A Lotus, A Triangle. . .and A Better Quality of Life: Yoga and Cancer

I’m a yoga junkie. I practice every day, and never miss my class on Wednesday nights–ever. Had one of my children chosen a Wednesday night for their wedding, I just would have begged off from 7-8:30, manipulated my body into odd configurations, and, returned, none the worse for wear.

I even love the Sanskrit names for the poses (known to the cognoscenti as “asanas”), and, although this certainly must make me look like a first-class show-off, when I practice lotus pose at home I announce, ‘I will now be doing Padmasana,’ and there’s no utilitarian ‘down-dog’ for me. Oh no. It’s (are you paying attention?) Adho Mukha Savasana.

In my advanced years I’ve perfected the headstand and am working on the handstand, despite eye-rolling from certain family members who shall remain unnamed–for the minute.

And I intuitively know that yoga is truly good for your body–more healing than jogging, more peaceful than the stairmaster, more complex than schlepping barbels up and down. I’ve recommended it to my cancer patients.

But I didn’t have proof of yoga’s healing effects on cancer patients and survivors until recently–and now there’ll really be no stopping me.


Actually, there have been a few studies on yoga’s impact on cancer, but very few of them  have been (have I taught you anything? What’s the phrase in scientific research? Quick guess. . . ) randomized controlled trials (RCT) (please tell me you knew that).

Lucky for us scientists took it into their heads to do things the right way. Of course, it started in a place far, far away, where they really know how to appreciate yoga (if maybe not always RCTs).

Not surprisingly, one of the early studies came out of (three guesses here. . . .) India.

Not to let anyone miss their scientific rigor in utilizing a RCT, they threw it in the title, “Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial” (did you get that?). They bit off a serious amount in this study, which may in fact undercut it a bit. They looked at cancer-related pain, depression, and fatigue–all areas they felt were being under-managed by the standard medical treatment team.

The study looked at 88 recently diagnosed women with stage II and III breast cancer. All had undergone surgery  and were receiving radiotherapy as adjuvant treatment.

As promised by the title, the patients were randomized to receive yoga or supportive talk therapy.

The yoga group did asanas, breathing exercises, and relaxation, while the other group had one-on-one sessions with a therapist.

And results were good. Researchers found:

A significant reduction was observed in psychological distress, physical distress, a significant increase in the activity level . . .and a significant reduction in fatigue, pain, insomnia, nausea and vomiting . . .following yoga intervention as compared to controls.

But there still didn’t seem to be a significant number of papers in mainstream cancer journals. There was one with the winning title, “Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma” in the journal Cancer, which was indeed randomized–but not controlled. So close. [Interestingly, it did find that it improves sleep quality, but found no significance in affective issues, despite the Indian study’s findings].

For it, 128 patients ethnically diverse patients from a Bronx cancer care center were assigned to either 12 weeks of once-a-week yoga, or a 12-week-long waitlist for the yoga. Only half were actually receiving medical treatment.
And another was published in 2007 in the Journal of Clinical Oncology, again touting its RCT credentials in its title, “Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life.” That was an interesting study, as it was the first to confirm that results found inCaucasian women applied to minorities, as well.

Turns out that attendance wasn’t too good to the yoga program, so that’s one of this study’s serious limitations. That may explain why the results were somewhat tepid. the upshot: More women from the non-yoga group “experienced a worsening of social well-being” in contrast to the yoga-intervention group (13% vs. 2%). However, the researchers did not find that yoga improves social well-being. Not exactly earth-shattering.

And then recently came a really large RCT in a major journal that got more compelling results.

According to researchers from the University of Rochester School of Medicine, cancer-related fatigue is the single most common side effect for cancer patients both during and after treatment (see Mustian 2009). It can come from the cancer itself, the treatment, and/or the treatment side effects. The fatigue frequently goes on long after treatment is completed.

Karen Mustian, Ph.D., director of the University of Rochester Cancer Center Community Clinical Oncology Program, and her colleagues, assert that 80% of cancer patients report trouble sleeping while in treatment, and a staggering 65% continue to struggle after treatment ends.

And then in a double-whammy–there’s sleep disturbance. Just when the patient craves–and needs–sleep like never before, there he is, desperately counting sheep, exhausted, as the minutes–and then hours–tick by.

It’s really not a satisfactory scenario.

Sleep can be chased away by any variety of cancer-related events: tumor growth, the treatments, staying overnight in the hospital (where I have never once slept a reasonable night’s sleep, and where the nurses like to come visit me at 11pm and 6am shift changes, just to wake me up to ask me if I’m sleeping), pain, GI distress, fever–really, you name it.

Doctors can give you more pills to pop, but it’s a short-term solution, and certainly doesn’t address the fatigue.

Here’s where knowing your Warrior Poses really pays off.

Mustian and her colleagues decided to do something about the sleep and fatigue problems that didn’t involve pushing more pills–and they  got on the yoga program.

Now I’m a Mustian fan, even if she titled her study one of the more dull and inscrutable titles I’ve come across in at least a few days: “Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors.” I mean–seriously?

(Translation for the alphabet soup impaired: YOCAS (this took a while) = Yoga for Cancer Survivors, URCC = University of Rochester Cancer Center (of course!), and CCOP = Community Clinical Oncology Program. There, now that’s better.)

Mustian’s study moved research out of the realm of individual cancers, was a completely randomized, controlled trial–the largest done to date, and was published in a more established medical journal, so her results have gotten a significant amount of play recently. And they’re pretty positive.

The study looked at non-metastatic cancer survivors who’d had sleep disruption for 2-24 months–and had not participated in yoga in the previous three months to the study. Then they randomized (of course) two groups–1 group just received standard care, the second had 75-minute yoga sessions 2 times per week, incorporating asanas, breathing exercises, and meditation.

The yoga group had a 42 per cent reduction in fatigue, versus only 12 per cent in the control group (that’s significant), and, comparing their pre- and post-yoga scores, the groups had more improvement in the quality of their sleep  (22 versus 12 per cent) and felt sleepy less during the day (29 versus 5 per cent) compared with the non-yoga group–and all that was accomplished while reducing use of sleep medication.

Bring on the Mountain Pose. (Ok–I can’t help it–it’s Tadasana.)


Cohen L, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004; 100(10):2253-60.

Hosakote VS, et al. Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial. International Journal of Yoga 2009; 2:73-9

Moadel AB, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Journal of Clinical Oncology 2007; 25(28):4387-95.

Mustian KM, et al. Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Journal of Clinical Oncology 2010; 28(15suppl):9013.

Mustian KM, et al. Exercise and cancer-related fatigue. US Oncology 2009; 5(2):20–23.

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