Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy

Abstract

Background: The current randomized trial examined the effects of a Tibetan yoga program (TYP) versus a stretching program (STP) and usual care (UC) on sleep and fatigue in women with breast cancer who were undergoing chemotherapy.

Methods: Women with stage (American Joint Committee on Cancer (AJCC) TNM) I to III breast cancer who were undergoing chemotherapy were randomized to TYP (74 women), STP (68 women), or UC (85 women). Participants in the TYP and STP groups participated in 4 sessions during chemotherapy, followed by 3 booster sessions over the subsequent 6 months, and were encouraged to practice at home. Self-report measures of sleep disturbances (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and actigraphy were collected at baseline; 1 week after treatment; and at 3, 6, and 12 months.

Results: There were no group differences noted in total sleep disturbances or fatigue levels over time. However, patients in the TYP group reported fewer daily disturbances 1 week after treatment compared with those in the STP (difference, -0.43; 95% confidence interval [95% CI], -0.82 to -0.04 [P = .03]) and UC (difference, -0.41; 95% CI, -0.77 to -0.05 [P = .02]) groups. Group differences at the other time points were maintained for TYP versus STP. Actigraphy data revealed greater minutes awake after sleep onset for patients in the STP group 1 week after treatment versus those in the TYP (difference, 15.36; 95% CI, 7.25-23.48 [P = .0003]) and UC (difference, 14.48; 95% CI, 7.09-21.87 [P = .0002]) groups. Patients in the TYP group who practiced at least 2 times a week during follow-up reported better Pittsburgh Sleep Quality Index and actigraphy outcomes at 3 months and 6 months after treatment compared with those who did not and better outcomes compared with those in the UC group.

Conclusions: Participating in TYP during chemotherapy resulted in modest short-term benefits in sleep quality, with long-term benefits emerging over time for those who practiced TYP at least 2 times a week. Cancer 2018;124:36-45. © 2017 American Cancer Society.

Keywords: Tibetan yoga; breast cancer; chemotherapy; patients; sleep quality.

Conflict of interest statement

Conflicts of Interest:

None

© 2017 American Cancer Society.

Figures

Fig. 1

CONSORT diagram. Abbreviations: TYP, Tibetan Yoga Program; STP, Stretch Program; UC, Usual Care.

Fig 2

Contrast comparisons for daily disturbances subscale of the (a) Pittsburg Sleep Quality Index – Total, (b) Pittsburgh Sleep Quality Index – Daily Disturbances, and (c) Brief Fatigue Inventory. CONTRAST statements within the mixed procedure were used to test for group differences adjusting for stage of disease, type of surgery, chemotherapy regimen (weekly versus every 3 weeks), timing of chemotherapy (adjuvant versus neoadjuvent), menopausal status, age, and time since diagnosis. Abbreviations: TYP, Tibetan Yoga Program; STP, Stretch Program; UC, Usual Care. * TYUC (p=0.026) ᶲ TY