Unpacking the Research and Best Teaching Practices for Breast Cancer Patients and Survivors
This post is part of an ongoing public discussion relating to the scientific research on yoga and cancer. It follows a two-part online webinar, Yoga for Breast Cancer Patients and Yoga for Breast Cancer Survivors, and three subsequent CE methods seminars with experts in the field. These seminars can be found on our events archive here. Comments are welcome in the comment field provided below this post. All comments are moderated for content and may or may not be published.
Research shows yoga offers many options for breast cancer patients and survivors.
Although modern conventional medicine continues to be proficient in extending the lifespan of those diagnosed with cancer, it is not as well-equipped for addressing the stress and mental health consequences of being diagnosed with and treated for a life-threatening disease.
Yoga is emerging as a useful complementary approach alongside conventional treatments as patients and caregivers form strategies of healing from diagnosis to life after treatment. To begin a series of conversations hosted by Yoga Alliance and moderated by me, Dr. Sat Bir Singh Khalsa, Yoga Alliance’s Director of Yoga Research and Assistant Professor of Medicine at Harvard Medical School, covered the scientific research on yoga for breast cancer in two lectures, Yoga for Breast Cancer Patients and Yoga for Breast Cancer Survivors. I then moderated a methodology conversation with teaching experts on yoga for breast cancer, called Applications of Scientific Research on Breast Cancer and Yoga, with Dr. Lois Steinberg, Tari Prinster, Kiersten Gallagher, and Smitha G. Mallaiah of the MD Anderson Cancer Center. This group shared teaching methods and strategies for working with breast cancer patients while focusing on the fact that behind every diagnosis of breast cancer is an individual woman with her own specific health needs and story..
A multi-component practice that’s infinitely modifiable
Yoga provides many tools to reduce the stress and mental health burden associated with confronting the realities of cancer. Dr. Khalsa illustrated in his presentations that yoga practices have shown efficacy in studies in tackling side effects of surgery, chemotherapy, and radiation. Initial evidence in this fast-growing body of research also suggests that yoga might even boost the immune function of cancer patients and survivors in the way that it helps mitigate treatment side effects. Perhaps just as compelling for caregivers and survivors alike, yoga appears to be lower in cost than pharmacological approaches to stress, mood disturbances, sleep, and other side effects.
Yoga also has no negative side effects, which both Dr. Khalsa and the expert group mentioned several times during their webinars.
Most interesting in the presentations was learning that while many in conventional medicine have historically been “afraid we will ‘break’ cancer patients” with yoga treatments, our group of yoga experts all agreed that this is a harmful misunderstanding of what patients and survivors both need in their journey. The group asserted that yoga teachers should focus on all levels of the students’ strengths, even if that strength comes only through simple breathwork or pranayama.
Of the comorbidities experienced with breast cancer, yoga research has assessed the efficacy of yoga for all of the consequences of diagnosis and side effects of treatment (left), though there is more of a body of work on the efficacy for the consequences.
Indeed, the benefits of doing yoga from diagnosis to post-treatment are convincing enough that the American Society of Clinical Oncology issued a consensus statement, which is read by clinicians and oncologists who are directly working with patients and thereby integrating this approach into the field.
Dr. Khalsa also put it this way: “You want to try not to give chemotherapy patients more drugs.” He referenced a study published in Sage Journals concluding that treatments such as yoga were better than medications for insomnia and sleep disturbance, for example, given that there are no negative side effects of doing yoga to improve sleep.
Three citation highlights
In a study of healthcare providers’ awareness of yoga as a modality for those with cancer, “Increasing provider awareness of and recommendations for yoga and meditation classes for cancer patients,” published in the journal Supportive Care for Cancer, “…43% were unaware at baseline that yoga and meditation classes were offered through the cancer center and 55% responded that they rarely or never recommend yoga or meditation for patients.” Following a brief presentation on yoga for cancer, 90% of providers expressed an increased likelihood of doing so.
In a 2018 study by the National Institutes of Health, “A Restorative Yoga Intervention for African-American Breast Cancer Survivors: a Pilot Study,” yoga was seen to have “a beneficial effect on depression in African American Breast Cancer Survivors.”
