Cochrane for Clinicians
Putting Evidence into Practice
Yoga for Cancer-Related Symptoms in Women with Breast Cancer
Am Fam Physician. 2017 Oct 1;96(7):434-435.
Author disclosure: No relevant financial affiliations.
Does yoga improve mental and physical health in women who have been diagnosed with breast cancer?
Yoga improves health-related quality of life, reduces sleep disturbances, and decreases fatigue in the short term (up to 12 weeks) among women diagnosed with breast cancer who have completed cancer-related treatment or are receiving cancer treatment compared with no intervention.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.) There are conflicting results regarding the effect of yoga on depression and anxiety in these patients. No significant differences were noted between yoga and exercise in improving health-related quality of life and fatigue; both were effective. Yoga was not associated with serious adverse effects.1
Yoga is an ancient nonaerobic practice that focuses on breathing, flexibility, and mindfulness. It was used by 9.5% of adults in the United States in 2012.2 Studies have shown that aerobic exercise improves physical functioning as well as quality of life, and that it decreases fatigue and mortality in women diagnosed with breast cancer.1 The authors of this review sought to evaluate whether yoga also improves quality of life for these patients, and whether yoga can be used to treat symptoms associated with breast cancer and its treatment.
This Cochrane review included 23 randomized controlled trials and 2,129 patients.1 Women included in the trial were undergoing or had undergone various types of cancer treatment. Outcomes were determined using a variety of self-report instruments to evaluate health-related quality of life, depression, anxiety, fatigue, and sleep disturbances.
Short-term results over five to 12 weeks showed that yoga improved health-related quality of life compared with no therapy (10 studies, N = 675; pooled standardized mean difference [SMD] = 0.22; 95% confidence interval [CI], 0.04 to 0.40). Yoga also improved fatigue (11 studies, N = 883; pooled SMD = −0.48; 95% CI, −0.75 to −0.20) and decreased sleep disturbances (six studies, N = 657; pooled SMD = −0.25; 95% CI, −0.40 to −0.09) in the short term when compared with no therapy. Yoga did not improve medium-term (30 to 48 weeks) health-related quality of life or fatigue. There was no statistically significant difference in health-related quality of life or fatigue in patients using yoga vs. other forms of exercise.
Compared with no therapy, yoga did not reduce depression or anxiety in patients with breast cancer. In addition, no serious adverse effects were associated with yoga.
The Society for Integrative Oncology recommends yoga to improve symptoms of depression and mood disturbance (Grade A), for anxiety and stress reduction (Grade B), and to improve sleep quality and global quality of life (Grade C) for patients with breast cancer.3 Yoga appears to have beneficial effects on health-related quality of life, fatigue, and sleep disturbance, and the risks of harm are low. Patients interested in pursuing yoga for these indications should be encouraged to do so by their physicians.
The practice recommendations in this activity are available at http://www.cochrane.org/CD010802.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Navy, the U.S. Army, or the Department of Defense.
1. Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health, and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017;(1):CD010802.
2. Clark TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Report. 2015;(79):1–16.
3. Greenlee H, Balneaves LG, Carlson LE, et al.; Society for Integrative Oncology. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer [published correction appears in J Natl Cancer Inst Monogr. 2015;2015(51):98]. J Natl Cancer Inst Monogr. 2014;2014(50):346–358.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
Copyright © 2017 by the American Academy of Family Physicians.
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