Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer

Teresa Zetzl, Agnes Renner, Andre Pittig, Elisabeth Jentschke, Carmen Roch, Birgitt van Oorschot, Teresa Zetzl, Agnes Renner, Andre Pittig, Elisabeth Jentschke, Carmen Roch, Birgitt van Oorschot

Abstract

Purpose: Examine the effects of an 8-week yoga therapy on fatigue in patients with different types of cancer.

Methods: A total of 173 cancer patients suffering from mild to severe fatigue were randomly allocated to yoga intervention (n = 84) (IG) versus waitlist control group (CG) (n = 88). Yoga therapy consisted of eight weekly sessions with 60 min each. The primary outcome was self-reported fatigue symptoms. Secondary outcomes were symptoms of depression and quality of life (QoL). Data were assessed using questionnaires before (T0) and after yoga therapy for IG versus waiting period for CG (T1).

Results: A stronger reduction of general fatigue (P = .033), physical fatigue (P = .048), and depression (P < .001) as well as a stronger increase in QoL (P = .002) was found for patients who attended 7 or 8 sessions compared with controls. Within the yoga group, both higher attendance rate and lower T0-fatigue were significant predictors of lower T1-fatigue (P ≤ .001). Exploratory results revealed that women with breast cancer report a higher reduction of fatigue than women with other types of cancer (P = .016) after yoga therapy.

Conclusion: The findings support the assumption that yoga therapy is useful to reduce cancer-related fatigue, especially for the physical aspects of fatigue. Women with breast cancer seem to benefit most, and higher attendance rate results in greater reduction of fatigue.

Trial registration: German Clinical Trials Register DRKS00016034.

Keywords: Complementary alternative medicine; Depression; Fatigue; Mind-body intervention; Quality of life; Yoga.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram showing screening, allocation, and participant flow by group
Fig. 2
Fig. 2
Mean changes in a EORTC QLQ FA 12–General Fatigue, b EORTC QLQ FA12–Physical Fatigue, c PHQ-9 Depression Score, and d EORTC QLQ C15 PAL–Quality between T0 und T1 in IG (completers) and CG. Results show mean and 95% CI

