ROLE OF YOGA IN CANCER PREVENTION ROLE OF YOGA IN CANCER TREATMENT

1. Yoga and Cancer

2. ROLE OF YOGA IN CANCER
Dr Prashant Kumbhaj
MBBS,MD,DM(Medical Oncology),MRCP
SCE(UK),ECMO,PDCR.
Associate Professor ,MedicalOncology Department
,MGUMST,Jaipur.

4. Overview
 Introduction of Yoga
 Elements of yoga
 Types of Yoga
 Benefits
 Role of stress in cancer
 Impact of yoga on inflammation
 Role of yoga in cancer patients
 Take Home Messages

5. YOGA

6. Elements

10. Benefits

11. Types of Yoga
 Hatha yoga is a popular style of yoga. It follows well-known methods for
doing certain postures and breathing. Hatha yoga can be very gentle or
intense depending on how it’s practiced.
 Ashtanga or Power Yoga is a more athletic style of yoga. Its fast pace gets
your heart rate up and helps you lose weight.
 Kundalini Yoga has a strong focus on meditation. It promotes proper
breathing and chanting. While it may not increase heart rate, this type of
yoga can improve mental clarity and flexibility.

12.  Restorative yoga- focuses on winding down after a
long day and relaxing your mind. At its core, this style
focuses on body relaxation. Restorative yoga also helps
to cleanse and free your mind.
 Prenatal yoga- is carefully adapted for "moms to be"
and is tailored to women in all trimesters. Many have
said that prenatal is one of the best types of exercise
for expectant moms because of the pelvic floor work,
focus on breathing, and bonding with the growing
baby;
 prenatal yoga also helps mothers prepare for labor and
delivery.

13.  Iyengar yoga
Iyengar yoga was founded by B.K.S. Iyengar and
focuses on alignment as well as detailed and precise
movements. In an Iyengar class, students perform a
variety of postures while controlling the breath.
 Yin yoga
Yin yoga is a slow-paced style of yoga with seated
postures that are held for longer periods of time. Yin
can also be a meditative yoga practice that helps you
find inner peace.

14.  Bikram Yoga is also known as hot yoga. It strengthens
the body through a series of physically challenging
positions in a 105-degree room with 40% humidity.
This exercise makes sweat and relaxes muscles for a
deeper stretch and workout.
 Tibetan Yoga focuses on controlled breathing, simple
movements and meditation. This type of yoga can
improve sleep, lessen fatigue and reduce stress.

15. Chronic Stress and Cancer
 Chronic stress can promote tumorigenesis and
oncogenesis through the
(1 )Production of stress hormones,
(2)The activation of inflammation,
(3) The suppression of immunity.

17.  Effects of stress hormones on the immune system.
Stress hormones stimulate pro-tumorigenic immune
cells to produce IL-6, IL-10, and other cytokines, and
activate the COX-2/PGE2 pathway to produce VEGF,
which together affect the tumor microenvironment to
suppress tumor immunity.
 The decrease in IL-12 and the increase in IL-10 lead to
selective Th1 inhibition, thereby suppressing the CTL-
mediated cellular immunity and interferon
production.

18. Inflammation
 A systematic review of literature showed the efficacy
of yoga interventions on reducing levels of
inflammatory biomarkers in individuals with chronic
inflammatory conditions including chronic stress.

19.  Of the 15 studies, 5 explored yoga’s effects on patients
with cancer, 4 of which were in breast cancer at varying
stages of disease and treatment periods (Bower et al.,
2014; Kiecolt-Glaser et al., 2014; Parma et al.,
2015; Rao et al., 2017) and 1 that included patients with
colorectal cancer during their chemotherapy treatment
(Sohl et al., 2016).
• Of the studies involving patients with breast cancer,
three found favorable outcomes on inflammation after
the yoga intervention (Bower et al., 2014; Kiecolt-Glaser
et al., 2014; Rao et al., 2017). The favorable outcomes on
inflammation were not associated with any particular

20.  Effects on biomarkers varied among similar
diagnoses. Kiecolt-Glaser et al. (2014) did not find
reductions in the levels of IL-6, IL-1B, or TNF-α
immediately post intervention, but levels were
significantly reduced 3 months later (p < .05).
 Rao et al. (2017) found significant reductions in
natural killer cells (p = .03) and morning waking
cortisol (p < .05).

