Yoga Practice Improves Sleep Quality and Reduces Fatigue in Cancer Survivors

Roxanne Nelson

May 25, 2010

May 26, 2010 — Practicing yoga might improve sleep and overall quality of life in cancer survivors. It appears to also improve fatigue, which along with impaired sleep quality are the most prevalent and troublesome adverse effects experienced by cancer survivors. Both can significantly affect quality of life.

Cancer survivors also reported reducing their need for sleep medication once they began a yoga program, according to the findings of the largest randomized controlled study ever to examine the value of yoga specifically designed for cancer survivors.

Participants in the yoga program were able to decrease their use of sleep medication by 21%, compared with the control group, who increased their use of sleep medication by 5% during the same time period.

The results of the study will be presented on June 5 at the upcoming American Society of Clinical Oncology (ASCO) 46th Annual Meeting in Chicago, Illinois.

"This is a readily applicable approach that improves quality of life and reduces medicine intake in cancer survivors. This is a real positive," said George W. Sledge, Jr., MD, president-elect of ASCO, during a presscast in which the results of the study were highlighted.

As previously reported by Medscape Oncology, complementary medicine, including yoga, is common among cancer survivors, particularly women. Dr. Sledge pointed out that this study is "a creative application of scientific technique to complementary and alternative medicine approaches."

"Physicians frequently have trouble discussing these approaches with patients, but this study applies real science to the issue," he said, adding that "this emphasizes the increasing importance of ameliorating complications of therapy in long-term cancer survivors, as there are literally millions of patients to whom this might be applicable in the United States."

Specialized Yoga Program

Lead author Karen Mustian, PhD, MPH, professor of radiation oncology and community and preventive medicine at the University of Rochester in New York, told journalists that the cancer survivors who participated in the study were enrolled into a specialized program known as YOCAS (Yoga for Cancer Survivors).

The program, designed by Dr. Mustian and colleagues, includes breathing exercises, gentle Hatha and restorative yoga postures, and mindfulness exercises. The YOCAS classes were 75 minutes long, and participants attended twice a week for 4 weeks. The instructors were Yoga Alliance–certified, and received specific training for the YOCAS program.

"The patients had to have completed treatment between 2 and 24 months prior to enrolling in the study," said Dr. Mustian. "They needed to have a sleep disturbance of 3 or greater on a scale ranging from 0 to 10."

The study population was primarily female (93%), with a mean age of 54 years, and 75% had a diagnosis of breast cancer. Patients were randomized to either usual follow-up care (n = 204) or usual care plus yoga (n = 206). None of the patients had distant metastatic disease or sleep apnea at baseline. Both groups met the clinical cutoff criteria for impaired sleep quality (Pittsburgh Sleep Quality Index [PSQI] > 5), and baseline assessments for sleep and fatigue used standardized and traditional tools that are common in oncology.

At the start of the study, 84% of the yoga group and 83% of the control group had clinically impaired sleep quality at baseline. At the end of the 4-week study period, 31% of the yoga group had recovered and no longer had clinically impaired sleep quality (PSQI < 5), whereas only 16% of patients in the control group experienced recovery (< .05).

Patients in the yoga group experienced a greater reduction in fatigue than those the control group (42% vs 12%; P < .05), and a greater reduction in daytime sleepiness (29% vs 5%; P < .05).

Those in the yoga group improved their quality of life by 6%, whereas those in the control group did not experience any improvement in quality of life (0% change; < .05). One of the most important outcomes was that patients in the yoga group reduced their use of sleep medication by 21%, compared with those in the control group, who increased their use by 5% during the study period (P < .05).

"In conclusion, we can state that it is possible that Hatha yoga classes and restorative yoga classes might be useful to cancer survivors in communities across the United States in helping these side effects that impair quality of life," said Dr. Mustian.

The study was funded by the National Cancer Institute. The authors have disclosed no relevant financial relationships.

American Society of Clinical Oncology (ASCO) 46th Annual Meeting: Abstract 9013. To be presented June 5, 2010.

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