A B S T R A C T PurposePrevious research incorporating yoga (YG) into radiotherapy (XRT) for women with breast cancer finds improved quality of life (QOL). However, shortcomings in this research limit the findings. Patients and MethodsPatients with stages 0 to III breast cancer were recruited before starting XRT and were randomly assigned to YG (n ϭ 53) or stretching (ST; n ϭ 56) three times a week for 6 weeks during XRT or waitlist (WL; n ϭ 54) control. Self-report measures of QOL (Medical Outcomes Study 36-item short-form survey; primary outcomes), fatigue, depression, and sleep quality, and five saliva samples per day for 3 consecutive days were collected at baseline, end of treatment, and 1, 3, and 6 months later. ResultsThe YG group had significantly greater increases in physical component scale scores compared with the WL group at 1 and 3 months after XRT (P ϭ .01 and P ϭ .01). At 1, 3, and 6 months, the YG group had greater increases in physical functioning compared with both ST and WL groups (P Ͻ .05), with ST and WL differences at only 3 months (P Ͻ .02). The group differences were similar for general health reports. By the end of XRT, the YG and ST groups also had a reduction in fatigue (P Ͻ .05). There were no group differences for mental health and sleep quality. Cortisol slope was steepest for the YG group compared with the ST and WL groups at the end (P ϭ .023 and P ϭ .008) and 1 month after XRT (P ϭ .05 and P ϭ .04). ConclusionYG improved QOL and physiological changes associated with XRT beyond the benefits of simple ST exercises, and these benefits appear to have long-term durability.

Overall, the general patterns of psychosocial adjustment and QOL are similar among the three surgery groups.

Background Radiotherapy may lead to side-effects undermining patients’ quality of life (QOL). While mind-body practices such as qigong appear to improve QOL in cancer survivors, little is known about benefits for patients undergoing radiotherapy. Thus, this RCT examined the efficacy of a qigong intervention on QOL in women with breast cancer during and after treatment. Methods Ninety-six women with breast cancer were recruited from a cancer center in Shanghai, China, and randomized to the qigong (N=49) or waitlist control (N=47) group. Women in the qigong group attended 5 weekly classes over 5–6 weeks of radiotherapy. QOL outcomes (i.e., depressive symptoms, fatigue, sleep disturbance, and overall QOL) and cortisol slopes were assessed at baseline, during and at the end of treatment, and 1 and 3 months later. Results The mean age of the women was 46 years (range 25–64); stage 0 (7%) stage I (25%), stage II (40%) and stage III (28%); with over half (54%) having undergone mastectomy surgery. Multilevel analyses revealed that women in the qigong group reported less depressive symptoms over time than in the control group (P=.05). Women with elevated depressive symptoms at radiotherapy onset reported less fatigue (P<.01) and better overall QOL (P<.05) in the qigong compared to the control group. Findings were clinically significant. No significant differences were found for sleep disturbance and cortisol slopes. Conclusion Qigong may have therapeutic effects in the management of QOL in women receiving radiotherapy for breast cancer. Benefits were particularly evident for patients with pre-intervention elevated levels of depressive symptoms.

PurposeEvidence has supported the association between psychological factors and cancer biology; however, findings are equivocal on the role of psychosocial factors in cancer progression. This study generates a hypothesis of mechanistic variables by examining the clinical effects of psychosocial factors and cortisol dysregulation in patients with metastatic renal cell carcinoma (RCC) and examines associated activation of transcription control pathways.MethodsPatients with metastatic RCC (n = 217) were prospectively enrolled in this study. Patients completed questionnaires (Centers for Epidemiologic Studies – Depression; SF-36 Health Status Survey; Duke Social Support Index; Coping Operations Preference Enquiry; organized and non-organized religious activity; and intrinsic religiosity), and provided blood and saliva samples. Cortisol levels and whole genome transcriptional profiling were assessed to identify potential alterations in circadian rhythms and genomic pathways.ResultsSeparate Cox regression models, controlling for disease risk category, revealed that CES-D scores (p = 0.05, HR = 1.5, 95% CI for HR: 1.00–2.23) and cortisol slope (p = 0.002; HR = 1.9; 95%CI for HR: 1.27–2.97) were significantly associated with decreased survival. Only cortisol slope and risk category remained significant in the complete model. Functional genomic analyses linked depressive symptoms to increased expression of pro-inflammatory and pro-metastatic genes in circulating leukocytes. 116 transcripts were found to be upregulated by an average of 50% or more in high CES-D patients, and 57 transcripts downregulated by at least 50%. These changes were also found in the tumor in a subset of patients.ConclusionThese findings identify depressive symptoms as a key predictor of survival in renal cell carcinoma patients with potential links to dysregulation of cortisol and inflammatory biology.

Background Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients and available treatments are of little benefit. The objective of this trial was to determine if acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy. Methods A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3 times/week on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire (XQ) and MD Anderson Symptom Inventory for Head/Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates (UWSFR; SSFR). Patients were followed for 6 months after the end of radiotherapy. Results XQ scores for acupuncture were statistically significantly lower than controls starting in week 3 through the 6-months(P=0.003 at week3, all other P’s < 0.0001), with clinically significant differences as follows: week 11- RR 0.63 [95% CI, 0.45, 0.87]; 6 months - RR 0.38 [95% CI, 0.19, 0.76]. Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (UWSFR, P = 0.0004), with greater saliva flow in the acupuncture group at week 7 (UWSFR, P < 0.0001; SSFR, P = 0.002) and 11 (UWSFR, P < 0.02; SSFR, P < 0.03) and at 6 months (SSFR, P < 0.003). Conclusions Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved QOL.