Yoga Therapy’s Value in Integrative Cancer Care

Yoga Therapy’s Value in Integrative Cancer Care

In Honour of Breast Cancer Awareness Month

 

The field of cancer care, especially for breast cancer, has garnered some of the strongest institutional support and highest quality research for yoga therapy as part of an integrative treatment approach. The Minded Institute hopes to raise awareness of yoga’s potential and to expand the integrative cancer care community.

 

Integrative medicine incorporates complementary modalities, including yoga, as adjuvants to conventional treatment. Clinical guidelines and ongoing research support yoga, mindfulness, and meditation within integrative oncology to manage whole-person issues in the cancer experience, such as secondary (particularly psychological) symptoms, treatment side effects, and survivorship strategies. 

 

Dr Naiyer Chadha, a physician and breast cancer survivor in the US, shared with the Houston Chronicle in 2023 how yoga therapy helped her to manage post-treatment anxiety and discomfort:

 

“I was at a point where I was willing to try whatever could be beneficial.”

She was skeptical. Having been a physician for 40 years, she was not sure that yoga had a place in medicine. But after six months of yoga therapy, she’s said she’s become a believer.

“I realized there was more to it than meets the eye,” Chadha said. “It’s a very old medicine.”

Yoga helped her calm her mind and deal with some of the anxieties that cancer left in its wake. The practice is comforting and gives her a greater sense of purpose and connection. 

“Yoga does something at a level I can’t explain exactly,” she said. “It’s subtle, but it works.”

— MD Anderson uses yoga in cancer treatment to help patients reduce stress and improve quality of life

Cancer Clinical Practice Guidelines and Consensus Statements Recommending Yoga

 

Clinical practice guidelines (CPGs) and consensus statements provide healthcare recommendations based on expert agreement about the strength of the evidence for a treatment in a specific population or condition. Integrative cancer care is one of the strongest areas of evidence for yoga therapy, which appears in several CPGs and consensus statements for cancer treatment, including the following major examples:

 

European Society for Medical Oncology (ESMO) CPGs for fatigue: 

• Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment
• Listed yoga as an option for fatigue and quality of life in survivors

 

Society for Integrative Oncology (SIO)-American Society of Clinical Oncology (ASCO) 2023 joint CPG update:

• Integrative Therapies in Cancer Care: An Update on the Guidelines | American Society of Clinical Oncology Educational Book
• Strongly recommended mindfulness-based interventions for anxiety and depression during and after cancer treatment
• Moderately recommended yoga for anxiety and depression during and after breast cancer treatment
• Recommended yoga for post-treatment management of fatigue
• During treatment: found insufficient evidence for yoga, but strongly recommended aerobic/resistance exercise and mindfulness, and conditionally recommended psychoeducation, all of which can easily be incorporated into yoga therapy by an appropriately trained yoga therapist, such as a Minded Institute graduate

 

SIO-ASCO CPGs for breast cancer: 

• Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline
• A notably high-quality report among CPGs for breast cancer treatment
• Included yoga and meditation among “key recommendations” for anxiety and stress
• Recommended yoga and meditation (especially mindfulness) for depression, mood disorders, and quality of life
• Listed yoga as an option for post-treatment fatigue and for sleep

 

“The ability to de-stress that comes with yoga is one of the greatest benefits […] Every effect of cancer all compounds into stress, and yoga helps patients work through this.”

— Dr Eleanor Walker, director of breast radiation oncology at Henry Ford Health (Detroit, Michigan), Breast Cancer And The Benefits Of Yoga | Henry Ford Health

 

Healthcare Organisations and Centres Promoting Yoga for Cancer Populations

 

Based on the strength of the evidence for yoga therapy in cancer care, institutions are increasingly embracing yoga as an integrative medicine modality. The following are examples of organisations and centres that advocate for or provide yoga in clinical cancer treatment settings (as of this writing in late 2024).

 

Society for Integrative Oncology (SIO): 

• (Dr Lois Ramondetta graciously contributed content about the SIO and Yoga SIG)
• US-based international professional network (including non-oncologists such as yoga teachers/therapists)
• SIO is a multi-disciplinary, professional organisation for integrative oncology focusing on communication, education, and research for cancer patients and survivors 
• SIO members may also join the Academic Consortium for Integrative Medicine and Health

 

SIO Yoga Special Interest Group (SIG): 

• Open to all upon joining the SIO 
• Develops educational programs, publications, and other resources to advance yoga therapy in cancer care and SIO’s operations, membership, and communications, including a commentary on developing best practices for yoga in oncology 

 

British Society for Integrative Oncology (BSIO):

• Professional network modelled after the SIO
• Aims to “empower healthcare practitioners with an expanded toolkit”
• Associated with the Integrative Oncology UK conference and resources

 

Examples of Cancer Centres Regularly Offering Yoga or Yoga Therapy in Treatment:

• Synthesis Integrative Oncology Clinic (UK)
• Melbourne Integrative Oncology Group (Australia)
• Chris O’Brien Life House Integrative Oncology and Wellness Centres (Australia)
• Memorial Sloan-Kettering Cancer Center (New York and New Jersey, US) 
• Hematology-Oncology Associates of Central New York (US) 
• Osher Center for Integrative Health at Vanderbilt University (Tennessee, US) 
• University of Cincinnati Cancer Center (Ohio, US)
• Yoga Therapy | Sylvester Comprehensive Cancer Center | University of Miami Health System (Florida, US)
• Yoga Therapy – Integrative Medicine | UCLA Health with Simms-Mann UCLA Center for Integrative Oncology (California, US)

 

“It made an enormous difference, more than any other treatment. It helped with my fatigue, made me able to sleep a lot better, calmed me down and made me a lot less anxious about the process.” 

