Yoga for breast cancer patients and survivors: a systematic review and meta-analysis

BMC Cancer

Holger Cramer¹  Silke Lange¹  Petra Klose¹  Anna Paul¹  Gustav Dobos¹ 

[1] Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, Knappschafts-Krankenhaus, Am Deimelsberg 34a, 45276, Essen, Germany

关键词: Review;    Meta-analysis;    Psychological health;    Quality of life;    Complementary therapies;    Yoga;    Breast neoplasms;   

Others  :  1080197
DOI  :  10.1186/1471-2407-12-412

 received in 2012-03-09, accepted in 2012-09-12,  发布年份 2012

【 摘 要 】

Background

Many breast cancer patients and survivors use yoga to cope with their disease. The aim of this review was to systematically assess and meta-analyze the evidence for effects of yoga on health-related quality of life and psychological health in breast cancer patients and survivors.

Methods

MEDLINE, PsycInfo, EMBASE, CAMBASE, and the Cochrane Library were screened through February 2012. Randomized controlled trials (RCTs) comparing yoga to controls were analyzed when they assessed health-related quality of life or psychological health in breast cancer patients or survivors. Risk of bias was assessed using the Cochrane risk of bias tool. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results

Twelve RCTs with a total of 742 participants were included. Seven RCTs compared yoga to no treatment; 3 RCTs compared yoga to supportive therapy; 1 RCT compared yoga to health education; and 1 RCT compared a combination of physiotherapy and yoga to physiotherapy alone. Evidence was found for short-term effects on global health-related quality of life (SMD = 0.62 [95% CI: 0.04 to 1.21]; P = 0.04), functional (SMD = 0.30 [95% CI: 0.03 to 0.57), social (SMD = 0.29 [95% CI: 0.08 to 0.50]; P < 0.01), and spiritual well-being (SMD = 0.41 [95% CI: 0.08; 0.74]; P = 0.01). These effects were, however, only present in studies with unclear or high risk of selection bias. Short-term effects on psychological health also were found: anxiety (SMD = −1.51 [95% CI: -2.47; -0.55]; P < 0.01), depression (SMD = −1.59 [95% CI: -2.68 to −0.51]; P < 0.01), perceived stress (SMD = −1.14 [95% CI:-2.16; -0.12]; P = 0.03), and psychological distress (SMD = −0.86 [95% CI:-1.50; -0.22]; P < 0.01). Subgroup analyses revealed evidence of efficacy only for yoga during active cancer treatment but not after completion of active treatment.

Conclusions

This systematic review found evidence for short-term effects of yoga in improving psychological health in breast cancer patients. The short-term effects on health-related quality of life could not be clearly distinguished from bias. Yoga can be recommended as an intervention to improve psychological health during breast cancer treatment.

