Tata Memorial Center presented a results of a research study carried out to examine the effects of Yoga on the risks of recurrence and death of breast cancer survivors, recently. Prof-Dr Nita Nair, Surgical Oncologist, Tata Memorial Hospital, shared in a spotlight presentation, the results of the study at the San Antonio Breast Cancer Symposium (SABCS) 2022, held at San Antonio, Texas in the US, from December 6-10, 2022.
SABCS is one of the most prestigious breast cancer conferences in the world, which is held annually in the US. Out of the thousands of research papers submitted to the conference, a few are chosen for the spotlight discussion. The study undertaken by Dr Nair is the first Indian intervention impacting outcomes in breast cancer.
The yoga intervention was carefully designed with inputs from yoga consultants, clinicians as well as physiotherapists to suit the needs of breast cancer patients and survivors, keeping in focus, the different phases of their treatment and recovery.
The yoga protocol included gentle and restorative yoga postures(asana) with regular periods of relaxation and pranayama. It was implemented through classes by qualified and experienced yoga instructors. Additionally, handouts and CDs of the protocol was provided for maintaining compliance.
The largest clinical trial is an important milestone in the use of yoga in breast cancer since this is the first example of an Indian traditional remedy being tested in a rigorous western design of a randomized study with a robust sample size.
Breast cancer is the commonest cancer affecting women not only in India but globally. It raises a huge amount of anxiety in women which is twofold, the first fear of cancer with a threat to life and the second worry due to side effects of treatment and coping with it. It is heartening to see that yoga practiced with rigor and perseverance has proved its superiority in maintaining an excellent quality of life and has also numerically reduced the risk of recurrence and death by 15 percent.
Abstract of the paper at SABCS 2022
Title: The role of yoga as a complementary therapy in women undergoing treatment for breast cancer: A randomized controlled trial.
Authors: Nita S. Nair, Nishu Singh Goel, Vani Parmar, Ashwini Dewade, Shabina Siddique, Rohini W Hawaldar, Rajendra A. Badwe.
Background: Yoga has been tested in multiple small-randomized studies for its impact on quality of life (QOL) on breast cancer (BC). We conducted a randomized controlled trial, to study the effect of yoga on disease-free survival as the primary endpoint in women with operable breast cancer. (NCT02161900).
Methods: Women with non-metastatic breast cancer during and after standard treatment, were randomized to yoga and conventional exercise (YCE) versus conventional exercise (CE) only. The primary endpoint was disease-free survival (DFS) with secondary endpoints of overall survival (OS) and QOL, which was assessed using the EORTC QLQC30, BR23, brief fatigue inventory (BFI), visual pain scores (VPS) and a spirituality questionnaire (SQ). EORTC QLQ was assessed at baseline (BL), 6-9 months (mo), 18-21 mo. BFI and VPS at BL, 6-8 mo and 12-15 mo and SQ at BL and 12-15 mo. We report the final analysis of DFS, OS and QOL in 850 women randomized to the study. The groups were balanced for clinic-pathologic factors in both arms.
Results: Of the 850 women randomized in the study, 426 were on YCE arm and 424 on CE arm. The median age (47 vs 48 years), median pT size (3 vs 2.85cm), grade 3, (82.7 vs 82.1 percent) hormone receptor-positive (69 percent vs 69.4 percent) and HER2neu positive (14.4 vs13.7 percent) were in YCE and CE arms respectively. At a median follow-up of 80 months, the disease free survival was 80 percent vs 76.7 percent (HR= 0.85, 95 percent CI= 0.64 – 1.14, p=0.28), and overall survival was 85.4 percent vs 83.1 percent (HR= 0.86, 95 percent CI = 0.61 – 1.21, p=0.38) in YCE and CE respectively. Physical(p=0.043) and emotional function (0.017), fatigue (p=0.002), pain (p=0.031), appetite loss (<0.001) arm symptoms (0.035) and systemic therapy side effects (0.036) reduced at 6-9month in YCE, with sustained improvements in physical (p=0.036) and emotional function (p=0.008) at 54mo. The median score of fatigue after adjuvant therapy measured by QLQ C30 was lower in YCE compared to CE (11.11vs 22.22, p = 0.002).
Similarly, in BFI the baseline median scores of the severity of fatigue were 5 in YCE and 6 in CE which reduced to 3 at one year in both groups. A further reduction to 0 was observed in the YCE arm at 2 years and then sustained till 4 years compared to the median score of fatigue in CE which stayed at 3. (p=0.04, 0.03 2 and 4 years respectively). In VPS, the number of patients experiencing severe pain in YCE group was less than CE group with a specific reduction noted in pain over the breast/ chest wall (p=0.018 at 24mo). Lastly, SQ assessed spirituality and showed no difference, but less deterioration compared to baseline scores was noted in YCE.
Fifty-three percent of women on YCE showed an improvement in QOL from baseline compared to 47 percent in CE. This cohort had overall compliance of 61 percent to yoga and physiotherapy in YCE with 91.75 percent compliance among those who did yoga for 6-9mo and 85 percent to physiotherapy alone in CE.
Conclusions: Yoga resulted in a 15 percent relative improvement in DFS and 14 percent in OS, which did not reach statistical significance in this trial since the study was planned to look for a 25 percent difference and was not powered to detect a 15 percent improvement.
This is the first study where the long-term benefits in quality of life have been noted with the addition of yoga for women undergoing treatment for breast cancer. Yoga is a low-risk, low-cost therapy that improves day-to-day activity, including pain, fatigue, and quality of life in women with breast cancer.