21.  Bower et al. (2014), who measured inflammatory gene
expression, made a unique discovery:
postintervention, there were no significant changes in
circulating IL-1, CRP, or IL-6, but researchers did find
lower levels of transcription factor nuclear factor-κB, a
pro-inflammatory factor, and increased levels of
glucocorticoid receptor, an anti-inflammatory factor
(p < .05).
 Additionally, a marker of TNF, soluble TNF receptor
Type II, remained stable in the yoga group, whereas in
the control group, it continued to increase, reflecting
increasing inflammation (p = .028).

22. These findings support the premise that yoga may
positively impact inflammatory pathways and the
symptoms of existing inflammatory disease.

23. Asanas for Cancer Patients
 1 Supta Badhha Konasana
 2 Bitliasana marjaryasana
 3 Sukhasana
 4 Viparita Karani Asana
 5 Setu Bandhasanas
 6 Savasana

25. Bitliasana
marjaryasana
Cat cow pose

26. Sukhasana

31.  Data from the National Health Interview Survey
suggest significant increases in the practice of yoga
and meditation in the United States, with the use of
yoga increasing from 9.5% to 14.3% and
meditation from 4.1% to 14.2% between 2012 and
2017.1
 Nowhere is the use of yoga more prevalent than in
people undergoing cancer treatment and in cancer
survivors, as more and more hospitals and cancer
centers offer this important treatment modality.

32.  Interest in the field of yoga and its expansion are due,
in part, to the robust evidence base showing that yoga
improves multiple aspects of quality of life,
physiologic outcomes, and biologic processes, as
well as the increased understanding of the harms of
chronic stress on cancer outcomes.

34.  Small trials in pediatric and adolescent patients have
shown yoga to be effective in alleviating fatigue and
pain as well as for improving quality of life. A pilot
study of cancer survivors, between the ages of 10 and
17, reported significant reductions in anxiety.
 Another study involving young adult survivors showed
that yoga decreased fatigue as well as improved social
functioning and somatization.
 Yoga also yielded significant improvements in quality
of life, functional mobility, and physical activity levels
in active patients as well as their parents.

36.  To conduct the study, 191 patients with breast cancer
(stage 0 to III) were randomised to one of three
groups(1) yoga; (2)simple stretching (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 radiotherapy.

37.  Participants were asked to report on their quality of
life, including levels of fatigue and depression, their
daily functioning and a measure assessing ability to
find meaning in the illness experience.
 Saliva samples were collected and electrocardiogram
tests were administered at baseline, end of treatment,
and at one, three and six months post-treatment

38.  Patients who practiced yoga had the steepest decline
in their cortisol levels across the day, indicating that
yoga had the ability to help 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.

39.  Additionally, after completing radiotherapy, only the
patients in the yoga and stretching groups reported a
reduction in fatigue.
 At one, three and six months after radiation therapy,
patients who practiced yoga during the treatment
period reported greater benefits to physical
functioning and general health. They were more likely
to find life meaning from their cancer experience than
the other groups.
 According to Cohen, research shows that developing a
yoga practice also helps patients after completing
cancer treatment

40.  "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."

42.  Background
Prior studies suggest the benefits of yoga in maintaining Diabetes and
Hypertension. In this study we aim to evaluate the effect of yoga on
Chemo-Radiotherapy induced Diabetes and Hypertension (CRID-H) in
cervical cancer patients.
 Methods
60 cervical cancer subjects (stage II - IV) undergoing chemo-radiation
therapy were randomized into yoga (n = 30) and control group (n = 30).
Yoga group was given loosening, breathing, chanting and meditation
for 5 days/ week for 6 weeks. Weekly assessment of Random Blood
Sugar and blood pressure was recorded from baseline to discharge.
Appropriate statistical analysis was conducted.

