Article

A Pilot Study of the Feasibility and Outcomes of Yoga for Lung Cancer Survivors

Judith M. Fouladbakhsh

Jean E. Davis

Hossein N. Yarandi

lung cancer, yoga, symptoms
ONF 2014, 41(2), 162-174. DOI: 10.1188/14.ONF.162-174

Purpose/Objectives: To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL).

Design: This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy.

Setting: A community-based cancer support center in the midwestern United States.

Sample: 7 adults who had completed initial treatment for stages I-IIIa NSCLC.

Methods: A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis.

Main Research Variables: Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants.

Findings: Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time.

Conclusions: Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship.

Implications for Nursing: Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors.

Jump to a section

    References

    American Cancer Society. (2013). Lung cancer (non-small cell). Retrieved from http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-key-statistics
    American Viniyoga Institute. (2014). What is viniyoga? Retrieved from http://www.viniyoga.com/about/what-is-viniyoga
    Amichai, T., Grossman, M., & Richard, M. (2012). Lung cancer patients beliefs about complementary and alternative medicine in the promotion of their wellness. European Journal of Oncology Nursing, 16, 520-527. doi:10.1016/j.ejon.2012.01.004
    Andersen, R.M. (1995). Revisiting the behavioral model and access to medical care. Journal of Health and Social Behavior, 36, 1-10.
    Brown, J.K., Cooley, M.E., Chernecky, C., & Sarna, L. (2011). A symptom cluster and sentinel symptom experienced by women with lung cancer [Online exclusive]. Oncology Nursing Forum, 38, E425-E435. doi:10.1188/11.ONF.E425-E435
    Büssing, A., Ostermann, T., Lüdtke, R., & Michalsen, A. (2012). Effects of yoga interventions on pain and pain-associated disability: A meta-analysis. Journal of Pain, 13, 1-9. doi:10.1016/j.jpain.2011.10.001
    Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J. (2000). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric practice and research. In J.A. Rush (Ed.), Handbook of psychiatric measures (2nd ed., pp. 653-655). Washington, DC: American Psychiatric Association.
    Carrieri-Kohlman, V., Stulbarg, M., Jacobs, B., Nguyen, H., Cuenco, D., & Park, S.K. (2007, May). Safety and feasibility of yoga in patients with COPD. Paper presented at the 2007 American Thoracic Society (ATS) International Conference, University of California, San Francisco.
    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
    Carson, J.W., Carson, K.M., Porter, L.S., Keefe, F.J., Shaw, H., & Miller, J.M. (2007). Yoga for women with metastatic breast cancer: Results from a pilot study. Journal of Pain and Symptom Management, 33, 331-341. doi:10.1016/j.jpainsymman.2006.08.009
    Chadwani, K.D., Thornton, B., Perkins, G.H., Arun, B., Raghuram, N.V., Nagendra, H.R., … Cohen, L. (2010). Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. Journal of the Society for Integrative Oncology, 8, 43-55.
    Cheville, A.L., Novotny, P.J., Sloan, J.A., Basford, J.R., Wampfler, J.A., Garces Y.I., … Yang, P. (2011). The value of symptom cluster of fatigue, dyspnea, and cough in predicting clinical outcomes in lung cancer survivors. Journal of Pain and Symptom Management, 42, 213-221. doi:10.1016/j.jpainsymman.2010.11.005
    Cohen, L., Wameke, C., Fouladi, R., Rodriguez, M.A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253-2260. doi:10.1002/cncr.20236
    Dedovic, K., Duchesne, A., Andrews, J., Engert, V., & Pruessner, J.C. (2009). The brain and the stress axis: The neural correlates of cortisol regulation in response to stress. Neuroimage, 47, 864-871. doi:10.1016/j.neuroimage.2009.05.074
    Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., & Hecht, F.M. (2012). Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: Results of a pilot randomized controlled trial. Journal of Alternative and Complementary Medicine, 18, 473-479. doi:10.1089/acm.2011.0555
