Yoga Protocol for Cancer Patients: A Systematic Exploration of Psychophysiological Benefits

Author(s): Mara Mirandola*, Miguel David Sabogal Rueda, Federica Andreis, Fausto Meriggi, Claudio Codignola, Elena Gadaldi, Tiziana Prochilo, Michela Libertini, Brunella Di Biasi, Chiara Abeni, Silvia Noventa, Luigina Rota, Chiara Ogliosi, Alberto Zaniboni.

Journal Name: Reviews on Recent Clinical Trials

Volume 14 , Issue 4 , 2019

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Abstract:

Background: Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the “Yoga in Oncology” project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer.

Methods: Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index.

Results: Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep.

Conclusion: It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients’ behavior.

Keywords: Anxiety, cancer, depression, fatigue, sleep quality, yoga.

[1]
Koula MJ, Knight JM. Increasing provider awareness of and recommendations for yoga and meditation classes for cancer patients. Support Care Cancer 2018; 26(10): 3635-40.
[http://dx.doi.org/10.1007/s00520-018-4220-3] [PMID: 29728846]
[2]
Lin PJ, Peppone LJ, Janelsins MC, et al. Yoga for the management of cancer treatment-related toxicities. Curr Oncol Rep 2018; 20(1): 5.
[http://dx.doi.org/10.1007/s11912-018-0657-2] [PMID: 29388071]
[3]
Lopez G, Chaoul A, Powers-James C, et al. Group yoga effects on cancer patient and caregiver symptom distress: Assessment of self-reported symptoms at a comprehensive cancer center. Integr Cancer Ther 2018; 17(4): 1087-94.
[http://dx.doi.org/10.1177/1534735418795301] [PMID: 30168358]
[4]
Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer Cochrane Database Syst Rev 2017; 1CD010802
[http://dx.doi.org/10.1002/14651858.CD010802.pub2] [PMID: 28045199]
[5]
Fillion L, Gagnon P, Leblond F, et al. A brief intervention for fatigue management in breast cancer survivors. Cancer Nurs 2008; 31(2): 145-59.
[http://dx.doi.org/10.1097/01.NCC.0000305698.97625.95] [PMID: 18490891]
[6]
Herzog TJ, Wright JD. The impact of cervical cancer on quality of life--the components and means for management. Gynecol Oncol 2007; 107(3): 572-7.
[http://dx.doi.org/10.1016/j.ygyno.2007.09.019] [PMID: 17963826]
[7]
Danhauer SC, Addington EL, Sohl SJ, Chaoul A, Cohen L. Review of yoga therapy during cancer treatment. Support Care Cancer 2017; 25(4): 1357-72.
[http://dx.doi.org/10.1007/s00520-016-3556-9] [PMID: 28064385]
[8]
Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol 2013; 31(26): 3233-41.
[http://dx.doi.org/10.1200/JCO.2012.43.7707] [PMID: 23940231]
[9]
Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017; 67(3): 194-232.
[http://dx.doi.org/10.3322/caac.21397] [PMID: 28436999]
[10]
Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004; 100(10): 2253-60.
[http://dx.doi.org/10.1002/cncr.20236] [PMID: 15139072]
[11]
Chaoul A, Milbury K, Sood AK, Prinsloo S, Cohen L. Mind-body practices in cancer care. Curr Oncol Rep 2014; 16(12): 417.
[http://dx.doi.org/10.1007/s11912-014-0417-x] [PMID: 25325936]
[12]
Milbury K, Mallaiah S, Lopez G, et al. Vivekananda Yoga program for patients with advanced lung cancer and their family caregivers. Integr Cancer Ther 2015; 14(5): 446-51.
[http://dx.doi.org/10.1177/1534735415583554] [PMID: 25917816]
[13]
Milbury K, Mallaiah S, Lopez G, et al. Vivekananda Yoga program for patients with advanced lung cancer and their family caregivers. J Aust Tradit-Med Soc 2017; 23(1): 46.
[14]
Lin PJ, Peppone LJ, Janelsins MC, et al. Yoga for the management of cancer treatment-related toxicities. Curr Oncol Rep 2018; 20(1): 5.
[http://dx.doi.org/10.1007/s11912-018-0657-2] [PMID: 29388071]
[15]
Lin PJ, Peppone LJ, Janelsins MC, et al. Yoga for the management of cancer treatment-related toxicities. Curr Oncol Rep 2018; 20(1): 5.
[http://dx.doi.org/10.1007/s11912-018-0657-2] [PMID: 29388071]
[16]
Antoni MH, Wimberly SR, Lechner SC, et al. Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry 2006; 163(10): 1791-7.
