Top

Supportive Care in Cancer

Published in:

Open Access 01-12-2021 | Mood Disorders | Original Article

Yoga therapy to reduce fatigue in cancer: effects of reminder e-mails and long-term efficacy

Authors: Teresa Zetzl, Andre Pittig, Agnes Renner, Birgitt van Oorschot, Elisabeth Jentschke

Published in: Supportive Care in Cancer | Issue 12/2021

Abstract

Objective

To examine the efficacy of reminder e-mails to continue yoga therapy on practice frequency and fatigue in cancer patients and long-term effects of yoga on fatigue, depression, and quality of life.

Methodology

One hundred two cancer patients who completed an 8-week yoga therapy were randomly allocated to two groups: reminder (N = 51) vs. no-reminder group (N = 51). After completing yoga therapy, the reminder group received weekly e-mails for 24 weeks, which reminded them of practicing yoga, whereas the no-reminder group did not. Primary outcomes were fatigue and practice frequency, and long-term outcomes were fatigue, depression, and quality of life. Data were assessed using questionnaires after yoga therapy (T1) and 6 months after completing yoga therapy (T2).

Result

A significantly stronger reduction of general (p = 0.038, d = 0.42) and emotional fatigue (p = 0.004, d = 0.59) and a higher increase of practice frequency (p = 0.015, d = 0.52) between T1 and T2 were found for the reminder group compared to the no-reminder group. In the mediation model, practice frequency as a mediator partially explained the changes in emotional fatigue (indirect effect B = − 0.10). Long-term effects of yoga therapy regarding fatigue, depression, and quality of life were found (F > 7.46, p < 0.001, d > 0.54).

Conclusion

Weekly reminder e-mails after yoga therapy can positively affect general and emotional fatigue and help cancer patients with fatigue establish a regular yoga practice at home. However, higher practice frequency did not lead to higher physical or cognitive fatigue improvement, suggesting other factors that mediate efficacy on physical or cognitive fatigue, such as mindfulness or side effects of therapy.

Allemani C, Matsuda T, Di Carlo V et al (2018) Global surveillance of trends in cancer survival 2000–14 (CONCORD-3). Lancet (London, England) 391(10125):1023–1075. https://doi.org/10.1016/S0140-6736(17)33326-3CrossRefPubMedCentral

Bower JE (2007) Cancer-related fatigue. Brain Behav Immun 21(7):863–871. https://doi.org/10.1016/j.bbi.2007.03.013CrossRefPubMedPubMedCentral

Miller AH, Ancoli-Israel S, Bower JE et al (2008) Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26(6):971–982. https://doi.org/10.1200/JCO.2007.10.7805CrossRefPubMed

Servaes P, Verhagen C, Bleijenberg G (2002) Fatigue in cancer patients during and after treatment. Eur J Cancer (Oxford, England: 1990) 38(1):27–43. https://doi.org/10.1016/s0959-8049(01)00332-xCrossRef

Kuhnt S, Friedrich M, Schulte T et al (2019) Predictors of fatigue in cancer patients: a longitudinal study. Support Care Cancer 27(9):3463–3471. https://doi.org/10.1007/s00520-019-4660-4CrossRef

Banasik J, Williams H, Haberman M et al (2011) Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract 23(3):135–142. https://doi.org/10.1111/j.1745-7599.2010.00573.xCrossRefPubMed

Bower JE, Greendale G, Crosswell AD et al (2014) Yoga reduces inflammatory signaling in fatigued breast cancer survivors. Psychoneuroendocrinology 43:20–29. https://doi.org/10.1016/j.psyneuen.2014.01.019CrossRefPubMedPubMedCentral

Carson JW, Carson KM, Olsen MK et al (2017) Mindful Yoga for women with metastatic breast cancer. BMC Complement Altern Med 17(1):153. https://doi.org/10.1186/s12906-017-1672-9CrossRefPubMedPubMedCentral

Cramer LR, Langhorst J et al (2016) Is one yoga style better than another? A systematic review of associations of yoga style and conclusions in randomized yoga trials. Complement Ther Med 25:178–187. https://doi.org/10.1016/j.ctim.2016.02.015CrossRefPubMed

10.

Zetzl T, Renner A, Pittig A et al (2020) Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer. Support Care Cancer. https://doi.org/10.1007/s00520-020-05794-2CrossRefPubMedPubMedCentral

11.

