A B S T R A C T PurposePrevious research incorporating yoga (YG) into radiotherapy (XRT) for women with breast cancer finds improved quality of life (QOL). However, shortcomings in this research limit the findings. Patients and MethodsPatients with stages 0 to III breast cancer were recruited before starting XRT and were randomly assigned to YG (n ϭ 53) or stretching (ST; n ϭ 56) three times a week for 6 weeks during XRT or waitlist (WL; n ϭ 54) control. Self-report measures of QOL (Medical Outcomes Study 36-item short-form survey; primary outcomes), fatigue, depression, and sleep quality, and five saliva samples per day for 3 consecutive days were collected at baseline, end of treatment, and 1, 3, and 6 months later. ResultsThe YG group had significantly greater increases in physical component scale scores compared with the WL group at 1 and 3 months after XRT (P ϭ .01 and P ϭ .01). At 1, 3, and 6 months, the YG group had greater increases in physical functioning compared with both ST and WL groups (P Ͻ .05), with ST and WL differences at only 3 months (P Ͻ .02). The group differences were similar for general health reports. By the end of XRT, the YG and ST groups also had a reduction in fatigue (P Ͻ .05). There were no group differences for mental health and sleep quality. Cortisol slope was steepest for the YG group compared with the ST and WL groups at the end (P ϭ .023 and P ϭ .008) and 1 month after XRT (P ϭ .05 and P ϭ .04). ConclusionYG improved QOL and physiological changes associated with XRT beyond the benefits of simple ST exercises, and these benefits appear to have long-term durability.

Acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea/vomiting, but additional studies are needed. For other symptoms, efficacy remains undetermined owing to high ROB among studies. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.

Hypothesis This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy. Methods Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.

In a previous systematic review of the worldwide literature of randomized controlled trials (RCTs) involving needle insertion into acupuncture points for symptom management in cancer patients, we identified only one high-quality RCT that was deemed to have a low risk of bias. Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 with no language limits applied. A total of 41 RCTs met all inclusion criteria and were rated. In the current review, we examined 18 trials published since our last report. The purpose of this update was to emphasize important recent findings and discuss how concerns such as blinding, separating non-specific placebo effects from specific needling effects, determining biologic mechanisms and dosing parameters, evaluating determinants of response such as expectation, controlling for sources of bias, and the lack of standardization in treatment and study methods may affect the interpretation of study results.