[http://dx.doi.org/10.1176/ajp.2006.163.10.1791] [PMID: 17012691]
[17]
Pinquart M, Duberstein PR. Depression and cancer mortality: A meta-analysis. Psychol Med 2010; 40(11): 1797-810.
[http://dx.doi.org/10.1017/S0033291709992285] [PMID: 20085667]
[18]
Kissane DW, Maj M, Sartorius N, Eds. Depression and cancer. John Wiley & Sons 2011; Vol. 19.
[19]
Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: A secondary analysis. J Clin Oncol 2011; 29(4): 413-20.
[http://dx.doi.org/10.1200/JCO.2010.28.4455] [PMID: 21149651]
[20]
Kanani R, Davies EA, Hanchett N, Jack RH. The association of mood disorders with breast cancer survival: An investigation of linked cancer registration and hospital admission data for South East England. Psychooncology 2016; 25(1): 19-27.
[http://dx.doi.org/10.1002/pon.4037] [PMID: 26619290]
[21]
Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol 2008; 5(8): 466-75.
[http://dx.doi.org/10.1038/ncponc1134] [PMID: 18493231]
[22]
Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: A meta-analysis. Cancer 2009; 115(22): 5349-61.
[http://dx.doi.org/10.1002/cncr.24561] [PMID: 19753617]
[23]
Phillips KA, Osborne RH, Giles GG, et al. Psychosocial factors and survival of young women with breast cancer: A population-based prospective cohort study. J Clin Oncol 2008; 26(28): 4666-71.
[http://dx.doi.org/10.1200/JCO.2007.14.8718] [PMID: 18824713]
[24]
Spiegel D, Giese-Davis J. Depression and cancer: Mechanisms and disease progression. Biol Psychiatry 2003; 54(3): 269-82.
[http://dx.doi.org/10.1016/S0006-3223(03)00566-3] [PMID: 12893103]
[25]
Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. Lancet Oncol 2011; 12(2): 160-74.
[http://dx.doi.org/10.1016/S1470-2045(11)70002-X] [PMID: 21251875]
[26]
Antoni MH, Jacobs JM, Bouchard LC, et al. Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up. Gen Hosp Psychiatry 2017; 44: 16-21.
[http://dx.doi.org/10.1016/j.genhosppsych.2016.10.002] [PMID: 28041571]
[27]
Yang H, Brand JS, Fang F, et al. Time-dependent risk of depression, anxiety, and stress-related disorders in patients with invasive and in situ breast cancer. Int J Cancer 2017; 140(4): 841-52.
[http://dx.doi.org/10.1002/ijc.30514] [PMID: 27859142]
[28]
Rickham PP. Rickham. Human experimentation. Code of ethics of the world medical association. Declaration of Helsinki. BMJ 1964; 2(5402): 177-7.
[http://dx.doi.org/10.1136/bmj.2.5402.177] [PMID: 14150898]
[29]
Elkins G, Fisher W, Johnson A. Mind-body therapies in integrative oncology. Curr Treat Options Oncol 2010; 11(3-4): 128-40.
[http://dx.doi.org/10.1007/s11864-010-0129-x] [PMID: 21116746]
[30]
Moadel AB, Shah C, Wylie-Rosett J, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects on quality of life. J Clin Oncol 2007; 25(28): 4387-95.
[http://dx.doi.org/10.1200/JCO.2006.06.6027] [PMID: 17785709]
[31]
Bishop SR, Lau M, Shapiro S, et al. Mindfulness: A proposed operational definition. Clin Psychol Sci Pract 2004; 11: 230-41.
[http://dx.doi.org/10.1093/clipsy.bph077]
[32]
Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 2004; 72(1): 31-40.
[http://dx.doi.org/10.1037/0022-006X.72.1.31] [PMID: 14756612]
[33]
Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 2000; 68(4): 615-23.
[http://dx.doi.org/10.1037/0022-006X.68.4.615] [PMID: 10965637]
[34]
Uebelacker LA, Epstein-Lubow G, Gaudiano BA, Tremont G, Battle CL, Miller IW. Hatha yoga for depression: Critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract 2010; 16(1): 22-33.
[http://dx.doi.org/10.1097/01.pra.0000367775.88388.96] [PMID: 20098228]
[35]
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67(6): 361-70.
[http://dx.doi.org/10.1111/j.1600-0447.1983.tb09716.x] [PMID: 6880820]
[36]
Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28(2): 193-213.
[http://dx.doi.org/10.1016/0165-1781(89)90047-4] [PMID: 2748771]
[37]
Cole JC, Motivala SJ, Buysse DJ, Oxman MN, Levin MJ, Irwin MR. Validation of a 3-factor scoring model for the Pittsburgh sleep quality index in older adults. Sleep 2006; 29(1): 112-6.