    Donesky-Cuenco, D., Nguyen, H.Q., Paul, S., & Carrieri-Kohlman, V. (2009). Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: A pilot study. Journal of Alternative and Complementary Medicine, 15, 225-234. doi:10.1089/acm.2008.0389
    Ferreira, K.A., Kimura, M., Teixeira, M.J., Mendoza, T.R., da Nobrega, J.C., Graziani, S.R., & Takagaki, T.Y. (2008). Impact of cancer-related symptom synergisms on health-related quality of life and performance status. Journal of Pain and Symptom Management, 35, 604-616. doi:10.1016/j.jpainsymman.2007.07.010
    Ferrell, B., Koczywas, M., Grannis, F., & Harrington, A. (2011). Palliative care in lung cancer. Surgical Clinics of North America, 91, 403-417. doi:10.1016/j.suc.2010.12.003
    Fouladbakhsh, J.M., Davis, J.E., & Yarandi, H. (2013). Using a standardized Viniyoga protocol for lung cancer survivors: A pilot study examining effects on breathing ease. Journal of Complementary and Integrative Medicine, 10, 175-187. doi:10.1515/jcim-2012-0013
    Fouladbakhsh, J.M., & Stommel, M. (2007). Using the behavioral model for complementary and alternative medicine: The CAM health-care model. Journal of Complementary and Integrative Medicine. Retrieved from http://www.degruyter.com/view/j/jcim.2007.4.1/jcim.2007.4.1.1035/jcim.2… http://www.degruyter.com/view/j/jcim.2007.4.1/jcim.2007.4.1.1035/jcim.2007.4.1.1035.xml
    Fouladbakhsh, J.M., & Stommel, M. (2008). Comparative analysis of CAM use in the U.S. cancer and noncancer populations. Journal of Complementary and Integrative Medicine. Retrieved from http://www.researchgate.net/publication/237504915_Comparative_Analysis_… http://www.researchgate.net/publication/237504915_Comparative_Analysis_of_CAM_Use_in_the_U.S._Cancer_and_Noncancer_Populations
    Fouladbakhsh, J.M., & Stommel, M. (2010). Gender, symptom experience, and use of complementary and alternative medicine among cancer survivors in the U.S. cancer in the acute care setting. Clinical Journal of Oncology Nursing, 14, 509-513.
    Fouladbakhsh, J.M., Szczesny, S., Kowalewski, K., & Blair, D. (2013). Honoring the spirit of research within: The yoga and more (CAM) research interest group. Journal of Nursing Education and Practice, 3, 132-140.
    Gaguski, M.E., Brandsema, M., Gernalin, L., & Martinez, E. (2010). Assessing dyspnea in patients with non-small cell lung cancer in the acute care setting. Clinical Journal of Oncology Nursing, 14, 509-513. doi:10.1188/10.CJON.509-513
    Galantino, M.L., Cannon, N., Hoelker, T., Iannaco, J., & Quinn, L. (2007). Potential benefits of walking and yoga on perceived levels of cognitive decline and persistent fatigue in women with breast cancer. Rehabilitation Oncology, 25, 3-16.
    George, M. (2012). Health beliefs, treatment preferences and complementary and alternative medicine for asthma, smoking and lung cancer self-management in diverse Black communities. Patient Education and Counseling, 89, 489-500. doi:10.1016/j.pec.2012.05.003
    Gift, A.G. (1989). Validation of vertical analog scale as a measure of clinical dyspnea. Rehabilitation Nursing, 14, 323-325. doi:10.1002/j.2048-7940.1989.tb01129.x
    Gift, A.G., & Narsavage, G. (1998). Validity of the numeric rating scale as a measure of dyspnea. American Journal of Critical Care, 7, 200-204.
    Gillett, J., Ientile, C., Hiscock, J., Plank, A., & Martin, J.M. (2012). Complementary and alternative medicine use in radiotherapy: What are patients using? Journal of Alternative and Complementary Medicine, 18, 1014-1020. doi:10.1089/acm.2011.0334
    Gooneratne, N.S., Dean, G.E., Rogers, A.E., Nkwuo, J.E., Coyne, J.C., & Kaiser, L.R. (2007). Sleep and quality of life in long-term lung cancer survivors. Lung Cancer, 58, 403-410. doi:10.1016/j.lungcan .2007.07.011
    Hansen, F., & Sawatzky, J.V. (2008). Stress in patients with lung cancer: A human response to illness. Oncology Nursing Forum, 35, 217-223. doi:10.1188/08.ONF.217-223