43.  Results
6 yoga and 6 non-yoga patients were found to be known case of
hypertension and on medications. During the course of chemo-
radiation 4 yoga and 6 non-yoga patients developed hypertension. The
systolic pressure among the yoga group remained constant with a mean
difference of just 11.3mm of Hg while non-yoga group recorded 37.2mm
of Hg .
Comparative analysis between the two groups show Systolic BP attained
significance of p = 0.03 and Diastolic BP, p = 0.11. Diastolic BP in non-
hypertensive patients of yoga group (p = 0.01) achieved good
significance while hypertensive patients (p = 0.14) and all patients
(p = 0.11) the results incline towards significance.

44.  Thus, yoga is effective to maintain BP among non-
hypertensive patients and attain moderate control in
hypertensive ones.
 RBS data reveals 5 yoga and 6 non-yoga subjects had
pre-existing diabetes. 4 yoga and 6 non-yoga subjects
developed diabetes with chemo-radiation by the 3rd
week of treatment.
 Good significance was achieved between the two
groups as a whole (p = 0.02). The difference was highly
significant at p = 0.009 among pre-existing diabetic
patients.

45.  Conclusions
Adjuvant yoga therapy helps to control CRID-H in
cervical cancer efficiently. The control achieved in RBS
is highly significant.
Considerable effect in hypertension was also observed.
The above direction can be employed in future studies
with larger sample size.

46.  At the 2003 annual meeting of the American Society of
Clinical Oncology (ASCO), results were reported from
a yoga study involving 126 women recently diagnosed
with Stage I or II breast cancer.
 The women were about to receive chemotherapy or
hormonal therapy. Some of the women were assigned
to yoga classes over a 3-month period.
 The women taking yoga had a 12% improvement in
fatigue, physical functioning, and quality of life
compared with those in the program who did not take
the yoga classes.

47.  In 2006, results of a yoga study were reported from an
M.D. Anderson Cancer Center study.
 The study followed 61 women receiving 6 weeks of
radiation treatment for breast cancer. Half the women
took a yoga class twice a week; the other half did not.
Compared with the women who did not take yoga.
 The women in the yoga group reported having more
energy and less daytime sleepiness, better physical
functioning, and better overall quality of life.

48.  According to the joint Society for Integrative Oncology and ASCO
guidelines for the use of integrative therapies during and after breast
cancer treatment, yoga is recommended for reducing anxiety as well as
for improving quality of life, mood, depressive symptoms, fatigue,
and sleep.
 Similarly, the National Comprehensive Cancer Network (NCCN®)
recommends patients “consider” yoga for improving some survivorship
areas, such as distress, cognitive functioning, menopausal
symptoms, and pain.
 Yoga is also formally listed in the NCCN Clinical Practice Guidelines in
Oncology as an effective intervention for cancer-related fatigue and
anticipatory nausea/vomiting.

49. Take home Messages
 Yoga means to join or to unite
 It helps in unification of physical ,mental ,intellectual
and spiritual aspects of human being .
 It has total 8 elements and three elements are mostly
practicised (1) Asanas (2) Prayanam,(3) Meditation
 Many Types ,Hath ayoga, Iyenger yoga are most
common styles
 Yoga reduces chronic inflammation and chronic stress.

50.  Yoga is a mind-body practice ,helps in reducing stress
and boost flexibility.
 Yoga can help patients with cancer both mentally and
physically.
 Yoga may ease some side effects of the disease and its
treatments.
 Ease cancer-related fatigue
 Improve sleep
 Help with recovery from cancer surgery
 Reduce depression, anxiety, and distress