Yoga

Yoga

PEP Topic 
Hot Flashes
Description 

Yoga is an ancient Eastern practice that employs stress-reduction techniques such as regulated breathing, visual imagery, and meditation as well as various postures. There are many varieties of the practice. Yoga has been examined as an intervention for anxiety, depression, CINV, hot flashes, cognitive impairment, sleep-wake disturbances, pain, and fatigue in patients with cancer. It has also been examined as an intervention for caregiver strain and burden.

Effectiveness Not Established

Research Evidence Summaries

Carson, J. W., Carson, K. M., Porter, L. S., Keefe, F. J., & Seewaldt, V. L. (2009). Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Supportive Care in Cancer, 17, 1301–1309.

doi: 10.1007/s00520-009-0587-5
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Study Purpose:

The study evaluated the effects of a yoga intervention on menopausal symptoms among breast cancer survivors.

Intervention Characteristics/Basic Study Process:

Patients were randomized to the yoga intervention or a wait-list control group. The intervention consisted of eight weekly, 120-minute, group classes led by a certified yoga instructor. Classes were videotaped and reviewed. Sessions involved 40 minutes of stretching poses, 10 minutes of breathing techniques, 25 minutes of meditation, 20 minutes of study of pertinent topics, and 25 minutes of group discussion. CD recordings were provided for home practice. Application of concepts to daily life were assigned weekly. Assessments were performed at baseline, posttreatment, and three months postintervention. Wait-list controls were reminded about the assessments they needed. Patients kept daily diaries to rate hot flashes and daily use of yoga.

Sample Characteristics:

  • The study was comprised of 37 women with a mean age of 54.4 years. 
  • Patients were an average of 4.9 years since diagnosis.
  • All patients had breast cancer, and 40.5% were stage IA.
  • Of the patients, 70.3% had prior chemotherapy, 13.5% were on tamoxifen during the study, 75.7% were married or partnered, 81.1% were Caucasian, and 80.3% had college or graduate level education.
  • Patients had no hormone therapy within three months.
  • Many patients were on antidepressants.
  • Of the patients, 50.5% were receiving aromatase inhibitors known to increase hot flashes.

Setting:

The study was performed in outpatient clinics at Duke University.

 

Phase of Care and Clinical Applications:

  • Patients were undergoing the late effects and survivorship phase of care.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Patients kept daily hot flash and yoga use diaries. Hot flashes were scored on a 0-to-9 numeric scale.
  • In addition, a questionnaire assessed the perceived credibility of the intervention.

Results:

Those in the yoga group had a significantly better decline in hot flash frequency, severity, joint pain, fatigue, and sleep disturbance (p < 0.002). Patients in the control group had significantly better decline in the degree to which they were bothered by symptoms (p < 0.0001). There was no difference in night sweats. Mean yoga practice time spent in use of techniques was associated with less fatigue (p = 0.032). Yoga daily participation ranged from 7.3 to 64.6 minutes. There was a 76% completion rate in the yoga group.

Conclusions:

The findings suggested a potential benefit of a group yoga and support intervention for some symptoms in breast cancer survivors.

Limitations:

  • The study had a small sample size.
  • The study had no blinding or attentional control.
  • It is unclear if the benefits were derived from the yoga activities or the group activities provided. 
  • There was a relatively high drop-out rate, raising the question of the practicality of the intervention as designed. 
  • The sample included patients with high education levels and current marriage or partnership support.
  • Measurement of symptoms was not clearly described, and scoring was unclear.

Nursing Implications:

The findings suggested that yoga and support activities provided in a group setting may help patients with symptoms of hot flashes, sleep deprivation, and fatigue. There was no apparent effect on night sweats.  

Cramer, H., Rabsilber, S., Lauche, R., Kummel, S., & Dobos, G. (2015). Yoga and meditation for menopausal symptoms in breast cancer survivors—A randomized controlled trial. Cancer, 121, 2175–2184. 

doi: 10.1002/cncr.29330
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Study Purpose:

To evaluate the effects of a 12-week traditional Hatha yoga and meditation intervention on menopausal symptoms in survivors of breast cancer

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned either to a 12-week Hatha yoga (90 minutes) and Buddhist meditation intervention or to usual care. All yoga sessions were led by the same yoga instructor and began with the same poses. Poses varied after the initial pose for all classes. Patients randomized to the yoga group were encouraged, but not required, to practice yoga at home. Women randomized to the control group were wait-listed and offered the yoga intervention at the conclusion of the trial. Data was collected at 1, 12, and 24 weeks.

Sample Characteristics:

  • N = 40  
  • MEAN AGE: 49.2 years (SD = 5.9 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: The study included survivors of breast cancer with no metastatic tumors after completing antineoplastic treatment, surgical chemotherapy, or radiotherapy. Women were aged 30-65 years, with or without antiestrogen medications.
  • OTHER KEY SAMPLE CHARACTERISTICS: Patients scored 5 points or more, moderate score, on the Menopause Rating Scale (MRS). Antiestrogens, nonhormonal, and antidepressant medication were included if dose was fixed/stabilized and no changes in perspective were noted in 24 weeks.

Setting:

  • SITE: Single site    
  • SETTING TYPE: Not specified    
  • LOCATION: Department of Gynecology Certified Breast Cancer at Malteser Hospital St. Anna, Duisburg, Germany

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Transition phase after active treatment

Study Design:

Unicenter, open-labeled, randomized clinical trial with two groups: (a) the group with yoga and meditation intervention and (b) the control group with usual care

Measurement Instruments/Methods:

  • Menopause Rating Scale (MRS)
  • Quality of life was measured with Functional Assessment of Cancer Therapy-Breast (FACT-B)
  • Fatigue measured with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
  • Depression and anxiety were measured with Hospital Anxiety and Depression Scale (HADS)

Results:

Primary outcome: At week 12 and week 24, total menopausal symptoms were lower in the yoga group than in the usual care group (week 12: p = 0.004; week 24: p = 0.023). Regarding quality of life, significant group differences were observed at week 12 for the FACT-B total score (p = 0.002), and for the social (p = 0.024), emotional (p = 0.005), and functional well-being subscales (p = 0.024). There were no group differences for anxiety or depression. Women who received antiestrogen medication (n = 36) presented total menopausal symptoms lower in yoga group at week 12 (p = 0.013) but not at week 24 (p = 0.084). At week 24, no group differences were observed for any of the MRS subscales in the subgroup analysis (p = 0.075–0.352).

Conclusions:

Yoga combined with meditation appears to be an effective intervention to relieve menopausal symptoms in survivors of breast cancer for at least three months after the end of the active neoplastic treatments. It can help reduce fatigue, and, for women who are receiving antiestrogen medication, yoga can have at least short-lasting effects.

Limitations:

  • Small sample (less than 100)
  • Risk of bias (no blinding)
  • Risk of bias (sample characteristics)
  • Unintended interventions or applicable interventions not described that would influence results 
  • Key sample group differences that could influence results
  • Intervention expensive, impractical, or training needs
  • Groups can be different, as well as anxiety and depression scores at the beginning. Groups also can be contaminated one to another if there is contact.
  • Previous experience in yoga was not controlled, and interventions are supposed to be adapted to the individual, so there can be differences in interventions for group members.
  • It is unclear if there were individual or group yoga sessions.

Nursing Implications:

Yoga is a good recommendation for patients with breast cancer to manage menopausal symptoms and to decrease fatigue. Intervention is effective to improve quality of life. Yoga does not have serious adverse events, and minor adverse events could be related to other causes.

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