Lo Yoga aiuta contro il cancro
Dicembre 7th, 2011 by admin

Lo Yoga aiuta contro il cancro

Medicina cinese_7507.jpgIn un congresso internazionale di oncologia ad Atlanta, sono stati presentati i risultati di uno studio secondo il quale lo yoga inciderebbe positivamente sulla qualità della vita delle pazienti con tumore al seno tanto da essere stato sperimentato come parte del piano di cure anti-cancro. “E” la prima volta che uno studio include lo yoga come parte del piano terapeutico’’, afferma Lorenzo Cohen, dell’universita’ del Texas e responsabile della ricerca. Il “segreto è la capacità di coinvolgere” – spiega il medico – “sia la mente che il corpo”. “Abbiamo ipotizzato, perciò, che i malati di tumore avrebbero potuto beneficiare di questa tecnica sia dal punto di vista fisico che emozionale. I risultati ottenuti ce lo hanno confermato’’. Il gruppo di lavoro ha coinvolto 61 donne di circa 52 anni colpite da tumore al seno e sottoposte a radioterapia. Rispetto ad altre pazienti, non pazienti, non coinvolte nel programma yoga, tali donne presentavano una miglior condizione fisica, voglia di entrare in contatto con altre persone nonchè un atteggiamento più positivo ed ottimista.

Comparing Relaxation Programs for Breast Cancer Patients Receiving Radiotherapy

Name of the Trial Biobehavioral Effects of Relaxation for Women with Breast Cancer Undergoing Radiotherapy (2009-0976; NCT01202851). See the protocol summary.

Principal Investigator Dr. Lorenzo Cohen, University of Texas MD Anderson Cancer Center

Why This Trial Is Important Women with early-stage breast cancer usually have surgery to remove the tumor followed by radiation therapy. Depending on the characteristics of their cancer, they may also receive systemic therapies, including chemotherapy, hormonal therapy, targeted therapy, or a combination of these, before and/or after surgery. This multimodality treatment has helped many women survive breast cancer, but the rigors of treatment can leave women with other problems that may affect their health and sense of well-being.

Breast cancer surgery can result in lingering pain and affect physical functioning and range of body movement. Systemic therapies can cause sleep disruption, reduced ability to concentrate and to remember, fatigue, peripheral neuropathy, and other complications, whereas radiation therapy may cause fatigue, tenderness or swelling in the treated area, and, in some cases, peripheral neuropathy. These side effects can greatly affect a person’s quality of life and cause stress, which may exacerbate a negative sense of well-being.

Radiation therapy following breast cancer surgery typically involves daily treatments for 4 to 6 weeks. Some doctors believe that this daily contact with patients may be an opportunity to teach them methods to reduce the severity of cancer symptoms and treatment side effects, as well as associated stress.

In this study, women with breast cancer who have had surgery and are scheduled to undergo radiation therapy will be randomly assigned to one of two different stretching and relaxation programs or to a control group that will receive usual care. Both active arms of the study will include stretching exercises, breathing exercises, and relaxation exercises. Women assigned to either of the relaxation programs will participate in 3 to 5 sessions a week for the duration of their radiation therapy and will then be asked to practice the relaxation techniques on their own every day for the following year.

All participants will complete questionnaires and 7-day sleep diaries before radiation therapy begins, midway through their radiation treatment, and during their last week of therapy, as well as at 3, 6, and 12 months after radiation treatment ends. Additionally, they will submit saliva samples before radiation therapy begins, during the last week of therapy, and at 3, 6, and 12 months after radiation treatment ends. The tests will measure levels of cortisol, a chemical in the body associated with stress, in their saliva at these different time points.

We’ve seen from our previous research that women who participate in these types of programs throughout treatment have improvement in aspects of physical functioning and their ability to engage in daily activities,” said Dr. Cohen.

One particularly interesting aspect of the study is that we are measuring cortisol as an indicator of stress. We know that cortisol levels vary throughout the day, usually higher in the morning and tapering off over the course of the day, and there’s evidence that a greater slope of this diurnal cortisol change is associated with better survival in patients with metastatic breast cancer. Our research indicates that women who practice mind-body relaxation programs, like yoga, tend to have steeper cortisol slopes.

