Abstract
BackgroundMany breast cancer patients and survivors use yoga to cope with their disease. The aim of this review was to systematically assess and meta-analyze the evidence for effects of yoga on health-related quality of life and psychological health in breast cancer patients and survivors.MethodsMEDLINE, PsycInfo, EMBASE, CAMBASE, and the Cochrane Library were screened through February 2012. Randomized controlled trials (RCTs) comparing yoga to controls were analyzed when they assessed health-related quality of life or psychological health in breast cancer patients or survivors. Risk of bias was assessed using the Cochrane risk of bias tool. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.ResultsTwelve RCTs with a total of 742 participants were included. Seven RCTs compared yoga to no treatment; 3 RCTs compared yoga to supportive therapy; 1 RCT compared yoga to health education; and 1 RCT compared a combination of physiotherapy and yoga to physiotherapy alone. Evidence was found for short-term effects on global health-related quality of life (SMD = 0.62 [95% CI: 0.04 to 1.21]; P = 0.04), functional (SMD = 0.30 [95% CI: 0.03 to 0.57), social (SMD = 0.29 [95% CI: 0.08 to 0.50]; P < 0.01), and spiritual well-being (SMD = 0.41 [95% CI: 0.08; 0.74]; P = 0.01). These effects were, however, only present in studies with unclear or high risk of selection bias. Short-term effects on psychological health also were found: anxiety (SMD = −1.51 [95% CI: -2.47; -0.55]; P < 0.01), depression (SMD = −1.59 [95% CI: -2.68 to −0.51]; P < 0.01), perceived stress (SMD = −1.14 [95% CI:-2.16; -0.12]; P = 0.03), and psychological distress (SMD = −0.86 [95% CI:-1.50; -0.22]; P < 0.01). Subgroup analyses revealed evidence of efficacy only for yoga during active cancer treatment but not after completion of active treatment.ConclusionsThis systematic review found evidence for short-term effects of yoga in improving psychological health in breast cancer patients. The short-term effects on health-related quality of life could not be clearly distinguished from bias. Yoga can be recommended as an intervention to improve psychological health during breast cancer treatment.
Highlights
Many breast cancer patients and survivors use yoga to cope with their disease
Six studies assessed psychological distress, 1 of those used the Analyses of overall effects Health-related quality of life Meta-analysis revealed evidence for a moderate shortterm effect of yoga on global health-related quality of life (SMD = 0.62; 95% confidence intervals (CI): 0.04 to 1.21; P = 0.04)
This review found a moderate size short-term effect on global health-related quality of life along with small size shortterm effects on functional, social, and spiritual quality of life
Summary
Many breast cancer patients and survivors use yoga to cope with their disease. The aim of this review was to systematically assess and meta-analyze the evidence for effects of yoga on health-related quality of life and psychological health in breast cancer patients and survivors. Breast cancer is the most frequent cancer in women worldwide with more than 1.5 million new cases in 2008. Cancer patients often experience side effects during treatment [3]. In order to cope with the disease, many breast cancer patients and survivors use complementary medicine [8] and yoga is among the most commonly used complementary treatments for breast cancer-related impairments [8]. Derived from ancient Indian philosophy, yoga comprises advice for ethical lifestyle, as well as spiritual practice and physical postures, with the ultimate goal of uniting mind, body and spirit [9]. An estimated 15 million American adults report having practiced yoga at least once in their lifetime, almost half of those using yoga explicitly for coping with disease or promoting health [11]
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