Buffart LM, van Uffelen JGZ, Riphagen II et al (2012) Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 12(1):559. https://doi.org/10.1186/1471-2407-12-559CrossRefPubMedPubMedCentral

12.

Cramer H, Lange S, Klose P et al (2011) Can yoga improve fatigue in breast cancer patients? A systematic review. Acta oncologica (Stockholm, Sweden) 51:559–560. https://doi.org/10.3109/0284186X.2011.637960CrossRef

13.

Danhauer SC, Addington EL, Cohen L et al (2019) Yoga for symptom management in oncology: a review of the evidence base and future directions for research. Cancer 125(12):1979–1989. https://doi.org/10.1002/cncr.31979CrossRefPubMed

14.

Dong B, Xie C, Jing X et al (2019) Yoga has a solid effect on cancer-related fatigue in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat 177(1):5–16. https://doi.org/10.1007/s10549-019-05278-wCrossRefPubMed

15.

Cramer H, Rabsilber S, Lauche R et al (2015) Yoga and meditation for menopausal symptoms in breast cancer survivors-a randomized controlled trial. Cancer 121(13):2175–2184CrossRef

16.

Bower JE, Crosswell AD, Stanton AL et al (2015) Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer 121(8):1231–1240. https://doi.org/10.1002/cncr.29194CrossRefPubMed

17.

Kiecolt-Glaser JK, Bennett JM, Andridge R et al (2014) Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors. J Clin Oncol 32(10):1040–1049. https://doi.org/10.1200/JCO.2013.51.8860CrossRefPubMedPubMedCentral

18.

Lundt A, Jentschke E (2019) Long-term changes of symptoms of anxiety, depression, and fatigue in cancer patients 6 months after the end of yoga therapy. Integr Cancer Ther 18:1534735418822096. https://doi.org/10.1177/1534735418822096CrossRefPubMedPubMedCentral

19.

Amritanshu RR, Rao RM, Nagaratna R et al (2017) Effect of long-term yoga practice on psychological outcomes in breast cancer survivors. Indian J Palliat Care 23(3):231–236. https://doi.org/10.4103/IJPC.IJPC_93_17CrossRefPubMedPubMedCentral

20.

Frikkel J, Götte M, Beckmann M et al (2020) Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced cancer patients. BMC Palliat Care 19(1):43. https://doi.org/10.1186/s12904-020-00542-zCrossRefPubMedPubMedCentral

21.

Mikkelsen MK, Nielsen DL, Vinther A et al (2019) Attitudes towards physical activity and exercise in older patients with advanced cancer during oncological treatment - a qualitative interview study. Eur J Oncol Nurs 41:16–23. https://doi.org/10.1016/j.ejon.2019.04.005CrossRefPubMed

22.

Moadel AB, Shah C, Wylie-Rosett J et al (2007) Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 25(28):4387–4395. https://doi.org/10.1200/JCO.2006.06.6027CrossRefPubMed

23.

Chandwani KD, Thornton B, Perkins GH et al (2010) Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 8(2):43–55PubMed

24.

Vadiraja HS, Rao RM, Nagarathna R et al (2017) Effects of yoga in managing fatigue in breast cancer patients. Indian J Palliat Care 23(3):247–252. https://doi.org/10.4103/IJPC.IJPC_95_17CrossRefPubMedPubMedCentral

25.

Fox MC, Creinin MD, Murthy AS et al (2003) Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance. Contraception 68(5):365–371. https://doi.org/10.1016/j.contraception.2003.08.013CrossRefPubMed

26.

Haramiova Z, Stasko M, Hulin M et al (2017) The effectiveness of daily SMS reminders in pharmaceutical care of older adults on improving patients’ adherence to antihypertensive medication (SPPA): study protocol for a randomized controlled trial. Trials 18(1):334. https://doi.org/10.1186/s13063-017-2063-8CrossRefPubMedPubMedCentral

27.

Berger AM, Wielgus K, Hertzog M et al (2010) Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer 18(1):105–114. https://doi.org/10.1007/s00520-009-0636-0CrossRefPubMed

28.

Zetzl T, Schuler M, Renner A et al (2019) Yoga intervention and reminder e-mails for reducing cancer-related fatigue - a study protocol of a randomized controlled trial. BMC Psychol 7(1):64. https://doi.org/10.1186/s40359-019-0339-3CrossRefPubMedPubMedCentral

29.

