Two Things That Go Together: Yoga and Advanced Lung Cancer

Roxanne Nelson, BSN, RN

October 23, 2017

Patients with advanced lung cancer are not stereotypical yoga practitioners, but a new study indicates they benefit, including from breathing exercises, or pranayama.

Compared with a control group, patients who participated in a yoga program while undergoing treatment experienced significant improvement in stamina and mental health.

The findings were presented at a press briefing held in an advance of the upcoming 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.

"We were encouraged by the high adherence to yoga sessions during radiation therapy," said lead author Kathrin Milbury, PhD, an assistant professor of cancer medicine in the Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center in Houston.

Prior research showed that women with breast cancer may benefit from yoga, and a recent randomized clinical trial found that yoga also relieved the side effects of radiotherapy and hormone therapy in patients with prostate cancer.

 As lung cancer patients often are symptomatic, older, and may be in poor physical shape, Dr Milbury and her team believed that yoga was a low-impact exercise that patients could perform easily. In addition, yoga has a strong emphasis on breathing, an important issue in lung cancer where shortness of breath is a common symptom.

"Patients tend to have difficulties with breathing, depression and fatigue," Dr Milbury said. "Cancer treatments may worsen these symptoms and reduce their physical function and overall quality of life."

During the study's yoga sessions, patients were accompanied by caregivers, who also benefited from the ancient practice.

"Similar to patients, family members providing care and support to the patient may also feel tired and anxious and sad," she explained during her presentation.

Dr Milbury sees yoga as a good fit for lung cancer patients:"There's reason to believe that yoga therapy involving breathing exercises and guided meditation or visualization may benefit this understudied population and may be an effective behavioral supportive care strategy."

Improvements Seen Across Parameters

In this feasibility study, the primary goal was to evaluate if patients with advanced lung cancer undergoing treatment were physically able to participate in a 15-session yoga program. The authors also wanted to see if participation in a yoga program improved patient physical fitness and quality of life for both the patient and caregiver.

The study comprised patients with non-small cell lung cancer (NSCLC) who were undergoing 6 weeks of radiation therapy, with or without chemotherapy, and who had a caregiver willing to participate in the study. Patients and their caregivers were randomized to either a 15-session yoga program or a waitlist control group. At baseline, all participants completed a 36-point survey assessing their quality of life (SF-36 domains) as well as the 6-minute walk test to measure physical performance.

A total of 26 patient/caregiver dyads completed all assessments, were reevaluated at the last day of radiation therapy, and were evaluated again 3 months later.

The patients were a mean age of 73 years (63% female, 67% stage III) and caregivers 62 years (38% female, 63% spouses), and completed a mean of 12 sessions.

Overall, 96% of the participants rated the program as "very useful."  After controlling for baseline levels and other relevant covariates, multilevel modeling showed that yoga was associated with a clinically and statistically significant difference in the measures evaluated.

"We saw preliminary results of improved physical function and quality of life," Dr Milbury noted.

For the6-minute walk test the mean distance covered for the yoga group was 478 meters compared with 402 meters for controls (D = 1.19; P < .05). A difference of 7 meters indicates a clinically significant difference, she pointed out. "Over time, the control group further declined in their physical fitness while the yoga group remained stable."

There were also clinically significant improvements in stamina and ability to perform daily tasks, and in the mental health domains of the SF-36.

"We were encouraged by the findings overall," Dr Milbury concluded, "And that advanced lung cancer patients undergoing treatment are not too sick to participate in a behavioral supportive intervention. Both caregivers and patients reported to have enjoyed the experience, and it gave them time away from cancer and they learned something new together."

 New steps will be a larger efficacy trial with a more stringent control group.

"This is a welcome addition in the ever growing body of literature on the benefit of yoga and other non-pharmacologic therapies that can be integrated not only into the care of cancer patients but also the caregivers who support them," commented American Society of Clinical Oncology expert Andrew S. Epstein, MD, moderator of the briefing.

This study was funded by the National Institutes of Health. Dr Milbury has disclosed no relevant financial relationships. Coauthors Zhongxing X. Liao, MD, reports Speakers' Bureau for Varian Medical Systems; travel, accommodations, and expenses from Varian Medical Systems; and honoraria from Varian Medical Systems. Lorenzo Cohen, PhD, reports consulting or advisory role with Cancer Treatment Centers of America; travel, accommodations, and expenses from Teva; and honoraria from Teva. Dr Epstein reports a relationship with Up to Date.

Palliative Care in Oncology Symposium (PCOS) 2017: Abstract 25. Presented October 27, 2017.

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