Lung cancer symptoms and side effects often persist in patients as they transition to the survivorship period, resulting in increased stress, poorer functional status, lower quality of life, and higher mortality. However, emerging evidence suggests that yoga can help patients with cancer and other chronic illnesses manage their symptoms, although clinical trials are lacking in the lung cancer survivor population.

In their article in the March 2014 issue of the Oncology Nursing Forum, Fouladbakhsh, Davis, and Yarandi discussed the results of their pilot study of a yoga intervention among non-small cell lung cancer (NSCLC) survivors and its effects on sleep, mood, stress (as measured by salivary cortisol levels), and quality of life.

How Yoga Can Help Symptom Burden in Lung Cancer Survivors

Fouladbakhsh et al. reported that studies have shown that symptoms often occur in clusters in patients with lung cancer that frequently persist into survivorship. These include sleep problems, distressed mood, fatigue, dyspnea, cough, chest pain, bronchitis, and pneumonia. Insomnia is the most common sleep problem, often occurring before cancer treatment and intensifying throughout the illness and into survivorship, affecting well-being, physical functioning, energy levels, and mood for as long as eight years after treatment. Dyspnea and other respiratory issues can contribute to insomnia, and lack of sleep affects stress levels, mood, and distress.

According to Fouladbakhsh et al., studies have shown that yoga can 

  • Improve sleep, appetite, and habits
  • Increase sense of peace and tranquility
  • Change immune and cardiopulmonary function
  • Decrease anxiety, fatigue, and pain.

Yoga’s meditative practices help calm and center patients and promote mindfulness that may reduce fear and anxiety. In addition, yoga’s deep breathing practices have been shown to be beneficial for patients with chronic obstructive pulmonary disease, emphysema, or asthma.

Finally, the ONS Putting Evidence Into Practice resources have identified exercise, such as yoga, as “likely to be effective” for patients with cancer who have anxiety, fatigue, or lymphedema. 

Results of the Yoga Intervention Study in Lung Cancer Survivors

Seven NSCLC survivors participated in the yoga intervention. Because of the small sample size and lack of randomized, controlled design (all seven patients participated in yoga and also served as their own controls), Fouladbakhsh et al. stressed that additional studies be completed to validate the results.

The yoga intervention included a series of poses (see Table 1) that were coordinated with participants’ breath and focused on expanding the diaphragm and rib cage with deep abdominal breathing and extended exhalation. Classes were held weekly for eight weeks, and participants were encouraged to also practice at home using a provided yoga manual. Sleep, mood, stress (as measured by salivary cortisol level), and quality of life were measured at baseline, throughout the intervention, and post-intervention.

Table 1. Example Yoga Class Protocol  
Component Type Practiced Every Week Duration
Poses (asanas) Forward bends (standing or in a chair) 
Triangle pose 
Warrior pose 
Breath-coordinated spinal movements 
Spinal twists 
Back bends		 25 minutes
Breathing exercises (pranayama) Pursed-lip breathing
Slow abdominal breathing
24/7 breath awareness
Conscious breathing		 10 minutes
Meditation (dhyana) Body scan
Walking meditation (mindful walking)
Heart-centered meditation		 2–4 minutes
3–5 minutes 

 

Sleep: Sleep efficiency increased significantly after the yoga intervention, but overall sleep quality and duration remained the same. Fouladbakhsh et al. found that use of sleep medications decreased 65% after the intervention, which may suggest improvement in sleep onset and sleep maintenance (sleep disturbance). 

Mood: Mood significantly improved from pre- to post-intervention and beyond. 

Stress: Mean salivary cortisol levels decreased throughout the intervention, although the improvement did not reach significance.

Quality of life: Both mental and physical quality of life improved significantly during the intervention. Mental health spiked in the first two weeks and remained high for the duration of the yoga intervention. 

Self-reports: All patients said that they enjoyed the classes and that they felt calmer, more relaxed, and better able to handle stressful events outside of class. They also said the yoga manual helped them continue their practice outside of class. In fact, all five of the seven participants who were available for the six-month post-intervention interview said they had continued their yoga practice after the study intervention. 

Feasibility: Going into the study, the prevalence of dyspnea and other breathing issues was the biggest concern influencing feasibility of a yoga intervention in lung cancer survivors. The study showed, however, that it did not interfere with the yoga classes or home practices.

Implications for Oncology Nurses

As mentioned previously, exercise and movement is a proven nursing intervention for patients and survivors experiencing several cancer symptoms and side effects, according to ONS’s Putting Evidence Into Practice resources. The study showed that yoga is a feasible option to satisfy exercise recommendations. Oncology nurses should fully understand how yoga affects the body, mind, and spirit, as well as the appropriateness for diverse groups of individuals across the cancer trajectory. As more evidence emerges, all members of the healthcare team should receive education about potential benefits, risks, and incorporation into treatment and survivorship.

For more information on yoga among lung cancer survivors, refer to the full article by Fouladbakhsh et al.

 

Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing or Oncology Nursing Forum (ONF). This edition summarizes “A Pilot Study of the Feasibility and Outcomes of Yoga for Lung Cancer Survivors,” by Judith M. Fouladbakhsh, PhD, PHCNS-BC, BC, AHN-BC, CHTP, Jean E. Davis, PhD, RN, and Hossein N. Yarandi, PhD, which was featured in the March 2014 issue of ONF. Questions regarding the information presented in this Five-Minute In-Service should be directed to the ONF editor at ONFEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.