    Hede, K. (2011). Supportive care: Large studies ease yoga, exercise into mainstream oncology. Journal of the National Cancer Institute, 103, 11-12. doi:10.1093/jnci/djq536
    Hellhammer, D.H., Wüst, S., & Kudielka, B.M. (2009). Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology, 34, 163-171. doi:10.1016/j.psyneuen.2008.10.026
    International Agency for Research on Cancer. (2012). GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. Retrieved from http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
    John, P.J., Sharma, N., Sharma, C.M., & Kankane, A. (2007). Effectiveness of yoga therapy in the treatment of migraine without aura: A randomized controlled trial. Headache, 47, 654-661. doi:10.1111/j.1526-4610.2007.00789.x
    Kepner, J., Strohmeyer, V., & Elgelid, S. (2002). Wide dimensions to yoga therapy: Comparative approaches from Viniyoga, Phoenix Rising Yoga Therapy, and the Feldenkrais Method. International Journal of Yoga Therapy, 12, 25-38.
    Kraftsow, G. (1999). Yoga for wellness: Healing with the timeless teachings of viniyoga. New York, NY: Penguin Compass.
    Liang, K.Y., & Zeger, S.L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13-22. doi:10.1093/biomet/73.1.13
    Lorr, M., McNair, D.M., Heuchert, J.W., & Droppleman, L.F. (2003). POMS: Profile of mood states. Toronto, Canada: Multi-Health Systems.
    Lövgren, M., Wilde-Larsson, B., Hök, J., Leveälahti, H., & Tishelman, C. (2011). Push or pull? Relationships between lung cancer patients' perceptions of quality care and use of complementary and alternative medicine. European Journal of Oncology Nursing, 15, 311-317. doi:10.1016/j.ejon.2010.10.004
    Lu, J.H., Tsay, S.L., & Sung, S.C. (2010). Taiwanese adult cancer patients' reports of using complementary therapies. Cancer Nursing, 33, 320-326. doi:10.1097/NCC.0b013e3181d1c7ee
    Micke, O., Buntzel, J., Kisters, K., Schafer, U., Micke, P., & Mucke, R. (2010). Complementary and alternative medicine in lung cancer patients: A neglected phenomenon? Frontiers of Radiation Therapy and Oncology, 42, 198-205. doi:10.1159/000262477
    Mishra, S.I., Scherer, R.W., Snyder, C., Geigle, P.M., Berlanstein, D.R., & Topaloglu, O. (2012). Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database of Systematic Reviews, 8, CD008465.
    Mohan, A., Singh, P., Singh, S., Goyal, A., Pathak, A., Mohan, C., & Guleria R. (2007). Quality of life in lung cancer patients—Impact of baseline clinical profiles and respiratory status. European Journal of Cancer Care, 16, 268-276. doi:10.1111/j.1365-2354.2006.00741.x
    Molassiotis, A., Panteli, V., Patiraki, E., Ozden, G., Platin, N., Madsen, E., … Margulies, A. (2006). Complementary and alternative medicine use in lung cancer patients in eight European countries. Complementary Therapies in Clinical Practice, 12, 34-39. doi:10.1016/j.ctcp.2005.09.007
    Mustian, K.M., Palesh, O., Sprod, L., Peppone, L.J., Heckler, C.E., Yates, J.S., … Morrow, G.R. (2010). Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors [Abstract 9013]. Journal of Clinical Oncology. Retrieved from http://meeting.ascopubs.org/cgi/content/abstract/28/15_suppl/9013 http://meeting.ascopubs.org/cgi/content/abstract/28/15_suppl/9013
    Otte, J.L., Carpenter, J.S., Russell, K.M., Bigatti, S., & Champion, V.L. (2010). Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. Journal of Pain and Symptom Management, 39, 535-547. doi:10.1016/j.jpainsymman.2009.07.004
    Palesh, O.G., Roscoe, J.A., Mustian, K.M., Roth, T., Savard, J., Ancoli-Israel, S., … Morrow, G.R. (2010). Prevalence, demographics, and psychological associations of sleep disruptions in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. Journal of Clinical Oncology, 28, 292-298. doi:10.1200/JCO.2009.22.5011
    Podnos, Y.D., Borneman, T.R., Koczywas, M., Uman, G., & Ferrell, B.R. (2007). Symptom concerns and resource utilization in patients with lung cancer. Journal of Palliative Medicine, 10, 899-903. doi:10.1089/jpm.2006.0232
