P., Kleckner, I.R., Loh, K.P., Inglis, J.E., Peppone, L.J., Janelsins, M.C., Mustian, K.M. (2019). Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors. Integrative Cancer Therapies, 18:1-11.
3. Teresa Zetzl & Agnes Renner & Andre Pittig & Elisabeth Jentschke & Carmen Roch & Birgitt van Oorschot. Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer. Supportive Care in Cancer (2021) 29:2973–2982.
4. Lyman, G.H., Greenlee, H., Bohlke, K., Bao, T., DeMichele, A.M., Deng, G.E., Cohen, L. (2018). Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. Journal of Clinical Oncology, 36 (25):2647-2651.
5. National Comprehensive Cancer Network (2021). NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue (version 1.2021).
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