— Margo McDonald, breast cancer patient, on yoga at Chris O’Brien Lifehouse cancer hospital (Sydney, Australia), Yoga an essential element for healing in breast cancer patients | Chris O’Brien Lifehouse

MD Anderson Cancer Center: Leader in Clinical Yoga Therapy Research and Provision

(Smitha Mallaiah graciously contributed content about MD Anderson)

 

MD Anderson Cancer Center (Houston, Texas), the largest cancer hospital in the US, has pioneered integrating yoga therapy into cancer care for over two decades. Under the leadership of Dr Lorenzo Cohen, Director of the Integrative Medicine Program, MD Anderson collaborates with Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), India’s largest yoga research institute, to conduct yoga research trials. The collaboration began with randomised controlled trials in breast cancer patients.

 

Research from MD Anderson shows that yoga offers significant benefits for women with breast cancer undergoing radiation therapy. Published in the Journal of Clinical Oncology, a 2010 study led by Dr Cohen highlighted that while simple stretching combats fatigue, yoga incorporating breathing, meditation, and relaxation techniques can enhance physical and mental well-being. Women in the yoga group reported better daily functioning, improved general health, and more regulated levels of cortisol, a stress hormone linked to cancer outcomes. They also found greater meaning in their cancer experience compared to those in the control group. The study involved 191 women randomised into yoga, stretching, or no-intervention groups. 

 

Yoga’s mind-body techniques proved effective in reducing stress and fatigue during and after treatment. Ongoing research now explores its mechanisms and cost efficiency for hospitals. Dr Cohen’s group has completed a 2014 phase III randomised controlled trial, funded with a 4.5 million-dollar grant from the US National Institutes of Health (NIH) National Cancer Institute, and is analysing the data on women with breast cancer undergoing radiation therapy. In terms of clinical trials, a successful phase III trial would mean that the treatment (here, the yoga intervention) has been shown to be not only safe (phase I) and effective for its purpose (phase II), but also better than standard treatments (phase III) with the same purpose in large groups of patients. 

 

Smitha Mallaiah, a senior yoga therapist, joined MD Anderson in 2011 from S-VYASA and significantly expanded both research and clinical services. While the research initially focused on breast cancer, Smitha helped bring yoga therapy to other cancer populations, including brain tumours, lung cancer, head and neck cancer, cervical cancer, and others. Under her leadership, yoga therapy is now offered as a clinical service line at MD Anderson, available to both inpatient and outpatient settings, helping patients manage symptoms and achieve health goals through personalised yoga interventions at various stages of cancer care. MD Anderson also offers group classes in therapeutic yoga asana, yoga nidra, and pranayama. 

 

University of Rochester: Providing Strong Evidence for Yoga in Cancer Care

 

The first large study (410 participants) to show clinical benefit from yoga in a cancer population was initially presented in 2010 by Karen Mustian of the Wilmot Cancer Institute (University of Rochester, New York), according to the US Journal of the National Cancer Institute. This nationwide, multisite, phase II/III randomised controlled clinical trial confirmed previous results of numerous smaller studies. Its 2013 report demonstrated a reduction in fatigue and a significant improvement in sleep quality in cancer survivors after four weeks of yoga compared to usual care, as well as a decrease in sleep medication use in the yoga group compared to an increase in the usual-care control group. In a huge stride forward for yoga therapy’s credibility in healthcare, these findings suggested that yoga is safe and effective (phase II) and can be more effective than standard treatment (phase III) for sleep issues in cancer survivors. The yoga intervention was Mustian’s Yoga for Cancer Survivors (YOCAS) programme of twice-weekly 75-minute sessions of gentle hatha and restorative asana, pranayama, and meditation.

 

One participant in the above trial, David Goldberg, shared with the Seattle Times:

 

“I was certainly a little skeptical, but so far it’s been very helpful in relaxing me, getting me in a good state of mind […] For me, it’s just an amazing experience to feel where my body is and what I’m experiencing.” 

— Study puts yoga in position for coverage as cancer therapy | The Seattle Times

 

In another YOCAS trial, done in 2023, yoga participants experienced improvements in walking, physical activity engagement, and quality of life compared to controls, due to a significant decrease in cancer-related fatigue. A second 2023 trial suggested that four weeks of YOCAS could significantly reduce inflammation in cancer survivors compared to a survivorship education placebo. 

 

As we became warriors, children, cats, cows and pigeons, I realized that concentrating on position and breath takes even the most cerebral of us out of our nattering, hectoring brains, reminding us that we have feet, ankles, knees, a spinal column, arms, shoulders, neck, mouth, all of which can stretch and relax, stretch and relax to release tension. 

— Susan Gubar, Living With Cancer: Patient Yoga – The New York Times

 

The Minded Institute Stands Ready to Assist with Whole-Person Cancer Care

 

With strong evidence-informed training, Minded yoga therapists and yoga psychotherapists can offer yoga’s benefits to cancer survivors or coordinate with cancer treatment professionals within yoga therapy’s scope. To locate a Minded yoga therapist, click here. The Institute also offers CPD courses and a diploma track for qualified healthcare professionals wishing to incorporate yoga skills into their practice. 

 

“We’re talking about relaxation techniques to integrate the mind and body — instead of feeling disconnected from this cancer that’s in you, to feel that you’re a whole human being and you’re going on this path toward healing.” 

— Woodson Merrell, past chairman of the department of integrative medicine at Beth Israel (New York CIty)