Long-Term Yogic Intervention Improves Symptomatic Scale and Quality of Life by Reducing Inflammatory Cytokines and Oxidative Stress in Breast Cancer Patients Undergoing Chemotherapy and/or Radiotherapy: A Randomized Control Study

Abstract

Introduction: Inflammation has been associated with tumor proliferation and metastasis in breast cancer. Yoga is an ancient therapy that helps in reducing inflammation and improves the patient's quality of life (QoL) and fatigue. In the current study, we investigated the effects of long-term yogic intervention at different time points on the level of inflammatory cytokines and oxidative stress, along with the symptomatic scale and QoL in stage II/III breast cancer patients.Methods: Ninety-six stage II/III breast cancer patients receiving chemotherapy and/or radiotherapy were enrolled and divided into two groups, non-yoga (Group I) and yoga (Group II). Participants in Group II practiced yoga five days per week for 48 weeks. The European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC-QLQ30) was used to measure the QoL and symptomatic scale. Serum levels of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), interferon-γ (IFN-γ) and granulocyte macrophage colony-stimulating factor (GM-CSF), and oxidative stress markers, superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and nitric oxide (NO) were measured at baseline, 16, 32, and 48 weeks in both groups.Results: Yoga significantly (p<0.05) reduced the level of IFN-γ, TNF-α, and MDA and improved QoL (p<0.001) and symptomatic scale (p<0.05) in Group II patients compared to Group I. NO was upregulated in Group I whereas in Group II, it was neither decreased nor increased.Conclusion: These findings suggest that yoga may reduce levels of inflammatory cytokines and improve QoL and symptomatic scale in breast cancer patients receiving chemotherapy and/or radiotherapy. Yoga can be an important additional therapy during cancer treatments to cope with treatment side effects including fatigue, depression, and immunological profile, which directly affects the patient's quality of life.

Health benefits of yoga for cancer survivors: An updated systematic review and meta-analysis

“… 44 noted the opposite. In addition, the yoga group showed significant increases in the serum granulocyte colony-stimulating factor, 44 monocyte chemotactic protein-1, 44 and malondialdehyde levels, 42 and significant decreases in the serum IL-10, 40 anti-apoptotic gene P53, 41 and anti-apoptotic gene Bcl2 levels. 41 …”

“…Jain et al. 42 found that the decline in the TNF-α level in the yoga group was better than that in the control group at 48 weeks of follow-up. Huberty et al.…”

“…For the serum level of interferon-γ, Jain et al. 42 showed a significant decrease in the yoga group, but Kaushik et al. 44 noted the opposite.…”

“…Owing to insufficient data for the pooled analysis, only descriptive analyses were performed. Five studies 22 , 29 , 40 , 42 , 43 reported the relationship between the serum level of the anti-inflammatory factor TNF-α and yoga. Jain et al.…”

“…Owing to the nature of the study interventions, it was difficult to achieve blinding of participants and interveners. Some included studies lacked clear descriptions of the procedures of randomization and allocation concealment, 27 , 36 , 39 , 42 , 45 resulting in potential selection bias. Accordingly, further rigorous and high-quality RCTs are needed to confirm the effects of yoga on health-related outcomes of cancer survivors.…”