Effects of yoga practice on physiological distress, fatigue and QOL in patients affected by breast cancer undergoing adjuvant radiotherapy

Abstract

Background and purpose: In this study we want to evaluate the efficacy of yoga practice on dysfunctional stress, inflammation and QOL in breast cancer patients undergoing adjuvant radiotherapy.

Patients and methods: Patients with stage 0 to III breast cancer were recruited before starting radiotherapy (XRT) and were randomly assigned to yoga group (YG) two times a week during XRT or control group (CG). Self-report measures of QOL, fatigue and sleep quality, and blood samples were collected at day 1 of treatment, day 15, end of treatment and 1, 3 and 6 months later. Cortisol blood level, IL6, IL10, IL1RA, TNFα and lymphocyte-to-monocyte ratio were analyzed as measures of dysfunctional stress and inflammation.

Results: Patients started XRT and yoga classes in October 2019. Due to COVID-19 pandemic we closed the enrollment in March 2020. We analysed 24 patients, 12 YG and 12 CG. The analysis of blood cortisol levels revealed an interaction (p = 0.04) between yoga practice and time, in particular YG had lower cortisol levels at the end of XRT respect to CG (p-adj = 0.02). The analysis of IL-1RA revealed an interaction effect (p = 0.04) suggesting differences between groups at some time points that post-hoc tests were not able to detect.

Conclusions: To our knowledge, this is the first study to evaluate the effects of yoga in a cancer population studying inflammation markers, cortisol trend and QOL during and until 6 months after XRT. This study suggests that yoga practice is able to reduce stress and inflammation levels over time. Besides including a larger number of patients to increase the power, future studies should consider other inflammatory or pro inflammatory factors and long-term yoga program to gain more evidence on yoga practice benefits.

Keywords: BFI, brief fatigue inventory; BH, Benjamini-Hochberg; BP, bodily pain; Breast cancer; CG, control group; EF, emotional functioning; GH, general health; LMR, lymphocyte-monocyte ratio; MCS, mental component scale; MH, mental health; Oncology; PCS, physical component scale; PF, physical functioning; PSQI, Pittsburgh sleep quality index; Physiological distress; QOL, quality of life; RE, role emotional; RP, role physical; Radiotherapy; SF, social functioning; VT, vitality; XRT, Radiotherapy; YG, yoga group; Yoga.

Fig. 1

Diagram of study participants over study period.

Fig. 2

Cortisol levels at each assessment for Yoga group (YG) and control group (CG). In × axis the time point, in y axis the boxplot of values. Box limits indicate the range of the central 50 % of the data (1st-3rd quartiles), while the central line marks the median value. (A) Both YG and CG; (B) Only YG to show the time effect.

Fig. 3

Proinflammatory cytokines levels at each assessment for Yoga group (YG) and control group (CG). In × axis the time point, in y axis the boxplot of values. Box limits indicate the range of the central 50 % of the data (1st-3rd quartiles), while the central line marks the median value. (A) IL-6; (B) IL-10; (C) Time effect on IL-1Ra in YG; (D) Time effect on IL-1Ra in CG.

Fig. 4

Lymphocyte-to-monocyte ratio (LMR) at each assessment ignoring practice factors. In × axis the time point, in y axis the boxplot of values. Box limits indicate the range of the central 50 % of the data (1st-3rd quartiles), while the central line marks the median value.