Another very important element of the study will be cost/benefit analyses between the women in each arm of the study, particularly in terms of documenting work productivity and functioning,” he explained. “We’re interested not only in whether women go to work or not, but also the degree to which they are able to focus on and be engaged in their work tasks, either outside or inside the home.”

The study is taking place at the University of Texas MD Anderson Cancer Center in Houston.

Study first to compare benefits of mind-body practices to simple stretching exercises

MD Anderson study first to compare benefits of mind-body practices to simple stretching exercises

MD Anderson News Release 05/18/11 Lorenzo Cohen, Ph.D.

For women with breast cancer undergoing radiation therapy, yoga offers unique benefits beyond fighting fatigue, according to new research from The University of Texas MD Anderson Cancer Center.

While simple stretching exercises improved fatigue, patients who participated in yoga that incorporated yogic breathing, postures, meditation and relaxation techniques into their treatment plan experienced improved physical functioning, better general health and lower cortisol (stress hormone) levels. They also were better able to find meaning in their cancer experience.

The findings, to be presented next month in an oral session at the 47th annual meeting of the American Society of Clinical Oncology by Lorenzo Cohen, Ph.D., professor and director of the Integrative Medicine Program at MD Anderson, are the latest in an ongoing effort to scientifically validate the age-old belief that mind-body interventions have a beneficial impact on the health of cancer patients. The research was conducted in collaboration with India’s largest yoga research institution, Swami Vivekananda Yoga Anusandhana Samsthana in Bangalore, India.

The study assessed, for the first time, yoga benefits to cancer patients by comparing their experience with patients in an active control group who integrated simple, generic stretching exercises into their lives. “The combination of mind and body practices that are part of yoga clearly have tremendous potential to help patients manage the psychosocial and physical distress associated with treatment and life after cancer, beyond the benefits of simple stretching,” said Cohen.

To conduct the study, 163 women with breast cancer (stage 0-3) averaging 52 years of age were randomized to one of three groups: 1) yoga; 2) simple stretching; or 3) no instruction in yoga or stretching. Participants in the yoga and stretching groups attended sessions specifically tailored to breast cancer patients for one hour three days a week throughout their six weeks of radiation treatment.

Participants were asked to report on their quality of life, including fatigue, daily functioning, benefit finding, depression and spirituality. Saliva samples were collected and electrocardiogram tests were administered at baseline, end of treatment, and at one, three and six months post-treatment.

After completing radiation treatment, only the women in the yoga and stretching groups reported a reduction in fatigue. At one, three and six months after radiation therapy, women who practiced yoga during the treatment period reported greater benefits to physical functioning and general health. They were more likely to perceive positive life changes from their cancer experience than either other group.

Women who practiced yoga also had the steepest decline in their cortisol across the day, indicating that yoga had the ability to regulate this stress hormone. This is particularly important because higher stress hormone levels throughout the day, known as a blunted circadian cortisol rhythm, have been linked to worse outcomes in breast cancer.

According to Cohen, developing a yoga practice also helps patients after completing cancer treatment. “The transition from active therapy back to everyday life can be very stressful as patients no longer receive the same level of medical care and attention. Teaching patients a mind-body technique like yoga as a coping skill can make the transition less difficult.”

Through a grant from the National Cancer Institute – the largest ever awarded for the study of yoga in cancer – Cohen and his team will next conduct a Phase III clinical trial in women with breast cancer to further determine the mechanisms of yoga that lead to improvement in physical functioning, quality of life, and biological outcomes during and after radiation treatment. A secondary aim of the trial, but one of great importance, stressed Cohen, is assessing cost efficiency analysis for the hospital, health care usage costs in general, and examining work productivity of patients.

MD Anderson recognizes the growing body of research indicating that relaxation-based interventions can contribute to the well-being of people with cancer. Through the Integrative Medicine Program, complementary therapies, such as yoga, are offered at MD Anderson’s Integrative Medicine Center, and are used in concert with mainstream care to manage symptoms, relieve stress, enhance quality of life, and improve outcomes for patients and their caregivers. MD Anderson’s Integrative Medicine faculty also conduct research in the biological and behavioral effects of mind-body based interventions; the anti-cancer potential of natural compounds; and, acupuncture to treat common cancer treatment-related side effects.