Fischer I, Weis J, Rüffer U et al. (2017) Cancer-related fatigue in the palliative situation. Z Palliativmed (18): 97–110

30.

Kabat-Zinn J (2015) Die MBSR Yogaübungen: Stressbewältigung durch Achtsamkeit, 4th edn. Arbor Verlag, Freiburg im Breisgau

31.

Weis J, Tomaszewski KA, Hammerlid E et al. (2017) International Psychometric Validation of an EORTC Quality of Life Module Measuring Cancer Related Fatigue (EORTC QLQ-FA12). J Natl Cancer Inst 109(5). https://doi.org/10.1093/jnci/djw273

32.

Weis J (2013) Diagnostik und Erfassung der tumorassoziierten Fatigue. Forum 28(1):39–42CrossRef

33.

Löwe B, Kroenke K, Herzog W et al (2004) Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 81(1):61–66. https://doi.org/10.1016/S0165-0327(03)00198-8CrossRefPubMed

34.

Hartung TJ, Friedrich M, Johansen C et al (2017) The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer 123(21):4236–4243CrossRef

35.

Groenvold M, Petersen MA, Aaronson NK et al (2006) The development of the EORTC QLQ-C15-PAL. Eur J Cancer 42(1):55–64CrossRef

36.

Steketee G, Chambless DL (1992) Methodological issues in prediction of treatment outcome. Clin Psychol Rev 12(4):387–400. https://doi.org/10.1016/0272-7358(92)90123-PCrossRef

37.

Hayes AF (2018) Partial, conditional, and moderated moderated mediation: quantification, inference, and interpretation. Commun Monogr 85(1):4–40. https://doi.org/10.1080/03637751.2017.1352100CrossRef

38.

Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891. https://doi.org/10.3758/BRM.40.3.879CrossRefPubMed

39.

Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173CrossRef

40.

Rucker DD, Preacher KJ, Tormala ZL et al (2011) Mediation analysis in social psychology: current practices and new recommendations. Soc Pers Psychol Compass 5(6):359–371. https://doi.org/10.1111/j.1751-9004.2011.00355.xCrossRef

41.

Bower JE, Garet D, Sternlieb B et al (2012) Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 118(15):3766–3775. https://doi.org/10.1002/cncr.26702CrossRefPubMed

42.

Cramer H, Rabsilber S, Lauche R et al (2015) Yoga and meditation for menopausal symptoms in breast cancer survivors—a randomized controlled trial. Cancer 121(13):2175–2184. https://doi.org/10.1002/cncr.29330CrossRefPubMed

43.

Liu Q, Abba K, Alejandria MM et al. (2014) Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment. Cochrane Database Syst Rev 2014(11): CD006594. https://doi.org/10.1002/14651858.CD006594.pub3

44.

Buffart LM, Ros WJG, Chinapaw MJM et al (2014) Mediators of physical exercise for improvement in cancer survivors’ quality of life. Psychooncology 23(3):330–338. https://doi.org/10.1002/pon.3428CrossRefPubMed

45.

Lin P-J, Peppone LJ, Janelsins MC et al (2018) Yoga for the management of cancer treatment-related toxicities. Curr Oncol Rep 20(1):5. https://doi.org/10.1007/s11912-018-0657-2CrossRefPubMedPubMedCentral

Title: Yoga therapy to reduce fatigue in cancer: effects of reminder e-mails and long-term efficacy
Authors: Teresa Zetzl
Andre Pittig
Agnes Renner
Birgitt van Oorschot
Elisabeth Jentschke
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Mood Disorders
Affective Disorder
Fatigue
Published in: Supportive Care in Cancer / Issue 12/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06345-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methodology

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2021

Neuropathy severity at the time of oxaliplatin treatment alteration in patients with colon cancer (Alliance A151912)

Relationships between health literacy, having a cancer care coordinator, and long-term health-related quality of life among cancer survivors

Clinical utility of a prediction tool to differentiate between breast cancer patients at high or low risk of chemotherapy-induced nausea and vomiting

Effects of parenteral nutrition and hydration on survival in advanced cancer patients with malignant bowel obstruction: secondary analysis of a multicenter prospective cohort study

Effectiveness of naloxegol in patients with cancer pain suffering from opioid-induced constipation

Breast cancer-related lymphedema patient and healthcare professional experiences in lymphedema self-management: a qualitative study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer