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.

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

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.

• 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.

The study was performed in outpatient clinics at Duke University.

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

The study was a randomized, controlled trial.

• 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.

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.

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

• 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.

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.