Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors

Abstract

Background: Cancer-related fatigue (CRF) often co-occurs with sleep disturbance and is one of the most pervasive toxicities resulting from cancer and its treatment. We and other investigators have previously reported that yoga therapy can improve sleep quality in cancer patients and survivors. No nationwide multicenter phase III randomized controlled trial (RCT) has investigated whether yoga therapy improves CRF or whether improvements in sleep mediate the effect of yoga on CRF. We examined the effect of a standardized, 4-week, yoga therapy program (Yoga for Cancer Survivors [YOCAS]) on CRF and whether YOCAS-induced changes in sleep mediated changes in CRF among survivors. Study Design and Methods: Four hundred ten cancer survivors were recruited to a nationwide multicenter phase III RCT comparing the effect of YOCAS to standard survivorship care on CRF and examining the mediating effects of changes in sleep, stemming from yoga, on changes in CRF. CRF was assessed by the Multidimensional Fatigue Symptom Inventory. Sleep was assessed via the Pittsburgh Sleep Quality Index. Between- and within-group intervention effects on CRF were assessed by analysis of covariance and 2-tailed t test, respectively. Path analysis was used to evaluate mediation. Results: YOCAS participants demonstrated significantly greater improvements in CRF compared with participants in standard survivorship care at post-intervention ( P < .01). Improvements in overall sleep quality and reductions in daytime dysfunction (eg, excessive napping) resulting from yoga significantly mediated the effect of yoga on CRF (22% and 37%, respectively, both P < .01). Conclusions: YOCAS is effective for treating CRF among cancer survivors; 22% to 37% of the improvements in CRF from yoga therapy result from improvements in sleep quality and daytime dysfunction. Oncologists should consider prescribing yoga to cancer survivors for treating CRF and sleep disturbance.

Effects of yoga in men with prostate cancer on quality of life and immune response: a pilot randomized controlled trial

“…Compared with the control group, the yoga group demonstrated significant global improvements in quality, duration, and efficiency of sleep and less use of sleep medication. Longer-term follow-up of that cohort revealed significant improvement in all subdomains of cancer-related fatigue [28].…”

“…Finally, higher expression levels of Flt-3 ligand have been linked to an autoimmune response and to chronic inflammatory responses in the lung, central nervous system, and gastrointestinal tract [38]. By lessening inflammation and fatigue and improving mood, yoga is an ideal exercise that can be modified for individuals with a sedentary lifestyle or functional limitations [11,16,28,[39][40][41]. Our pilot data are consistent with those of previous retrospective studies demonstrating the beneficial effects of yoga on several psychological and QoL outcomes, add granularity at the molecular level, and identify putative inflammatory markers for future research.…”

A qualitative evaluation of the use of interventions to treat fatigue among cancer survivors: A healthcare provider’s view

“…Only some interviewees recommended psychosocial support to treat CRF (more specifically seeing a psychologist in a one‐on‐one meeting), but surprisingly, there was no specific mention of CBT use to treat CRF among the interviewees, even if its efficiency has been shown in the literature (Gielissen et al, 2007; Quesnel et al, 2003). In addition, mind–body interventions were only proposed in the setting of breast cancer care, and some interviewees expressed the belief that such interventions have no role in CRF treatment, even though there is evidence in the literature that mindfulness‐based approaches such as meditation or yoga may relieve fatigue in cancer survivors (Bower et al, 2012; Dong et al, 2019; Hoffman et al, 2012; Kiecolt‐Glaser et al, 2014; Lin et al, 2019; van der Lee and Garssen, 2012), and studies have shown a favourable impact of acupuncture to treat CRF in cancer patients (Molassiotis et al, 2012; Zhang et al, 2018).…”

“…viewees expressed the belief that such interventions have no role in CRF treatment, even though there is evidence in the literature that mindfulness-based approaches such as meditation or yoga may relieve fatigue in cancer survivors(Bower et al, 2012;Dong et al, 2019;Hoffman et al, 2012;Kiecolt-Glaser et al, 2014;Lin et al, 2019; van der Lee and Garssen, 2012), and studies have shown a favourable impact of acupuncture to treat CRF in cancer patients(Molassiotis et al, 2012;Zhang et al, 2018).…”

Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment

“…91e93 Regarding cancer survivors, a phase III RCT compared the effect of yoga with standard survivorship care on CRF, and a significant benefit of yoga was reported. 94 Acupuncture: After a pilot study demonstrating promising findings, several RCTs have been published on the role of acupuncture in the control of CRF. A meta-analysis including seven RCT studies, some with methodological flaws, has been published.…”