【 授权许可】

   
2012 Cramer et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Lyon, France: International Agency for Research on Cancer; 2010. http://globocan.iarc.fr webcite
• [2]Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ: Cancer Intervention and Surveillance Modeling Network (CISNET): Collaborators: effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005, 353:1784-1792.
• [3]Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S: The prevalence of psychological distress by cancer site. Psychooncology 2001, 10:19-28.
• [4]Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S: Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer 2008, 8:330. BioMed Central Full Text
• [5]Patrick DL, Ferketich SL, Frame PS, Harris JJ, Hendricks CB, Levin B, Link MP, Lustig C, McLaughlin J, Ried LD, Turrisi AT 3rd, Unützer J, Vernon SW: National Institutes of Health State-of-the-Science Panel: National Institutes of Health State-of-the-Science Conference Statement: symptom management in cancer: pain, depression, and fatigue, July 15–17, 2002. J Natl Cancer Inst 2003, 95:1110-1117.
• [6]Andrykowski MA, Lykins E, Floyd A: Psychological health in cancer survivors. Semin Oncol Nurs 2008, 24:193-201.
• [7]Perry S, Kowalski TL, Chang CH: Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health Qual Life Outcomes 2007, 5:24. BioMed Central Full Text
• [8]Fouladbakhsh JM, Stommel M: Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Oncol Nurs Forum 2010, 37:E7-E15.
• [9]Iyengar BKS: Light on yoga. New York: Schocken Books; 1966.
• [10]Feuerstein G: The yoga tradition. Prescott: Hohm Press; 1998.
• [11]Saper RB, Eisenberg DM, Davis RB, Culpepper L, Phillips RS: Prevalence and patterns of adult yoga use in the United States: results of a national survey. Altern Ther Health Med 2004, 10:44-49.
• [12]McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS: Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006, 175:34-41.
• [13]Visovsky C: Muscle strength, body composition, and physical activity in women receiving chemotherapy for breast cancer. Integr Cancer Ther 2006, 5:183-191.
• [14]Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR: Effects of exercise on quality of life in women living with breast cancer: a systematic review. Breast J 2009, 15:45-51.
• [15]Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY: Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evid Based Complement Alternat Med 2011, 2011:659876.
• [16]Smith KB, Pukall CF: An evidence-based review of yoga as a complementary intervention for patients with cancer. Psychooncology 2009, 18:465-475.
• [17]Moher D, Liberati A, Teztlaff J, Altman DG, The PRISMA Group: Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med 2009, 51:1-7.
• [18]Higgins JPT, Green S: Cochrane handbook for systematic reviews of interventions. Version 510th edition. The Cochrane Collaboration; 2011. http://www07November2011.cochrane-handbook.org webcite
• [19]Cramer H, Lauche R, Paul A, Dobos G: Mindfulness-based stress reduction for breast cancer - a systematic review and meta-analysis. Curr Oncol 2012. in press
• [20]Furlan AD, Pennick V, Bombardier C, van Tulder M, Cochrane Back Review Group: 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 2009, 34:1929-1941.
• [21]Cohen J: Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
• [22]Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ 1997, 315:629-634.
• [23]Banasik J, Williams H, Haberman M, Blank SE, Bendel R: Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract 2011, 23:135-142.
• [24]Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS, Ramesh BS, Rao N, Kumar A, Raghuram N, Hegde S, Nagendra HR, Prakash Hande M: Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther 2007, 6:242-250.
• [25]Blank SE, Kittel J, Haberman MR: Active practice of Iyengar yoga as an intervention for breast cancer survivors. Int J Yoga Ther 2003, 13:51-59.
• [26]Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G: Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 2011.
• [27]Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL: Yoga of awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer 2009, 17:1301-1309.
• [28]Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, Nagendra HR, Wei Q, Cohen L: Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 2010, 8:43-55.
• [29]Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, Daley K, Levine EA: Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psychooncology 2009, 18:360-368.
• [30]Kovačič T, Kovačič M: Impact of relaxation training according to Yoga In Daily Life® system on perceived stress after breast cancer surgery. Integr Cancer Ther 2011, 10:16-26.
• [31]Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J, McGregor B, McTiernan A: Randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: effects on quality of life and anthropometric measures. Support Care Cancer 2011.
• [32]Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, Sparano JA: Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 2007, 25:4387-4395.
• [33]Raghavendra MR, Nagendra HR, Raghuram N, Vinay C, Chandrashekara S, Gopinath KS, Srinath BS: Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery. Int J Yoga 2008, 1:11-20.
• [34]Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, Gopinath KS, Srinath BS, Vishweshwara MS, Madhavi YS, Ajaikumar BS, Ramesh BS, Nalini R, Kumar V: Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther 2009, 8:37-46.
• [35]Vadiraja HS, Rao MR, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, Gopinath KS, Srinath BS, Vishweshwara MS, Madhavi YS, Ajaikumar BS, Bilimagga SR, Rao N: Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Complement Ther Med 2009, 17:274-280.
• [36]Vadiraja SH, Rao MR, Nagendra RH, Nagarathna R, Rekha M, Vanitha N, Gopinath SK, Srinath B, Vishweshwara M, Madhavi YS Ajaikumar B, Ramesh SB, Rao N: Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. Int J Yoga 2009, 2:73-79.
• [37]Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S: A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology 2006, 15:891-897.
• [38]Rao RM, Telles S, Nagendra HR, Nagarathna R, Gopinath K, Srinath S, Chandrashekara C: Effects of yoga on natural killer cell counts in early breast cancer patients undergoing conventional treatment. Comment to: recreational music-making modulates natural killer cell activity, cytokines, and mood states in corporate employees Masatada Wachi, Masahiro Koyama, Masanori Utsuyama, Barry B. Bittman, Masanobu Kitagawa, Katsuiku Hirokawa Med Sci Monit, 2007; 13(2): CR57-70. Med Sci Monit 2008, 14:LE3-4.
• [39]Raghavendra MR, Nagendra HR, Raghuram N, Vinay C, Chandrashekara S, Gopinath KS, Srinath BS: Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Int J Yoga 2008, 1:33-41.
• [40]Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, Diwakar RB, Patil S, Bilimagga SR, Rao N, Varambally S: Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complement Ther Med 2009, 17:1-8.
• [41]Ledesma D, Kumano H: Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology 2009, 18:571-579.
• [42]Shapiro D, Cline K: Mood changes associated with Iyengar yoga practices: a pilot study. Int J Yoga Ther 2004, 14:35-44.
• [43]Cramer H, Lauche R, Haller H, Dobos G: A systematic review and meta-analysis of yoga for low back pain. Clin J Pain in press.
• [44]Lundh A, Gøtzsche PC: Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies. BMC Med Res Methodol 2008, 8:22. BioMed Central Full Text
• [45]Bower JE, Woolery A, Sternlieb B, Garet D: Yoga for cancer patients and survivors. Cancer Control 2005, 12:165-171.
• [46]Hede K: Supportive care: large studies ease yoga, exercise into mainstream oncology. J Natl Cancer Inst 2011, 103:11-12.