Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery

Abstract

Context:Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery.Objective:The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery.Methods:Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines—soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes.Results:Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels.Conclusion:The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.

Review of yoga therapy during cancer treatment

“…Six studies delivered yoga in group classes [38, 41-42, 44-47, 57], five in one-on-one sessions [40, 43, 48-52, 54-56, 58], and two did not specify the format [36, 39]. Most (9 of 13) provided audio or printed materials for home practice.…”

“…In studies with sufficient information to compare, attrition was greater among yoga participants in two studies [37, 47], among control participants in three studies [38, 48-49, 51-52, 54-56], and approximately equal across groups in four studies [41-43, 58]. Two trials reported 100% completion [39, 57].…”

“…Several of the 13 RCTs demonstrated significant improvements in yoga participants’ mental health, including positive and negative affect, distress, depression, and anxiety [38, 42-46, 48-49, 52-56]. Yoga participants, compared to controls, also reported significantly better emotional, mental, social, physical, and general QOL [42-43, 48].…”

“…Treatment-related side effects, including sleep, fatigue, pain, appetite loss, nausea and vomiting, sequelae-related distress, and toxicity, improved among yoga participants in several studies [39, 41, 48-49, 52, 54, 57]. One study documented better post-operative outcomes, including decreased drain retention, earlier suture removal, and shorter hospitalization, among yoga vs. control participants [51].…”

“…Compared to controls, yoga participants had lower 6:00 am and mean pooled levels of salivary cortisol [54-56] and a steeper cortisol slope [58], which may predict improved survival [59-60]. In the other two studies investigating physiologic results, yoga participants demonstrated a favorable immune response (i.e., serum immunoglobulins and lymphocytes, TNF-alpha) [51-52] and decreased DNA damage [38, 51-52]. …”