Longitudinal Impact of Yoga on Chemotherapy-Related Cognitive Impairment and Quality of Life in Women with Early Stage Breast Cancer: A Case Series
Adjuvant chemotherapy for women with breast cancer has significantly improved the cure rate; however, it has been associated with chemotherapy-related cognitive impact (CRCI). The literature provides preliminary support for the feasibility and efficacy of yoga interventions for the general cancer population, however, controlled trials are scarce and no studies have examined the effect of yoga on cognition for women with breast cancer during chemotherapy. This case series aims to identify the impact of yoga on measures of cognition, functional outcomes, and quality of life (QOL) for breast cancer survivors (BCS).
Four women with a diagnosis of early-stage breast cancer prior to chemotherapy treatment were administered the following physiologic measures at baseline, 6, and 12 weeks during chemotherapy, and at one and three months after the conclusion of the study: Functional Reach test (balance) and Sit and Reach test (flexibility), and QOL, POMS (Mood) and FACT-B (QOL), at baseline. Primary outcomes of cognition were measured with the Perceived Cognition Questionnaire (PCQ) and CogState, a computerized measurement of cognition. Women attended an Iyengar-inspired yoga program twice a week for 12 weeks. Qualitative questionnaires were administered after the completion of the study to determine perceived benefits and challenges of the yoga program.
Four women with Stage II breast cancer ranged in age from 44-65 years. CogState computerized testing showed changes in varying domains of cognition through treatment and follow-up. Improved balance, flexibility, and QOL were also noted over time. No adverse events were observed. Analysis of qualitative data revealed the yoga classes were helpful and subjects continued the practice elements of yoga including relaxation, breathing, and stretching. The most challenging aspect of the study was physical limitations due to various medical complications and included fatigue, decreased range of motion, and pain.
This case series suggests that yoga may impact various aspects of cognition during and after chemotherapy administration as noted through quantitative measures. Women describe yoga as improving various domains of QOL through the treatment trajectory. This mind-body intervention may stave off CRCI; however, further investigation is needed for additional randomized controlled trials on the effects of yoga on cognition for women with breast cancer undergoing adjuvant chemotherapy treatment.
Available from: Manoj Sharma
- "significantly; for every 1 h of yoga practiced, the quality-of-life scores improved by a specific coefficient found for each subscale (e.g., depression, stress, physical component) Galantino et al., 2012 14 Pretest–post-test design; 4 women with early-stage breast cancer "
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Cancer is an important public health concern, with millions of patients affected worldwide. Given the physical, psychological, and physiologic changes associated with cancer, holistic therapies are needed to treat all aspect of the disease.
A systematic review was conducted to determine the efficacy of yoga as a treatment option for cancer since 2010. Included studies were published from January 2010 to July 2012 and were indexed in MEDLINE, CINAHL, and Alt HealthWatch.
Thirteen studies met the inclusion criteria. Eight of these studies were performed in the United States, and one each was conducted in Slovenia, Italy, the United Kingdom, Canada, and Turkey.
The evidence for efficacy of yoga as an alternative and complementary treatment for cancer is mixed, although generally positive. Limitations of the reviewed interventions included a mixed use of instruments, weak quantitative designs, small sample sizes, and a lack of theory-based studies.
Available from: ncbi.nlm.nih.gov
- "Evidence-Based Complementary and Alternative Medicine Table 3: Components of Yoga. West [USA, Europe, Australia, Brazil, and Turkey] Back pain Other pain CVD Cancer Total Percentage Postures 9 (Galantino 04, Jacobs 04, Williams 05, Sherman 05, Williams 09, Saper 09, Cox 10, Tilbrook 11, and Sherman 11) 6 (Carson 2011 (fibromyalgia), da Silva 2007 (fibromyalgia), Evans 2011 (IBS), Evans 2011 (rheumatoid arthritis), Garfinkel 1998 (carpal tunnel syndrome), and Kuttner 2007 (IBS)) 5 (Cade 2010, Cheema 2011, Pullen 2008, Pullen 2010, and van Montfrans 1990) 7 (Banasik 2011, Carson 2009, Cohen 2004, Culos-Reed 2006, Galantino 2012, Moadal 2007, and Ulger 2010) 27 96% Breathing 6 (Galantino 04, Sherman 05, Saper 09, Cox 10, Tilbrook 11, and Sherman 11) 3 (Carson 2011 (fibromyalgia), da Silva 2007 (fibromyalgia), and Kuttner 2007 (IBS)) 5 (Cade 2010, Cheema 2011, Pullen 2008, Pullen 2010, and van Montfrans 1990) 7 (Carson 2009, Cohen 2004, Culos-Reed 2006, Galantino 2012, Kovacic 2011, Moadal 2007, and Ulger 2010) 21 75% Relaxation 7 (Galantino 04, Jacobs 04, Sherman 05, Saper 09, Cox 10, Tilbrook 11, and Sherman 11) 2 (da Silva 2007 (fibromyalgia), Garfinkel 1998 (carpal tunnel syndrome)) 4 (Cade 2010, Pullen 2008, Pullen 2010, and van Montfrans 1990) 4 (Culos-Reed 2006, Galantino 2012, Kovacic 2011, and Ulger 2010) 17 61% "
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ABSTRACT: Little guidance is available to assist researchers in developing treatment protocols for research on yoga for health concerns. Because yoga is a complex multifactorial mind-body discipline historically developed for nonmedical purposes, numerous decisions must be made in order to thoughtfully develop such protocols. In this paper, a systematic approach is proposed to assist researchers in selecting an intervention that is appropriate for the condition under consideration and explicitly developed. Researchers need to consider the type or "style" of yoga, the components to include (e.g., breathing exercises, postures) as well as the specific protocol for each component, the dose to be delivered (frequency, duration of practice, and the total duration of practice), and issues related to selection of instructors and monitoring the fidelity to the intervention. Each of these domains and the key issues for the development of protocols is discussed. Finally, some areas for further research related to protocol development are recommended.
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ABSTRACT: Meditation and attention are considered associated in different ways. For example, contemporary concepts state that to meditate, a practitioner has either to (i) focus attention on the object of meditation (FA) or (ii) maintain vigilance and disengage their attention consciously from all distracters (OM). The Indian sage Patanjali (circa 900 B.C.), mentioned that there are two stages of meditation, which differ subtly from the descriptions of FA and OM. One stage is called dharana, or focusing attention on the object of meditation. Another stage is called dhyana, during which all thoughts remain effortlessly directed to the object of meditation, excluding all other thoughts. Vigilance and attention are not required during dhyana, which is the actual phase of meditation. In a previous study, participants who practiced dharana performed better in a task for selective attention than those who practiced dhyana. Brainstem auditory evoked potential changes during the two states differed. Descriptions of yoga practices from ancient texts can give added insights about meditation and attention, supported by objective assessments.
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