Cramer, H., Pokhrel, B., Fester, C., Meier, B., Gass, F., Lauche, R., . . . Langhorst, J. (2015). A randomized controlled bicenter trial of yoga for patients with colorectal cancer. Psycho-Oncology, 25, 412–420.

DOI Link

Study Purpose

To evaluate the effects of yoga on quality of life, anxiety, depression, and sleep in patients with colorectal cancer.

Intervention Characteristics/Basic Study Process

Patients were randomized to the yoga or usual care group. The yoga group had weekly 90 minute hatha yoga classes for 10 weeks. Classes were done in a group setting. Patients were encouraged to practice yoga at home and keep a daily log of practice. Study measures were obtained at week 1, 10, and 22. After 22 weeks, patients in the control group were offered yoga participation.

Sample Characteristics

  • N = 44  
  • MEAN AGE = 68.26 years (range = 40-87)
  • MALES: 61.1%, FEMALES: 38.9%
  • KEY DISEASE CHARACTERISTICS: All had colorectal cancer and were an average of 23 months since surgery
  • OTHER KEY SAMPLE CHARACTERISTICS: The majority of patients were retired and were married

Setting

  • SITE: Multi-site  
  • SETTING TYPE: Outpatient    
  • LOCATION: Germany

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship

Study Design

  • Randomized, controlled trial

Measurement Instruments/Methods

  • Functional Assessment of Cancer Therapy (FACT) colorectal and fatigue scales
  • Hospital Anxiety and Depression Scale (HADS)
  • Pittsburgh Sleep Quality Index (PSQI)

Results

At week 10, the yoga group had greater decline in anxiety (p = 0.043) and depression (p = 0.038) scores, but, at week 22, there was no difference between groups. At week 10, there were no differences between groups in PSQI scores, however, at week 22, those in the yoga group had better sleep quality (p = 0.043). There was no relationship between home practice time and outcomes. Only about half attended yoga sessions, and average home practice was about one hour per week. There were no significant differences between groups in overall quality of life scores.

Conclusions

Yoga may be helpful to some patients to reduce sleep disturbances.

Limitations

  • Small sample (less than 100)
  • Baseline sample/group differences of import
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)
  • Measurement validity/reliability questionable
  • Subject withdrawals of 10% or greater 
  • Other limitations/explanation: More than 20% were lost to follow up. Baseline anxiety and depression scores were very low, so it is not likely that reduction would be seen due to floor effects, and those reductions seen have questionable clinical relevance.

Nursing Implications

These results did not show meaningful impact of yoga on anxiety or depression. Yoga was beneficial in terms of improving sleep, although changes seen were small, and findings are limited due to study limitations. Further research in the potential role of yoga for sleep improvement is needed.