Another 2018 study, also by NIH, “Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial,” concluded that yoga was “an effective and safe exercise for alleviating shoulder and arm pain, which is a complication with a high prevalence in patients with breast cancer.”
Research Citations
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Yoga for the Management of Cancer Treatment-Related Toxicities, Po-Ju Lin, Luke J. Peppone, Michelle C. Janelsins, Supriya G. Mohile, Charles S. Kamen, Ian R. Kleckner, Chunkit Fung, Matthew Asare, Calvin L. Cole, Eva Culakova, and Karen M. Mustian, 2016.
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Supportive Care: Large Studies Ease Yoga, Exercise Into Mainstream Oncology, Karyn Hede, 2011.
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Mind-body medicine use by women diagnosed with breast cancer: results of a nationally representative survey, Petra Voiß, Melanie Désirée Höxtermann, Gustav Dobos & Holger Cramer, 2019.
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Increasing provider awareness of and recommendations for yoga and meditation classes for cancer patients, Koula MJ, Knight JM, 2018.
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The Principles and Practice of Yoga in Health Care, Khalsa, Cohen, McCall, Telles, 2016.
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Yoga for symptom management in oncology: A review of the evidence base and future directions for research, Suzanne C. Danhauer, Elizabeth L. Addington, 2019.
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Effects of Yoga-Based Interventions on Cancer-Associated Cognitive Decline: a Systematic Review, Mohamad Baydoun, Devesh Oberoi, Michelle Flynn, Chelsea Moran, Andrew McLennan, Katherine-Ann L. Piedalue & Linda E. Carlson, 2020.
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Cognitive Behavioral Therapy for Insomnia, Mindfulness, and Yoga in Patients With Breast Cancer with Sleep Disturbance: A Literature Review, Simon B Zeichner, Rachel L Zeichner, Keerthi Gogineni, 2017.
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Yoga has a solid effect on cancer-related fatigue in patients with breast cancer, Dong, Xie, Jing, Lin, 2019.
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Effectiveness of Yoga Interventions in Breast Cancer-Related lymphedema: A systematic review, Ching-Wen Wei, Yi-Chen Wu, Pei-Yi Chen, Pei-En Chen, Ching-Chi Chi, Tao-Hsin Tung, 2019.
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Yoga-Specific Enhancement of Quality of Life Among Women With Breast Cancer: Systematic Review and Exploratory Meta-Analysis of Randomized Controlled Trials, Daline El-Hashimi, Kevin M. Gorey, 2019.
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Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline, Gary H. Lyman, Heather Greenlee, Kari Bohlke, Ting Bao, Angela M. DeMichele, Gary E. Deng, 2018.
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Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment, A. Fabi, R. Bhargava, S. Fatigoni, K. Jordan, C.I. Ripamonti, 2020.
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Randomized, Controlled Trial of Yoga in Women With Breast Cancer Undergoing Radiotherapy, Kavita D. Chandwani, George Perkins, Hongasandra Ramarao Nagendra, Nelamangala V. Raghuram, Amy Spelman, Raghuram Nagarathna, Kayla Johnson, Adoneca Fortier, Banu Arun, Qi Wei, Clemens Kirschbaum, Robin Haddad, G. Stephen Morris, Janet Scheetz, Alejandro Chaoul, and Lorenzo Cohen, 2012.
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Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy, Alejandro Chaoul, Kathrin Milbury, Amy Spelman, 2017.
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Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Vadiraja HS, Rao MR, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, Gopinath KS, Srinath BS, Vishweshwara MS, Madhavi YS, Ajaikumar BS, Bilimagga SR, Rao N., , 2009.
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The Effect of Yoga on Arm Volume, Strength, and Range of Motion in Women at Risk for Breast Cancer-Related Lymphedema, Melissa Mazor, Jeannette Q. Lee, Anne Peled, Sarah Zerzan, Chetan Irwin, Margaret A. Chesney, Katherine Serrurier, Hani Sbitany, Anand Dhruva, Devorah Sacks, and Betty Smoot, 2018.
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A Randomized Study of Yoga for Fatigue and Quality of Life in Women with Breast Cancer Undergoing (Neo) Adjuvant Chemotherapy, Miek C. Jong, Inge Boers, Arjan P. Schouten van der Velden, Suzan van der Meij, Emine Göker, Anja N.J.H. Timmer-Bonte, and Herman A. van Wietmarschen, 2018.
