Raghavendra, R.M., Nagarathna, R., Nagendra, H.R., Gopinath, KS, Srinath, B.S., Ravi, B.D., … Nalini, R. (2007).  Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients.  European Journal of Cancer Care, 16, 462-474.

To examine the effects of an integrated yoga program in reducing frequency and intensity of nausea and vomiting in chemotherapy-naïve patients with early stage breast cancer 

Patients were randomly assigned to receive either a yoga intervention or a supportive therapy intervention. Patients in the yoga group received both supervised and home practice of yoga sessions for 60 minutes daily, starting prior to chemotherapy. These patients received supervised initial training, audio and videocassettes for home use, and a supervised home visit. Patients in the control group received supportive therapy and coping preparation during hospital visits over a complete course of chemotherapy. Both interventions were initiated prior to the first chemotherapy cycle. The yoga instructor was trained in counseling and facilitated both groups. 

• The study consisted of 62 participants. The yoga intervention group had 28 patients, and the supportive therapy intervention group had 34 patients.
• Patients ranged in age from 30–70 years.
• All patients had at least a high school education.
• Patients were chemotherapy naïve with recently diagnosed, operable stage II or III breast cancer with a treatment plan that included surgery followed by adjuvant chemotherapy or both adjuvant chemotherapy and radiation therapy.
• Patients had Zubrod’s performance statuses of 0–2.
• Patients were excluded from the study if they had a medical condition that was likely to interfere with treatment; major psychiatric, neurologic, or autoimmune disorders; known metastases; a history of intestinal obstruction; or a known sensitivity to antiemetics.

Patients were recruited from a comprehensive cancer care center in India.

Patients maintained diaries to record episodes of vomiting and duration of nausea, and, at the fourth cycle, they completed the Morrow Assessment of Nausea and Emesis (MANE), State-Trait Anxiety Index (STAI), Beck Depression Inventory (BDI), Functional Living Index-Cancer (FLIC), and a symptom checklist questionnaire.

• The severity of post-chemotherapy vomiting was mild to moderate in both groups.
• The nausea severity was moderate to severe for the control group and mild to moderate for the yoga group.
• Frequency and intensity of nausea were lower in the yoga group. In addition, intensity of anticipatory nausea and vomiting was lower in the yoga group compared to the control group.
• A positive correlation was found between MANE scores and anxiety, depression, and distressful symptoms.

The yoga intervention was effective in reducing the frequency and intensity of nausea and the intensity of anticipatory nausea and vomiting in women with early stage breast cancer.

• The antiemetics for the management of delayed emesis were not based on guidelines or consensus statements.
• Participants in the control group were offered supportive therapy and coping less frequently than the yoga intervention group. In addition, the yoga group started the intervention earlier than the control group, closer to the time of surgery and radiation than chemotherapy.
• With the overlap of physical symptoms of cancer, the BDI and STAI in cancer populations have limitations.