Yoga is often recommended for stress reduction, to support a healthy range of motion, and as a tool for emotional self-regulation. Are these just unproven claims or facts that can be measured and are relevant in clinical practice? The following is a review of studies that have been conducted on the effects of yoga on breast cancer patients.
Yoga reduces stress, anxiety, depression, and improves the quality of sleep and range of motion in cancer patients. Randomized controlled trials (RCTs) of yoga interventions conducted with patients both while undergoing and after completing cancer treatment returned promising results and lead to yoga being introduced in many Cancer Centers all around the United States to support symptom management in oncology. (Danhauer, 2019, p. 125)
Yoga improves cancer-related fatigue. Numerous studies that measured the effects of yoga during or after cancer treatment reported improvements of fatigue, quality of sleep, and cognition. (Danhauer 2019, p. 125)
One study published by SAGE Journals, states that “[c]ognitive behavioral therapy for insomnia, mindfulness, and yoga are 3 behavioral health interventions that have been recommended in the treatment of sleep disturbance in patients with cancer. Depending on cancer disease severity, nonpharmacologic approaches may be more beneficial because efficacy appears to be similar to pharmacological approaches, patients can continue to implement behavioral strategies long after active treatment has ended, and there are fewer adverse effects.” (Zeichner et al., 2017)
Yoga reduces pain and swelling from lymphedema. The journal Complementary Therapies in Clinical Practice published results of a study conducted in 2018, which looked at yoga as a pain management tool in breast cancer patients suffering from post-surgery lymphedema in their arms. The yoga group reported a significant and lasting reduction of pain in both shoulders and arms. (Eyigor et al., 2018, pp. 40-45)
Yoga significantly reduces musculoskeletal pain in breast cancer survivors on aromatase blockers (Peppone et al., 2015, pp. 597-604).
Yoga improves range of motion post-treatment. 20 women completed an 8-week intervention, practicing yoga twice per week, and reported significantly improved range of motion in their shoulders, as well as grip strength and elbow flexion. (Mazor et al., 2018., pp. 154-160)
Another study published in 2019 concluded that yoga reduces lymphatic swelling and fibrotic change of joint and muscle tissues better than clinical routine care, and improves quality of life significanty. (Wei et al., 2019, pp. 49-50)
Yoga reverses the negative effects of chemotherapy and radiation on brain health. One study about cancer-related toxicities summarizes, “[…] low-intensity forms of yoga, specifically gentle hatha and restorative, are feasible, safe, and effective for treating sleep disruption, cancer-related fatigue, cognitive impairment, psychosocial distress, and musculoskeletal symptoms in cancer patients receiving chemotherapy and radiation and cancer survivors.” (Lin et al, 2018, p. 5)
And the researchers continue, “yoga may improve sleep disruption and lower cancer related fatigue, reduce cognitive impairment, decrease psychological distress, and decrease musculoskeletal symptoms among cancer patients and survivors during and after cancer treatments. Clinicians should consider prescribing yoga for their patients suffering with these toxicities by referring them to yoga professionals who are qualified to work with cancer patients and survivors.” (Lin et al., 2018, p. 5)
The Clinical Practice Guidelines compiled by the ESMO Guidelines Committee and published in the Annals of Oncology, also recommend yoga as an option to improve cancer-related fatigue. (Fabi et al., 2020, pp. 713-723)
Yoga resets the HPA-axis and improves cortisol patterns. Abnormal circadian rhythms, primarily a flattened cortisol awakening response, have been observed in cancer patients. That means that a woman does not produce sufficient cortisol upon waking the morning. In 2000, a study conducted by researchers from the University of Louisville School of Medicine, published in the Journal of the National Cancer Institute, found that the morning cortisol curve is a marker to predict survival. (Sephton et al., 2000, pp. 994-1000) The effect of a low cortisol awakening response (CAR) does not play out immediately following cancer treatment but becomes relevant 5 to 7 years later. “We found that patients who had abnormal cortisol patterns died significantly sooner,” one researcher said. “There was no relationship in the first year. It’s only down the road that it occurs. It’s as if we’re tapping into some physiologic system that is a marker for rapid tumor growth.” (Sephton, 2000)
Flattened cortisol curves are also linked to reduced immune function, specifically low counts and suppressed activity of NK cells. NK cell count is a secondary predictor of survival. Yoga reduces stress, helps reset the HPA-axis and cortisol levels, and improves natural killer (NK) cell counts (Rao et al., 2017, pp. 253–260).
Linked to stress is disrupted sleep. Frequently not sleeping through the night disrupts cortisol patterns and also suppresses the normal production of melatonin, which is associated with increased breast cancer risk due to increased estrogen output (Davis, 2001, pp. 1557-1562). And again, yoga helps to improve the quality of sleep and melatonin production.
Yoga improves Heart Rate Variability (HRV) and reduces inflammation. A Korean study found that in cancer patients experiencing severe, prolonged fatigue after treatment, the hs-CRP levels are significantly increased while their HRV-index is reduced (Park et al., 2019, pp. 71-79). Randomized trials found that an 8-week Hatha yoga program reduced serum concentrations of inflammation markers, specifically IL-6 and hs-CRP, more effectively than standard medical treatment (Pullen-Seffens et al., 2008, pp. 407-412; Nugent, 2019, pp. 1-10). Mindfulness-based stress reduction (which includes gentle yoga postures), as well as yogic meditation, have been shown to reduce inflammatory signaling through the pro-inflammatory NF-κB control pathway (Bower et al., 2014, pp. 20-29).
Yoga reduces stress. Many breast cancer patients state that stress and emotional trauma contributed to their illness. It has been demonstrated that stress affects tumor emergence, progression, and metastasis (Garland et al., 1999, p. 113). Dysregulation of the circadian cortisol rhythm and increased inflammation often coincide with long-term stress. In a 12-week intervention, breast cancer patients were practicing restorative Iyengar yoga, which resulted in significantly decreased inflammation-related gene expression and circulating markers of proinflammatory cytokine activity. (Bower et al., 2014, pp. 20–29)
Yoga is an important part of Integrative Medicine Programs. The Society for Integrative Oncology’s (SIO) published Clinical Practice Guidelines on the Evidence-Based Use of Integrative Therapies During and After Breast Cancer Treatment. These guidelines have been endorsed by the American Society for Clinical Oncology (ASCO) (Lyman et al., 2018; Greenlee et al., 2017, pp. 194–232).
Most of the listed modalities are offered at MANYA Whole Health & Yoga.
Use of Integrative Therapies During and After Breast Cancer Treatment as Recommended by the Society for Integrative Oncology (SIO)
| Anxiety/ Stress reduction | Chemo- therapy- induced nausea | Depression | Fatigue | Pain | Quality of Life (QoL) | Sleep distur-bance | Vaso-motor hot flashes |
| Meditation | Acupressure | Meditation | Hypnosis | Acupuncture | Meditation | Gentle yoga | Acupuncture |
| Yoga | Electroacu-puncture | Yoga | Ginseng | Reiki | Yoga | ||
| Ginger | Massage | Acupuncture | Hypnosis | Acupuncture | |||
| Music / Sound therapy | Yoga | Music / Sound therapy | Mistletoe, Reflexology Qigong |
References:
Bower, J. E., Greendale, G., Crosswell, A. D., Garet, D., Sternlieb, B., Ganz, P. A., Irwin, M. R., Olmstead, R., Arevalo, J., & Cole, S. W. (2014, May). Yoga reduces inflammatory signaling in fatigued breast cancer survivors: a randomized controlled trial. Psychoneuroendocrinology. 43, pp. 20-29. https://doi.org/10.1016/j.psyneuen.2014.01.019
Chida, Y., Hamer, M., Wardle, J., & Steptoe, A. (2008). Do stress-related psychosocial factors contribute to cancer incidence and survival? Natural Clinical Practice Oncology. 5, pp. 466-475.
Danhauer, S. C., Addington, E. L., Cohen, L., Sohl, S. J., Van Puymbroeck, M., Albinati, N. K. and Culos-Reed, S. N. (2019). Yoga for symptom management in oncology: A review of the evidence base and future directions for research. Cancer. 125, pp. 1979-1989. https://doi.org/10.1002/cncr.31979
Davis, S., Mirick, D. K., Stevens, R.G. (2001, October 17). Night shift work, light at night, and risk of breast cancer. J Natl Cancer Inst. 93(20), pp. 1557-1562. https://doi.org/10.1093/jnci/93.20.1557
Eyigor, S., Uslu, R., Apaydın, S., Caramat, I., & Yesil, H. (2018, August). Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial. Complement Ther Clin Pract. 32, pp. 40-45. https://doi.org/10.1016/j.ctcp.2018.04.010
Fabi, A., Bhargava, R., Fatigoni, S., Jordan, K., Ripamonti, C.I. et al. (2020, June 1). On behalf of the ESMO Guidelines Committee. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Annals of Oncology. 31(6), pp. 713-723. https://doi.org/10.1016/j.annonc.2020.02.016
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Greenlee, H., DuPont-Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G.,Johnson, J., Mumber, M. Seely, D., Zick, S. M., Boyce, L. M., & Tripathy, D. (2017). Clinical Practice Guidelines on the Evidence-Based Use of Integrative Therapies During and After Breast CancerTreatment, Ca Cancer J Clin. 67, pp. 194–232. Retrieved from http://onlinelibrary.wiley.com/doi/10.3322/caac.21397/epdf
Lin, P. J., Peppone, L. J., Janelsins, M. C. et al. (2018). Yoga for the Management of Cancer Treatment-Related Toxicities. Curr Oncol Rep. 20(5). https://doi.org/10.1007/s11912-018-0657-2
Lyman, G. H., Bohlke, K., & Cohen, L. (2018, August). Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline Summary. J Oncol Pract. 14(8), pp. 495-499. https://doi.org/10.1200/JOP.18.00283
Mazor, M., Lee, J. Q., Peled, A., Zerzan, S., Irwin, C., Chesney, M. A., Serrurier, K., Sbitany, H., Dhruva, A., Sacks, D., & Smoot, B. (2018, February). The Effect of Yoga on Arm Volume, Strength, and Range of Motion in Women at Risk for Breast Cancer-Related Lymphedema. J Altern Complement Med. 24(2), pp. 154-160. https://doi.org/10.1089/acm.2017.0145
Nugent, N., Brick, L., Armey, M., Tyrka, A., Ridout, K., & Uebelacker, L. (2019). Benefits of Yoga on IL-6: Findings from a Randomized Controlled Trial of Yoga for Depression. Behavioral Medicine. 47, pp. 1-10. https://doi.org/10.1080/08964289.2019.1604489
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