References

    1. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023–1075. doi: 10.1016/S0140-6736(17)33326-3.
    1. Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C, National comprehensive cancer network Cancer-related fatigue, version 2.2015. J Natl Compr Canc Ne. 2015;13(8):1012–1039. doi: 10.6004/jnccn.2015.0122.
    1. Ahlberg K, Ekman T, Wallgren A, Gaston-Johansson F. Fatigue, psychological distress, coping and quality of life in patients with uterine cancer. J Adv Nurs. 2004;45(2):205–213. doi: 10.1046/j.1365-2648.2003.02882.x.
    1. Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ. Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist. 2000;5(5):353–360. doi: 10.1634/theoncologist.5-5-353.
    1. Brown LF, Kroenke K. Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics. 2009;50(5):440–447. doi: 10.1176/appi.psy.50.5.440.
    1. Jones JM, Olson K, Catton P, Catton CN, Fleshner NE, Krzyzanowska MK, McCready DR, Wong RKS, Jiang H, Howell D. Cancer-related fatigue and associated disability in post-treatment cancer survivors. J Cancer Surviv. 2016;10(1):51–61. doi: 10.1007/s11764-015-0450-2.
    1. Bower JE. Cancer-related fatigue: links with inflammation in cancer patients and survivors. Brain Behav. 2007;21(7):863–871. doi: 10.1016/j.bbi.2007.03.013.
    1. Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol. 2008;26(6):971–982. doi: 10.1200/JCO.2007.10.7805.
    1. Schubert C, Hong S, Natarajan L, Mills PJ, Dimsdale JE. The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun. 2007;21(4):413–427. doi: 10.1016/j.bbi.2006.11.004.
    1. Al-Majid S, McCarthy DO. Cancer-Induced Fatigue and Skeletal Muscle Wasting: The Role of Exercise. Biol Res Nurs. 2001;2(3):186–197. doi: 10.1177/109980040100200304.
    1. Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18(4):743–753. doi: 10.1200/JCO.2000.18.4.743.
    1. Donovan KA, Small BJ, Andrykowski MA, Munster P, Jacobsen PB. Utility of a cognitive-behavioral model to predict fatigue following breast cancer treatment. Health Psychol. 2007;26(4):464–472. doi: 10.1037/0278-6133.26.4.464.
    1. Kangas M, Bovberg Monthomery G (2008) Cancer-related fatigue: a systematic and meta-analytic review of non pharmacological therapies for cancer patients. Psychol Bull 134(5):700–741
    1. National Comprehensive Cancer Network (2017) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Cancer-related fatigue [v. 2.2017]
    1. Buffart LM, van Uffelen JGZ, Riphagen II, Brug J, van Mechelen W, Brown WJ, Chinapaw MJM. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012;12(1):559. doi: 10.1186/1471-2407-12-559.
    1. Xunlin NG, Lau Y, Klainin-Yobas P. The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis. Support Care Cancer. 2020;28(4):1563–1578. doi: 10.1007/s00520-019-05219-9.
    1. Cramer H, Lauche R, Langhorst J, Paul A, Michalsen A, Dobos G. Predictors of yoga use among internal medicine patients. BMC Complem Altern M. 2013;13(1):172. doi: 10.1186/1472-6882-13-172.
    1. Vadiraja HS, Raghavendra RM, et al. Effects of yoga in managing fatigue in breast cancer patients: a randomized controlled trial. Indian J Palliat Care. 2017;23(3):247. doi: 10.4103/IJPC.IJPC_95_17.
    1. Bower JE. Cancer-related fatigue—mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597–609. doi: 10.1038/nrclinonc.2014.127.
    1. Chen N, Xia X, Qin L, Luo L, Han S, Wang G, Zhang R, Wan Z. Effects of 8-week Hatha yoga training on metabolic and inflammatory markers in healthy, female chinese subjects: a randomized clinical trial. Biomed Res Int. 2016;2016:5387258–5387212. doi: 10.1155/2016/5387258.
    1. Kiecolt-Glaser JK, Bennett JM, Andridge R, Peng J, Shapiro CL, Malarkey WB, Emery CF, Layman R, Mrozek EE, Glaser R. Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol. 2014;32(10):1040–1049. doi: 10.1200/JCO.2013.51.8860.
    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(3):135–142. doi: 10.1111/j.1745-7599.2010.00573.x.
    1. Gothe NP, Keswani RK, McAuley E. Yoga practice improves executive function by attenuating stress levels. Biol Psychol. 2016;121(Pt A):109–116. doi: 10.1016/j.biopsycho.2016.10.010.
    1. Vadiraja HS, Raghavendra RM, Nagarathna R, 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(1):37–46. doi: 10.1177/1534735409331456.
    1. Peppone LJ, Janelsins MC, Kamen C, Mohile SG, Sprod LK, Gewandter JS, Kirshner JJ, Gaur R, Ruzich J, Esparaz BT, Mustian KM. The effect of YOCAS(c)(R) yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy. Breast Cancer Res Tr. 2015;150(3):597–604. doi: 10.1007/s10549-015-3351-1.
