Abstract
Background
Several cognitive behavioral interventions have been reported to reduce psychological symptoms in breast cancer (BC) patients. The goal of this study was to evaluate the effects of a yoga intervention in reducing depression and anxiety symptoms in BC patients.
Methods
This study was a randomized, partially blinded, controlled trial comparing a standardized yoga intervention to standard care. It was conducted at three medical centers in Montreal, Canada. Eligible patients were women diagnosed with stage I–III BC receiving chemotherapy. Participants were randomly assigned to receive yoga intervention immediately (experimental group, n=58) or after a waiting period (n=43 control group). The Bali Yoga Program for Breast Cancer Patients (BYP-BC) consisted of 23 gentle Hatha asanas (poses), 2 prayanamas (breathing techniques), shavasanas (relaxation corpse poses) and psychoeducational themes. Participants attended eight weekly sessions lasting 90 min each and received a DVD for home practice with 20- and 40-min sessions. Participants in the wait list control group received standard care during the 8-week waiting period.
Results
A total of 101 participants took part in the final intention-to-treat analyses. The repeated measures analyses demonstrated that depression symptoms increased in the control group (p=0.007), while no change was reported in the BYP-BC group (p=0.29). Also, depression symptoms decreased in the WL control group after receiving the BYP-BC intervention (p=0.03). Finally, there was no statistical significance in terms of anxiety symptoms (p=0.10).
Conclusions
Results support the BYP-BC intervention as a beneficial means of reducing and preventing the worsening of depression symptoms during chemotherapy treatment.
Acknowledgments
The authors would like to thank Dr. Dubé and Dr. Martin for their contributions. Support for this research was provided by the Quebec Breast Cancer Foundation, the private organization Foundation Mireille-Lanctôt, and the Centre de liaison sur l’intervention et la prevention psychosociales (CLIPP).
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Ferlay J, Soerjomataram I, ErvikM, et al. Cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2014, World Cancer research fund International. Available at: www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics. Accessed: 16 Jan 2015.Search in Google Scholar
2. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian cancer statistics 2014. Canadian Cancer Society. Available at: www.cancer.ca/fr-ca/cancer-information/cancer-type/breast/statistics/?region=qcSearch in Google Scholar
3. Tatrow K, Montgomery GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 2006;29:17–27.10.1007/s10865-005-9036-1Search in Google Scholar
4. Linden W, Vodermaier A, MacKenzie R, Greig D. Anxiety and depression after cancer diagnosis: prevalence rates by type, gender and age. J Affect Disorders 2012;141:343–51.10.1016/j.jad.2012.03.025Search in Google Scholar
5. Badger TA, Braden CJ, Mishel MH. Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer. Oncol Nurs Forum 2001;28:567–74.Search in Google Scholar
6. Ho SM, So WK, Leung DY, Lai ET, Chan CW. Anxiety, depression and quality of life in Chinese women with breast cancer during and after treatment: a comparative evaluation. Eur J Oncol Nurs 2013;17:877–82.10.1016/j.ejon.2013.04.005Search in Google Scholar
7. Enache RG. The relationship between anxiety, depression and self-esteem in women with breast cancer after surgery. Procedia Soc Behav Sci 2012;33:124–7.10.1016/j.sbspro.2012.01.096Search in Google Scholar
8. Song Q-H, Xu R-M, Zhang Q-H, et al. Relaxation training during chemotherapy for breast cancer improves mental health and lessens adverse events. Int J Clin Exp Med 2013;6:979–84.Search in Google Scholar
9. Targ EF, Levine EG. The efficacy of a mind–body–spirit group for woman with breast cancer: a randomized controlled trial. Gen Hosp Psychiatry 2002;24:238–48.10.1016/S0163-8343(02)00191-3Search in Google Scholar
10. Raghavendra Rao M, Raghuram N, Nagendra HR, et al. Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complent Ther Med 2009;17:1–8.10.1016/j.ctim.2008.05.005Search in Google Scholar PubMed
11. Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol 2013;31:1–11.10.1200/JCO.2012.43.7707Search in Google Scholar PubMed PubMed Central
12. Dhruva A, Mlaskowski C, Abrams D, et al. Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial. J Altern Complement Med 2012;18:473–9.10.1089/acm.2011.0555Search in Google Scholar PubMed PubMed Central
13. Zhang J, Yang K-H, Tian J-H, Wang C-M. Effects of yoga on psychologic function and quality of life in women with breast cancer: a meta-analysis of randomized controlled trials. J Altern Complement Med 2012;18:994–1002.10.1089/acm.2011.0514Search in Google Scholar PubMed
14. Galantino ML, Greene L, Daniels L, et al. Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with early stage breast cancer: a case series. Explore 2012;8:127–35.10.1016/j.explore.2011.12.001Search in Google Scholar PubMed
15. 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;25:4387–95.10.1200/JCO.2006.06.6027Search in Google Scholar PubMed
16. Raghavendra RM, Nagarathna R, Nagendra HR, et al. Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care (Engl) 2007;16:462–74.10.1111/j.1365-2354.2006.00739.xSearch in Google Scholar PubMed
17. Vadiraja HS, Raghavendra Rao M, Ngarathna R, et al. 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 2009;17:274–80.10.1016/j.ctim.2009.06.004Search in Google Scholar PubMed
18. Siedentopf F, Utz-Billing I, Gairing S, et al. Yoga for patients with early breast cancer and its impact on quality of life – a randomized controlled trial. Geburtshilfe Franenheilkd 2013;73:311–7.10.1055/s-0032-1328438Search in Google Scholar PubMed PubMed Central
19. Culos-Reed SN, Mackenzie MJ, Sohl SJ, et al. Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors. Evid Based Complement Alternat Med 2012; 2012:1–17.10.1155/2012/642576Search in Google Scholar PubMed PubMed Central
20. Ügler O, Yağh NV. Effects of yoga on the quality of life in cancer patients. Complement Ther Clin Pract 2010;16:60–3.10.1016/j.ctcp.2009.10.007Search in Google Scholar PubMed
21. Danhauer S, Mihalko SL, Russell GB, et al. Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psychooncology 2009;18:360–8.10.1002/pon.1503Search in Google Scholar PubMed PubMed Central
22. Côté A, Daneault S. Effects of yoga on patients with cancer. Our current understanding. Can Fam Physician 2012;58:e475–9.10.1093/czoolo/58.1.1Search in Google Scholar
23. Cramer H, Lange S, Klose P, et al. Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer 2012;12:412.10.1186/1471-2407-12-412Search in Google Scholar PubMed PubMed Central
24. Carson JW, Carson KM, Porter LS, et al. Yoga awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer 2009;17:1301–9.10.1007/s00520-009-0587-5Search in Google Scholar PubMed
25. Buffart LM, van Uffelen JG, Riphagen II, Brug J, van Mechelen W, Brown WJ, Chinapaw MJ. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. [Meta-Analysis Research Support, Non-U.S. Gov’t Review]. BioMed Central Cancer 2012;12: 559.Search in Google Scholar
26. Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY. Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. J Evid Based Complementary Altern Med 2011;2011:659876.10.1155/2011/659876Search in Google Scholar
27. Kelley GA, Kelley KS. Meditative movement therapies and health related quality-of-life in adults: a systematic review of meta-analyses. PLOS One 2015;10: 0129181.10.1371/journal.pone.0129181Search in Google Scholar
28. Smith KB, Pukall CF. An Evidence-based review of yoga as a complementary intervention for patients with cancer. Psychooncology 2009; 18:465–75.10.1002/pon.1411Search in Google Scholar
29. Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and survivors. Cancer Control 2005;12:165–71.10.1177/107327480501200304Search in Google Scholar
30. Harder H, Parlour L, Jenkins V. Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review. Support Care Cancer 2012;20:3055–64.10.1007/s00520-012-1611-8Search in Google Scholar
31. Pan Y, Yang K, Wang Y, Zhang L, Liang H. Could yoga practice improve treatment-related side effects and quality of life for women with breast cancer? A systematic review and meta-analysis. Asia Pac J Clin Oncol 2015;12:1–17.10.1111/ajco.12329Search in Google Scholar
32. Rao RM, Raghuram N, Nagendra HR, Usharani MR, Gopinath KS, Diwakar SP, et al. 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 2015;21:174–81.10.4103/0973-1075.156486Search in Google Scholar
33. Bourque P, D. Beaudette. Psychometric study of the beck depressive inventory scale among French speaking university students (Étude psychométrique du questionnaire de dépression de Beck auprès d’un échantillon d’étudiants universitaires francophones). Can J Behav Sci 1982;14:211–18.10.1037/h0081254Search in Google Scholar
34. Spielberger CD, Bruchon-Schweitzer M, Paulhan I.State-Trait anxiety inventory, Y format, French translation (Inventaire d’anxiété état-trait. forme y, adaptation française). Paris: Édition du Centre de Psychologie Appliquée, 1993:68.Search in Google Scholar
35. Hurst MW, Jenkins CD, Rose RM. The assessment of life change stress: a comparative and methodological inquiry. Psychosom Med 1978;40:126–41.10.1097/00006842-197803000-00005Search in Google Scholar
36. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32: 705–14.10.1016/0277-9536(91)90150-BSearch in Google Scholar
37. Allison PD. Multiple imputation for missing data: a cautionary tale. Soc Method Res 2005;28:301–9.10.1177/0049124100028003003Search in Google Scholar
38. Bodner TE. What improves with increased missing data imputations? Struct Equ Model 2008;15:651–75.10.1037/e645052007-001Search in Google Scholar
39. IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp, 2013.Search in Google Scholar
©2016 by De Gruyter
