Effect of Yoga on Sleep Quality and Neuroendocrine Immune Response in Metastatic Breast Cancer Patients

Raghavendra Mohan Rao, H S Vadiraja, R Nagaratna, K S Gopinath, Shekhar Patil, Ravi B Diwakar, H P Shahsidhara, B S Ajaikumar, H R Nagendra, Raghavendra Mohan Rao, H S Vadiraja, R Nagaratna, K S Gopinath, Shekhar Patil, Ravi B Diwakar, H P Shahsidhara, B S Ajaikumar, H R Nagendra

Abstract

Background: Studies have shown that distress and accompanying neuroendocrine stress responses as important predictor of survival in advanced breast cancer patients. Some psychotherapeutic intervention studies have shown have modulation of neuroendocrine-immune responses in advanced breast cancer patients. In this study, we evaluate the effects of yoga on perceived stress, sleep, diurnal cortisol, and natural killer (NK) cell counts in patients with metastatic cancer.

Methods: In this study, 91 patients with metastatic breast cancer who satisfied selection criteria and consented to participate were recruited and randomized to receive "integrated yoga based stress reduction program" (n = 45) or standard "education and supportive therapy sessions" (n = 46) over a 3 month period. Psychometric assessments for sleep quality were done before and after intervention. Blood draws for NK cell counts were collected before and after the intervention. Saliva samples were collected for three consecutive days before and after intervention. Data were analyzed using the analysis of covariance on postmeasures using respective baseline measure as a covariate.

Results: There was a significant decrease in scales of symptom distress (P < 0.001), sleep parameters (P = 0.02), and improvement in quality of sleep (P = 0.001) and Insomnia Rating Scale sleep score (P = 0.001) following intervention. There was a decrease in morning waking cortisol in yoga group (P = 0.003) alone following intervention. There was a significant improvement in NK cell percent (P = 0.03) following intervention in yoga group compared to control group.

Conclusion: The results suggest modulation of neuroendocrine responses and improvement in sleep in patients with advanced breast cancer following yoga intervention.

Keywords: Cortisol; immune; natural killer cell; sleep; yoga.

Conflict of interest statement

There are no conflicts of interest.

Figures

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Figure 1
Trial profile

References

    1. Cleeland CS, Mayer M, Dreyer NA, Yim YM, Yu E, Su Z, et al. Impact of symptom burden on work-related abilities in patients with locally recurrent or metastatic breast cancer: Results from a substudy of the VIRGO observational cohort study. Breast. 2014;23:763–9.
    1. Kenne Sarenmalm E, Ohlén J, Odén A, Gaston-Johansson F. Experience and predictors of symptoms, distress and health-related quality of life over time in postmenopausal women with recurrent breast cancer. Psychooncology. 2008;17:497–505.
    1. Hagen KB, Aas T, Lode K, Gjerde J, Lien E, Kvaløy JT, et al. Illness uncertainty in breast cancer patients: Validation of the 5-item short form of the Mishel Uncertainty in Illness Scale. Eur J Oncol Nurs. 2015;19:113–9.
    1. Berger AM. Update on the state of the science: Sleep-wake disturbances in adult patients with cancer. Oncol Nurs Forum. 2009;36:E165–77.
    1. Fetveit A. Late-life insomnia: A review. Geriatr Gerontol Int. 2009;9:220–34.
    1. Berger AM, Farr L. The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncol Nurs Forum. 1999;26:1663–71.
    1. Abercrombie HC, Giese-Davis J, Sephton S, Epel ES, Turner-Cobb JM, Spiegel D. Flattened cortisol rhythms in metastatic breast cancer patients. Psychoneuroendocrinology. 2004;29:1082–92.
    1. Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000;92:994–1000.
    1. Giese-Davis J, Sephton SE, Abercrombie HC, Durán RE, Spiegel D. Repression and high anxiety are associated with aberrant diurnal cortisol rhythms in women with metastatic breast cancer. Health Psychol. 2004;23:645–50.
    1. Baltrusch HJ, Stangel W, Titze I. Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research. Acta Neurol (Napoli) 1991;13:315–27.
    1. Levy S, Herberman R, Lippman M, d’Angelo T. Correlation of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with breast cancer. J Clin Oncol. 1987;5:348–53.
    1. Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress management: A randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3–10.
    1. Cruess DG, Antoni MH, McGregor BA, Kilbourn KM, Boyers AE, Alferi SM, et al. Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer. Psychosom Med. 2000;62:304–8.
    1. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;2:888–91.
    1. Lengacher CA, Kip KE, Barta M, Post-White J, Jacobsen PB, Groer M, et al. A pilot study evaluating the effect of mindfulness-based stress reduction on psychological status, physical status, salivary cortisol, and interleukin-6 among advanced-stage cancer patients and their caregivers. J Holist Nurs. 2012;30:170–85.
    1. 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;23:135–42.
    1. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, et al. 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.
    1. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29:448–74.
    1. Moul D, Pilkonis P, Miewald J. Preliminary study of the test-retest reliability and concurrent validities of the Pittsburgh Insomnia Rating Scale (PIRS) Sleep Abstract Supplement. 2002:A246–7.
    1. Veqar Z, Hussain ME. Validity and reliability of insomnia severity index and its correlation with pittsburgh sleep quality index in poor sleepers among Indian university students. Int J Adolesc Med Health. 2017 pii:/j/ijamhahead-of-print/ijamh-2016-0090/ijamh-2016-0090xml.
    1. Telles S, Nagarathna R, Nagendra HR. Autonomic changes while mentally repeating two syllables – One meaningful and the other neutral. Indian J Physiol Pharmacol. 1998;42:57–63.
    1. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration following two yoga relaxation techniques. Appl Psychophysiol Biofeedback. 2000;25:221–7.
    1. Helgeson VS, Cohen S, Schulz R, Yasko J. Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer. Health Psychol. 2001;20:387–92.
    1. Helgeson VS, Cohen S, Schulz R, Yasko J. Education and peer discussion group interventions and adjustment to breast cancer. Arch Gen Psychiatry. 1999;56:340–7.
    1. Burish TG, Snyder SL, Jenkins RA. Preparing patients for cancer chemotherapy: Effect of coping preparation and relaxation interventions. J Consult Clin Psychol. 1991;59:518–25.
    1. Greer S, Moorey S, Baruch JD, Watson M, Robertson BM, Mason A, et al. Adjuvant psychological therapy for patients with cancer: A prospective randomised trial. Br Med J. 1992;304:675–80.
    1. Telch CF, Telch MJ. Group coping skills instruction and supportive group therapy for cancer patients: A comparison of strategies. J Consult Clin Psychol. 1986;54:802–8.
    1. Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003;28:916–31.
    1. Rogosa D, Saner H. Longitudinal data analysis examples with random coefficient models. J Educ Behav Statistics. 1995;20:149–70.
    1. Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med. 2005;12:278–85.
    1. Schedlowski M, Jung C, Schimanski G. Effects of behavioral intervention on plasma cortisol and lymphocytes in breast cancer patients: An exploratory study. Psychooncology. 1994;3:181–7.
    1. van der Pompe G, Duivenvoorden HJ, Antoni MH, Visser A, Heijnen CJ. Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: An exploratory study. J Psychosom Res. 1997;42:453–66.
    1. Turner-Cobb JM, Sephton SE, Koopman C, Blake-Mortimer J, Spiegel D. Social support and salivary cortisol in women with metastatic breast cancer. Psychosom Med. 2000;62:337–45.

Source: PubMed

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