Yoga

 To identify the evidence in scientific literature related to nonpharmacologic interventions for the treatment of chemotherapy-induced nausea and vomiting (CINV)

Databases searched were Cochrane, PubMed, Latin American and Caribbean Health Sciences Literature (LILACSO), and Brazilian Nursing Database (BDENF).

Search keywords were nausea, vomiting, chemotherapy, nursing care, cursing care protocols for cancer chemotherapy, and chemotherapy induced nausea and vomiting.

Studies were included in the review if they

• Addressed nonpharmacological interventions for nausea and vomiting.
• Were completed within the past 10 years (1998–2008).
• Were conducted in English or Spanish.

• An initial set of 111 articles were identified. Of these, 102 were related to pharmacological management and were eliminated. A final sample of nine studies was included in the review.
• The authors developed an instrument to analyze the literature related to method, journal type, and author.
• The articles were published in English (78%), Portuguese (11%), and Spanish (11%).
• The majority of the articles (67%) were written by physicians in collaboration with psychologists and pharmacists.

• Across the nine studies, a total sample of 1,635 patients were studied.
• The majority of studies involved the use acupuncture, acupressure, or electroacupuncture (5 trials and 1 meta-analysis).
• Studies involved patients receiving highly emetogenic chemotherapy or those with refractory CINV.

• One of the studies involved patient dietary education and adherence to antiemetic therapy in which patients reported a better sense of security with the provision of written information.
• One study, which had 16 participants, found hypnosis to be effective in reducing anticipatory CINV.
• One randomized, controlled trial of 62 patients using a yoga program showed no decrease in frequency or intensity of CINV with the intervention.
• Findings among studies of acupuncture and acupressure had mixed results, with most showing no significant difference in symptoms with the intervention.
• The meta-analysis showed a reduction in the proportion of patients with acute vomiting but not in the severity of nausea.
• Electrical stimulation did not improve results.

This review demonstrated no substantial effects among the interventions included. Findings regarding the use of acupuncture, acupressure, and electroacupuncture were mixed. Most studies using acupuncture and acupressure involved use of the p6 point on the wrist.

This review included a limited number of studies.

The evidence does not demonstrate significant effect of these interventions for CINV. However, these interventions may be useful as adjuncts to pharmacologic treatment. Nonpharmacologic interventions appear to be most effective in the prevention of acute vomiting rather than symptoms of nausea.

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.