[http://dx.doi.org/10.1093/sleep/29.1.112] [PMID: 16453989]
[38]
Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 1999; 85(5): 1186-96.
[http://dx.doi.org/10.1002/(SICI)1097-0142(19990301)85:5<1186: AID-CNCR24>3.0.CO;2-N] [PMID: 10091805]
[39]
Zhang Z. Univariate description and bivariate statistical inference: The first step delving into data. Ann Transl Med 2016; 4(5): 91.
[http://dx.doi.org/10.21037/atm.2016.02.11]
[40]
Catania G, Bell C, Ottonelli S, et al. Cancer-related fatigue in Italian cancer patients: Validation of the Italian version of the Brief Fatigue Inventory (BFI). Support Care Cancer 2013; 21(2): 413-9.
[http://dx.doi.org/10.1007/s00520-012-1539-z] [PMID: 22790224]
[41]
Yennurajalingam S, Tayjasanant S, Balachandran D, et al. Association between daytime activity, fatigue, sleep, anxiety, depression, and symptom burden in advanced cancer patients: A preliminary report. J Palliat Med 2016; 19(8): 849-56.
[http://dx.doi.org/10.1089/jpm.2015.0276] [PMID: 27148765]
[42]
Stagl JM, Antoni MH, Lechner SC, et al. Randomized controlled trial of cognitive behavioral stress management in breast cancer: A brief report of effects on 5-year depressive symptoms. Health Psychol 2015; 34(2): 176-80.
[http://dx.doi.org/10.1037/hea0000125] [PMID: 25068452]
[43]
Zhu L, Ranchor AV, Helgeson VS, et al. Benefit finding trajectories in cancer patients receiving psychological care: Predictors and relations to depressive and anxiety symptoms. Br J Health Psychol 2018; 23(2): 238-52.
[http://dx.doi.org/10.1111/bjhp.12283] [PMID: 29139593]
[44]
Park EM, Gelber S, Rosenberg SM, et al. Anxiety and depression in young women with metastatic breast cancer: A cross-sectional study. Psychosomatics 2018; 59(3): 251-8.
[http://dx.doi.org/10.1016/j.psym.2018.01.007] [PMID: 29525523]
[45]
Brown SL, Hope-Stone L, Heimann H, Damato B, Salmon P. Predictors of anxiety and depression 2 years following treatment in uveal melanoma survivors. Psychooncology 2018; 27(7): 1727-34.
[http://dx.doi.org/10.1002/pon.4715] [PMID: 29601654]
[46]
Nishiura M, Tamura A, Nagai H, Matsushima E. Assessment of sleep disturbance in lung cancer patients: Relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliat Support Care 2015; 13(3): 575-81.
[http://dx.doi.org/10.1017/S1478951513001119] [PMID: 24524428]
[47]
Eichler C, Pia M, Sibylle M, Sauerwald A, Friedrich W, Warm M. Cognitive behavioral therapy in breast cancer patients--a feasibility study of an 8 week intervention for tumor associated fatigue treatment. Asian Pac J Cancer Prev 2015; 16(3): 1063-7.
[http://dx.doi.org/10.7314/APJCP.2015.16.3.1063] [PMID: 25735332]
[48]
Van Vulpen JK, Velthuis MJ, Steins Bisschop CN, et al. Effects of an exercise program in colon cancer patients undergoing chemotherapy. Med Sci Sports Exerc 2016; 48(5): 767-75.
[http://dx.doi.org/10.1249/MSS.0000000000000855] [PMID: 26694846]
[49]
May AM, Hiensch AE, Witlox L, et al. Four-year effects of physical exercise during adjuvant treatment on fatigue and physical activity in breast and colon cancer patients. J Clin Oncol 2018; 36: 99.
[http://dx.doi.org/10.1200/JCO.2018.36.7_suppl.99]
[50]
Otte JL, Carpenter JS, Manchanda S, et al. Systematic review of sleep disorders in cancer patients: Can the prevalence of sleep disorders be ascertained? Cancer Med 2015; 4(2): 183-200.
[http://dx.doi.org/10.1002/cam4.356] [PMID: 25449319]
[51]
Berger AM, Parker KP, Young-McCaughan S, et al. Sleep wake disturbances in people with cancer and their caregivers: State of the science. Oncol Nurs Forum 2005; 32(6): E98-E126.
[http://dx.doi.org/10.1188/05.ONF.E98-E126] [PMID: 16270104]
[52]
Vena C, Parker K, Cunningham M, Clark J, McMillan S. Sleep-wake disturbances in people with cancer part I: An overview of sleep, sleep regulation, and effects of disease and treatment. Oncol Nurs Forum 2004; 31(4): 735-46.
[http://dx.doi.org/10.1188/04.ONF.735-746] [PMID: 15252429]
[53]
