By Jyothirmai Gubili, MS, Melissa Emerzian, MSN, AGPCNP-BC, CBCN®, and Shelly Latte-Naor, MD
As a movement-based mind-body practice, yoga aims to “yoke” or join the mind and body. Among the several schools and traditions of yoga originating in India and Tibet, Hatha yoga practices are most common in the West. Beyond physical yoga postures, the practice of yoga often involves breathing techniques, meditation, chanting, and study of philosophic texts and rules of conduct.
According to the 2012 National Health Interview Survey, 85% of the 21 million adults who practice yoga say that it decreases their stress levels. Many cancer centers across the United States now offer yoga as an adjunct to conventional treatment.
Clinical Evidence for Yoga
Yoga has been validated in several randomized trials as a safe and effective strategy to alleviate stress, increase sense of well-being, improve quality of life, and facilitate sleep in newly diagnosed and long-term cancer survivors, potentially minimizing the need for sleep medications. Additional studies in breast cancer survivors reported improvements in social functioning and mood and significant reductions in fatigue, joint pain, and the number of hot flashes, with sustained benefits at three months’ follow-up. It was also useful in improving physical functioning and reducing fatigue in patients with breast cancer who were undergoing radiation therapy.
Preliminary findings suggested that yoga can ease respiratory distress by increasing the forced expiratory volume in patients with non-small cell lung cancer. It reduced anxiety and improved physical activity/health-related quality-of-life measures in pediatric patients both during active treatment and post-treatment.
Yoga sessions in these clinical trials involved physical alignment postures, breathing, and mindfulness exercises. The intervention was delivered over a period of four to six weeks in an instructor-taught, group format, with two to three sessions a week that lasted 60–75 minutes each.
Mechanistic studies suggest that the meditative component of yoga increases blood flow to the brain, thereby releasing endogenous dopamine and reducing respiratory rate. It may relieve stress and anxiety by increasing the amount of gamma amino-butyric acid and improve the functioning of the hypothalamic-pituitary-adrenal axis.
Yoga has been found to potentially impact biologic markers that are thought to contribute to cancer-related fatigue. Several studies demonstrated lower inflammatory markers (interleukin-6, tumor necrosis factor-alpha, and interleukin-1 beta) and reduced activity of the proinflammatory transcription factor nuclear factor kappa B in yoga participants, associated with reduced fatigue.
Is Yoga Safe?
In the breast cancer setting, not all patients undergo similar treatment. For example, some have the underarm lymph nodes surgically removed; others undergo lumpectomy versus mastectomy. Different treatments can affect a patient’s ability to perform common yoga poses that require supporting body weight with arm and chest muscles. Nurses should consider patients’ medical and surgical history when encouraging them to pursue yoga, and also advise patients to discuss potential restrictions with their breast surgeon.
Current evidence supports use of yoga in mitigating physical and psychological symptoms in patients with cancer and survivors. The Society of Integrative Oncology recommends yoga to reduce anxiety, stress, and depression and to improve quality of life during and after breast cancer treatment. Guidelines advise that patients interested in practicing yoga consult with their physicians and learn proper techniques from certified instructors who have experience working with patients with cancer.
Oncology nurses have a unique opportunity to liaise between patients and other disciplines. By listening to patients’ needs and staying updated on complementary therapies intended to ameliorate symptoms associated with the disease process, side effects of chemotherapy, or physical changes that evolve as a result of radiation therapy and surgery, nurses can educate patients on the many benefits of yoga.