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Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial, Sibel Eyigor, Ruchan Uslu, Sebnem Apaydın, Ismail Caramat, Hilal Yesil, 2018.
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Cost Savings in Inpatient Oncology Through an Integrative Medicine Approach, Benjamin Kligler, Peter Homel, Louis B. Harrison, Hanniel D. Levenson, Jeanne B. Kenney, and Woodson Merrell, 2011l.
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Effect of Long-term Yoga Practice on Psychological outcomes in Breast Cancer Survivors, Ram R Amritanshu, Raghavendra Mohan Rao, Raghuram Nagaratna, Vidya Harini Veldore, MR Usha Usha Rani, Kodaganur S Gopinath, and B S Ajaikumar, 2017.
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Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Banasik J, Williams H, Haberman M, Blank SE, Bendel R., 2011.
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Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G., 2012
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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. Lin PJ, Kleckner IR, Loh KP, Inglis JE, Peppone LJ,…Mustian KM. Integrative Cancer Therapies 18:1534735419855134, 2019.
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Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. Kiecolt-Glaser JK, Bennett JM, Andridge R, Peng J, Shapiro CL, Malarkey WB, Emery CF, Layman R, Mrozek EE, Glaser R. Journal of Clinical Oncology 32:1040-9, 2014.
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Yoga reduces inflammatory signaling in fatigued breast cancer survivors: a randomized controlled trial. Bower JE, Greendale G, Crosswell AD, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Arevalo J, Cole SW. Psychoneuroendocrinology 43:20-9, 2014.
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YOCAS©® Yoga Reduces Self-reported Memory Difficulty in Cancer Survivors in a Nationwide Randomized Clinical Trial: Investigating Relationships Between Memory and Sleep. Janelsins MC, Peppone LJ, Heckler CE, Kesler SR, Sprod LK, Atkins J, Melnik M, Kamen C, Giguere J, Messino MJ, Mohile SG, Mustian KM. Integrative Cancer Therapies 15:263-71, 2016.
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Yoga and self-reported cognitive problems in breast cancer survivors: a randomized controlled trial. Derry HM, Jaremka LM, Bennett JM, Peng J, Andridge R, Shapiro C, Malarkey WB, Emery CF, Layman R, Mrozek E, Glaser R, Kiecolt-Glaser JK, 2015.
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Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Palesh OG, Chandwani K, Reddy PS, Melnik MK, Heckler C, Morrow GR. Journal of Clinical Oncology, 31:3233-41, 2013.
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The effect of YOCAS©® yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy. Peppone LJ, Janelsins MC, Kamen C, Mohile SG, Sprod LK, Gewandter JS, Kirshner JJ, Gaur R, Ruzich J, Esparaz BT, Mustian KM. Breast Cancer Research and Treatment 150:597-604, 2015.
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Yoga and meditation for menopausal symptoms in breast cancer survivors-A randomized controlled trial. Cramer H, Rabsilber S, Lauche R, Kümmel S, Dobos G., Cancer 121:2175- 84, 2015.
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A Restorative Yoga Intervention for African-American Breast Cancer Survivors: a Pilot Study. Taylor TR, Barrow J, Makambi K, Sheppard V, Wallington SF, Martin C, Greene D, Yeruva SLH, Horton S., 2018.
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Perceived health benefits from yoga among breast cancer survivors. Van Puymbroeck M, Burk BN, Shinew KJ, Cronan Kuhlenschmidt M, Schmid AA., 2013.
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A web streamed yoga intervention for breast cancer survivors, Winters, Loren, Post, Kathryn, Flanagan, Jane, 2020.
About the Author
Kim Weeks
Certified Iyengar Yoga Teacher and wellness expert, and founder of a wellness consulting and education company called Weeks Well, whose mission is to foster transformation in work and life.
Videos Associated With This Article
Cancer and Yoga
Unpack the fast-growing body of research on yoga and its relationship to cancer and cancer-related symptoms. This conversation will specifically touch on some of the most researched cancers today and how yoga can be utilized by those living with this medical condition.
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