In addition to Cohen, other MD Anderson researchers contributing to this study include: Kavita Chandwani, M.D., former senior research coordinator and yoga teacher; Robin Haddad, M.P.H. , research coordinator, George Perkins, M.D. in the Department of Radiation Oncology; Amy Spelman, Ph.D., Kayla Johnson, B.S. and Adoneca Fortier, B.S., all staff in the Integrative Medicine Program; Banu Arun, M.D., in the Department of Breast Medical Oncology; and Qi Wei, M.S., Sr. Statistical Analyst. Clemens Kirschbaum, Ph.D. contributed from the Technical University of Dresden, Dresden, Germany. Collaborators from SVYASA include NV Raghuram, B.E.; R. Nagarathna, M.D., and HR Nagendra, Ph.D., founder.

Effect of yoga on QOL, cortisol rhythym, and HRV for women with breast cancer undergoing radiotherapy.

Sub-category: Quality of Life Mgmt

Category: Patient and Survivor Care

Meeting: 2011 ASCO Annual Meeting

Session Type and Session Title: Oral Abstract Session, Patient and Survivor Care.

Abstract No: 9009.

Citation: J Clin Oncol 29: 2011 (suppl; abstr 9009).

Author(s): L. Cohen, K. Chandwani, N. V. Raghuram, R. Haddad, G. H. Perkins, A. Spelman, R. Nagarathna, K. Johnson, A. Fortier, B. Arun, Q. Wei, C. Kirschbaum, H. R. Nagendra; University of Texas M. D. Anderson Cancer Center, Houston, TX; Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India; Department of Investigational Cancer Therapeutics, University of Texas M. D. Anderson Cancer Center, Houston, TX; Technical University of Dresden, Dresden, Germany

Abstracts that were granted an exception in accordance with ASCO’s Conflict of Interest Policy are designated with a caret symbol (^) here and in the printed Proceedings.

Abstract: Background: Radiotherapy (XRT) can decrease quality of life (QOL), disrupt cortisol rhythm and contribute to cardiovascular disease. We examined the effects of yoga on buffering changes in QOL, cortisol slope and heart rate variability (HRV) in women with breast cancer undergoing XRT. Methods: Patients with stage 0-III disease were recruited prior to XRT (baseline) and randomized to one of three groups: Yoga (YG-n=53) or Stretching (STR-n=56) 3 times a week for 6 weeks during XRT or Waitlist Control (WLC-n=54). Self-report measures of fatigue (BFI), depression (CESD), QOL (SF-36), benefit finding (BF), and spirituality (FACT-SP) were completed, and saliva and 10-minute ECGs were collected at baseline, end of treatment, and 1, 3, and 6 months later. We examined change from baseline for questionnaires and HRV data and slope analyses for cortisol. Results: By the end of XRT, the YG and STR groups had a reduction in fatigue while the WLC had an increase (YG: -0.23, STR: -0.45, WLC: 0.52; p’s<.05). At 1, 3, and 6 months after XRT, the YG group had a greater increase in SF-36 physical functioning compared to STR and WLC (1 month: 5.8, 2.0, 0.8; 3 months: 6.5, 3.4, -0.2; 6 months: 6.1, 3.4, 1.1; p’s<.05), with differences between STR and WLC at 3 months (p<.02) and similar outcomes for SF-36 general health scores. By 3 and 6 months after XRT, there was a significant increase in BF for the YG group (3 months: 3.1, -2.5, -2.5; 6 months: 1.1; -3.9; -4.7; p’s<.05). There were no differences for spirituality and depression. Cortisol slope was steepest for the YG group compared to STR and WLC (end of XRT: -0.12, -0.08, -0.08; 1 month: -0.12, -0.08, -0.07; p’s<.01). Within group changes of the standard deviation of all n-n intervals (SDNN) from baseline to the end of XRT revealed significant increases in HRV for YG (p<.05; 64.3ms) but not for STR or WLC (5.8ms, -8.1ms). Conclusions: While stretching improved fatigue and physical functioning, yoga buffered changes associated with XRT in terms of fatigue, QOL and benefit finding, resulted in steeper cortisol slopes, and increased HRV. This is the first yoga study to include an active control group, suggesting that the benefits of yoga are due to more than simple stretching, social support or other indirect effects.

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