    Rao, M.R., Raghuram, N., Nagendra, H.R., Gopinath, K.S., Srinath, B.S., Diwaker, R.B., … Varambally, S. (2009). Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: A randomized controlled trial. Complementary Therapies in Medicine, 17, 1-8. doi:10.1016/j.ctim.2008.05.005
    Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative and Complementary Medicine, 16, 3-12. doi:10.1089/acm.2009.0044
    Sarna, L., Cooley, M.E., & Brown, J.K. (2010). Women with lung cancer. Quality of life after thoracotomy: A 6-month prospective study. Cancer Nursing, 33, 85-92. doi:10.1097/NCC.0b013e3181be5e51
    Sarna, L., Cooley, M.E., Brown, J.K., Chernecky, C., Elashoff, D., & Kotlerman, J. (2008). Symptom severity 1 to 4 months after thoracotomy for lung cancer. American Journal of Critical Care, 17, 455-467.
    Shadish, W.R., Cook, T.D., & Campbell, D.T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Boston, MA: Houghton Mifflin.
    Shannahoff-Khalsa, D.S. (2005). Patient perspectives-Kundalini yoga meditation techniques for psycho-oncology and as potential therapies for cancer. Integrative Cancer Therapies, 4, 87-100. doi:10.1177/1534735404273841
    Sharma, V. (2008, March). Yoga for respiratory challenges. Paper presented at the Second IAYT Symposium on Yoga Therapy and Research, Los Angeles, CA.
    Smith, K.B., & Pukall, C.F. (2009). An evidence-based review of yoga as a complementary intervention for patients with cancer. Psycho-Oncology, 18, 465-475. doi:10.1002/pon.1411
    Snyder, C.F., Garrett-Mayer, E., Brahmer, J.R., Carducci, M.A., Pili, R., Stearns, V., … Wu A.W. (2008). Symptoms, supportive care needs, and function in cancer patients: How are they related? Quality of Life Research, 17, 665-677. doi:10.1007/s11136-008-9331-8
    Speed-Andrews, A.E., Stevinson, C., Belanger, L.J., Mirus, J.J., & Courneya, K.S. (2010). Pilot evaluation of an Iyengar yoga program for breast cancer survivors. Cancer Nursing, 33, 369-381. doi:10.1097/NCC.0b013e3181cfb55a
    Stommel, M., & Wills, C.E. (2004). Clinical research: Concepts and principles for advanced practice nurses. Philadelphia, PA: Lippincott Williams and Wilkins.
    Thomas, S., Bausewein, C., Higginson, I., & Booth S. (2011). Breathlessness in cancer patients—Implications, management and challenges. European Journal of Oncology Nursing, 15, 459-469. doi:10.1016/j.ejon.2010.11.013
    Ulger, O., & Yagli, N.V. (2010). Effects of yoga on the quality of life of cancer patients. Complementary Therapies in Clinical Practice, 16, 60-63. doi:10.1016/j.ctcp.2009.10.007
    Vadiraja, H.S., Rao, M.R., Nagarathna, R., Nagrenda, H.R., Rehka, M., Vanitha M., … Rao, N. (2009). Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Complementary Therapies in Medicine, 17(5-6), 274-280.
    Vena, C., Parker, K., Allen, R., Bliwise, D.L., Jain, S., & Kimble, L. (2006). Sleep-wake disturbances and quality of life in patients with advanced lung cancer. Oncology Nursing Forum, 33, 761-769. doi:10.1188/06.ONF.761-769
    Vena, C., Parker, K., Cunningham, M., Clark, J., & McMillan, S. (2004). Sleep-wake disturbances in people with cancer part I: An overview of sleep, sleep regulation, and effects of disease and treatment. Oncology Nursing Forum, 31, 735-746. doi:10.1188/04.ONF.735-746
    Ware, J.E. (2000). SF-36 health survey update. Spine, 25, 3130-3139. doi:10.1097/00007632-200012150-00008
    Wells, M., Sarna, L., Cooley, M.E., Brown, J.K., Chernecky, C., Williams, R.D., … Danao, L.L. (2007). Use of complementary and alternative medicine therapies to control symptoms in women living with lung cancer. Cancer Nursing, 30, 45-55. doi:10.1097/00002820-200701000-00008
    Winer, B.J., Brown, D.R., & Michels, K.M. (1991). Statistical principles in experimental design (3rd ed.). New York, NY: McGraw Hill.
    Yorke, J., Brettle, A., & Molassiotis, A. (2012). Nonpharmacological interventions for managing respiratory symptoms in lung cancer. Chronic Respiratory Disease, 9, 117-129. doi:10.1177/14799 72312441632