    1. Cramer H, Pokhrel B, Fester C, Meier B, Gass F, Lauche R, Eggleston B, Walz M, Michalsen A, Kunz R, Dobos G, Langhorst J. A randomized controlled bicenter trial of yoga for patients with colorectal cancer. Psycho-oncology. 2016;25(4):412–420. doi: 10.1002/pon.3927.
    1. Carson JW, Carson KM, Olsen MK, Sanders L, Porter LS. Mindful yoga for women with metastatic breast cancer: design of a randomized controlled trial. BMC Complem Altern M. 2017;17(1):153. doi: 10.1186/s12906-017-1672-9.
    1. 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(2):43–55.
    1. Lin P-J, Peppone LJ, Janelsins MC, Mohile SG, Kamen CS, Kleckner IR, Fung C, Asare M, Cole CL, Culakova E, Mustian KM. Yoga for the management of cancer treatment-related toxicities. Curr Oncol. 2018;20(1):5. doi: 10.1007/s11912-018-0657-2.
    1. Fischer I, Weis J, Rüffer JU, et al. Tumorassoziierte Fatigue in der Palliativsituation. Zeitschrift für Palliativmedizin. 2017;18(02):97–110. doi: 10.1055/s-0042-124041.
    1. Lundt A, Jentschke E. Long-term changes of symptoms of anxiety, depression, and fatigue in cancer patients 6months after the end of yoga therapy. Integr Cancer Ther. 2019;18:1534735418822096. doi: 10.1177/1534735418822096.
    1. 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(4):360–368. doi: 10.1002/pon.1503.
    1. Weis J, Tomaszewski KA, Hammerlid E, Ignacio Arraras J, Conroy T, Lanceley A, Schmidt H, Wirtz M, Singer S, Pinto M, Alm el-Din M, Compter I, Holzner B, Hofmeister D, Chie WC, Czeladzki M, Harle A, Jones L, Ritter S, Flechtner HH, Bottomley A, on Behalf of the EORTC Quality of Life Group International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12) J Natl Cancer I. 2017;109(5):273. doi: 10.1093/jnci/djw273.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Groenvold M, Petersen MA, Aaronson NK, Arraras JI, Blazeby JM, Bottomley A, Fayers PM, de Graeff A, Hammerlid E, Kaasa S, Sprangers MA, Bjorner JB, EORTC Quality of Life Group The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer (Oxford, England : 1990) 2006;42(1):55–64. doi: 10.1016/j.ejca.2005.06.022.
    1. Derry HM, Jaremka LM, Bennett JM, Peng J, Andridge R, Shapiro C, Malarkey WB, Emery CF, Layman R, Mrozek E, Glaser R, Kiecolt-Glaser JK. Yoga and self-reported cognitive problems in breast cancer survivors: a randomized controlled trial. Psycho-oncology. 2015;24(8):958–966. doi: 10.1002/pon.3707.
    1. Garland SN, Tamagawa R, Todd SC, Speca M, Carlson LE. Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integr Cancer Ther. 2013;12(1):31–40. doi: 10.1177/1534735412442370.
    1. Speca M, Carlson LE, Goodey E, Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613–622. doi: 10.1097/00006842-200009000-00004.
    1. 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(28):4387–4395. doi: 10.1200/JCO.2006.06.6027.
    1. 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. 2012;20(2):267–277. doi: 10.1007/s00520-010-1066-8.
    1. Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. Am J Prev Med. 2016;50(2):230–235. doi: 10.1016/j.amepre.2015.07.037.
    1. Barnes B, Kraywinkel K, Nowossadeck E, Schönfeld I, Starker A, Wienecke A, Wolf U (2016) Bericht zum Krebsgeschehen in Deutschland 2016
    1. Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Palesh OG, Chandwani K, Reddy PS, Melnik MK, Heckler C, Morrow GR. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol. 2013;31(26):3233–3241. doi: 10.1200/JCO.2012.43.7707.
    1. Hardoerfer K, Jentschke E. Effect of yoga therapy on symptoms of anxiety in cancer patients. Oncol Res Treat. 2018;41(9):526–532. doi: 10.1159/000488989.
    1. Adams M, Jewell AP. The use of complementary and alternative medicine by cancer patients. Int Semin Surg Oncol. 2007;4:10. doi: 10.1186/1477-7800-4-10.
    1. Bahall M. Prevalence, patterns, and perceived value of complementary and alternative medicine among cancer patients: a cross-sectional, descriptive study. BMC Complement Altern Med. 2017;17(1):345. doi: 10.1186/s12906-017-1853-6.
    1. Danhauer SC, Addington EL, Cohen L, Sohl SJ, van Puymbroeck M, Albinati NK, Culos-Reed SN. Yoga for symptom management in oncology: a review of the evidence base and future directions for research. Cancer. 2019;125(12):1979–1989. doi: 10.1002/cncr.31979.
    1. Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G. Yoga for persistent fatigue in breast cancer survivors. Cancer. 2012;118(15):3766–3775. doi: 10.1002/cncr.26702.
    1. Zetzl T, Schuler M, Renner A, Jentschke E, van Oorschot B. Yoga intervention and reminder e-mails for reducing cancer-related fatigue-a study protocol of a randomized controlled trial. BMC Psych. 2019;7(1):64. doi: 10.1186/s40359-019-0339-3.

Source: PubMed

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