Cooper JE. On the publication of the Diagnostic and Statistical Manual of Mental Disorders : Fourth Edition (DSM-IV) Br J Psychiatry 1995; 166(1): 4-8.
[http://dx.doi.org/10.1192/bjp.166.1.4] [PMID: 7894874]
[54]
Driver HS, Hawari M. Range and classification of sleep disorders sleep disorders in psychiatric patients. Berlin, Heidelberg: Springer 2018; pp. 27-40.
[http://dx.doi.org/10.1007/978-3-642-54836-9_2]
[55]
American Sleep Disorders Association. 1997.International classification of sleep disorders http://www. absm. org/PDF/ICSD. pdf
[56]
Golbin A, Kravitz H, Keith LG, Eds. Sleep psychiatry. CRC Press 2004.
[57]
Kenner BJ. Early detection of pancreatic cancer: The role of depression and anxiety as a precursor for disease. Pancreas 2018; 47(4): 363-7.
[http://dx.doi.org/10.1097/MPA.0000000000001024] [PMID: 29498966]
[58]
Olson SH, Xu Y, Herzog K, et al. Weight loss, diabetes, fatigue, and depression preceding pancreatic cancer. Pancreas 2016; 45(7): 986-91.
[http://dx.doi.org/10.1097/MPA.0000000000000590] [PMID: 26692445]
[59]
Fras I, Litin EM, Pearson JS. Comparison of psychiatric symptoms in carcinoma of the pancreas with those in some other intra-abdominal neoplasms. Am J Psychiatry 1967; 123(12): 1553-62.
[http://dx.doi.org/10.1176/ajp.123.12.1553] [PMID: 4381627]
[60]
Kurzrock R. The role of cytokines in cancer-related fatigue. Cancer 2001; 92(6)(Suppl.): 1684-8.
[http://dx.doi.org/10.1002/1097-0142(20010915)92:6+<1684:AID-CNCR1497>3.0.CO;2-Z] [PMID: 11598887]
[61]
Błogowski W, Deskur A, Budkowska M, et al. Selected cytokines in patients with pancreatic cancer: A preliminary report. PLoS One 2014; 9(5)e97613
[http://dx.doi.org/10.1371/journal.pone.0097613] [PMID: 24849506]
[62]
Bower JE. Cancer-related fatigue: Links with inflammation in cancer patients and survivors. Brain Behav Immun 2007; 21(7): 863-71.
[http://dx.doi.org/10.1016/j.bbi.2007.03.013] [PMID: 17543499]
[63]
Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 2008; 26(6): 971-82.
[http://dx.doi.org/10.1200/JCO.2007.10.7805] [PMID: 18281672]
[64]
Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecol Oncol 2015; 136(3): 446-52.
[http://dx.doi.org/10.1016/j.ygyno.2014.10.013] [PMID: 25458588]
[65]
Paulsen Ø, Laird B, Aass N, et al. The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer. PLoS One 2017; 12(5)e0177620
[http://dx.doi.org/10.1371/journal.pone.0177620] [PMID: 28542626]
[66]
Saligan LN, Olson K, Filler K, et al. The biology of cancer-related fatigue: A review of the literature. Support Care Cancer 2015; 23(8): 2461-78.
[http://dx.doi.org/10.1007/s00520-015-2763-0] [PMID: 25975676]
[67]
Kwekkeboom KL, Tostrud L, Costanzo E, et al. The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer. J Pain Symptom Manage 2018; 55(5): 1286-95.
[http://dx.doi.org/10.1016/j.jpainsymman.2018.01.008] [PMID: 29360570]
[68]
Bower JE, Wiley J, Petersen L, Irwin MR, Cole SW, Ganz PA. Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories. Health Psychol 2018; 37(11): 1025-34.
[http://dx.doi.org/10.1037/hea0000652] [PMID: 30321021]
[69]
Steel JL, Terhorst L, Collins KP, et al. Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer. Psychosom Med 2018; 80(5): 483-91.
[http://dx.doi.org/10.1097/PSY.0000000000000579] [PMID: 29621045]
[70]
Kühl T, Behrens S, Jung AY, et al. Validation of inflammatory genetic variants associated with long-term cancer related fatigue in a large breast cancer cohort. Brain Behav Immun 2018; 73: 252-60.
[http://dx.doi.org/10.1016/j.bbi.2018.05.009] [PMID: 29763737]
[71]
Mock V, Piper B, Sabbatini P, Escalante C. National comprehensive cancer network fatigue practice guidelines. Oncology 2000; 14(11A): 151-61.
[PMID: 11195408]
[72]
Fatigoni S, Fumi G, Roila F. La fatigue cancro-correlata. Recenti Prog Med 2015; 106(1): 28-31.
[PMID: 25621777]


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VOLUME: 14
ISSUE: 4
Year: 2019
Page: [261 - 268]
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DOI: 10.2174/1574887114666190729143742
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