Yoga and Quality of Life in Breast Cancer Patients
Rao et al. (2015) provides a unique insight into complementary treatment for women with breast cancer by examining the effects of yoga on their quality of life. The article focuses on the psychosocial needs of breast cancer patients, rather than on the medical treatment of the cancer itself. The prevalence of depression in this population is heavily emphasized. The researchers aim to determine the effectiveness in treating these comorbid psychological conditions by having the participants engage in regular yoga exercises. The paper is useful for anyone studying complementary care in patients with breast cancer.
Depression is frequently seen in all types of cancer patients as a result of the hopelessness many patients feel in reaction to their diagnosis. Depression reduces patient quality of life and it is the nurse's role to attempt to counteract this effect. A common form of complementary care to handle depression for cancer patients is support groups. All patients who receive a diagnosis of cancer are offered to participate in a support group where they can share experiences with other people who understand their condition and experience. While this form of therapy has proven effective in managing depression, medical professionals continue to look for new methods. Physical exercise is known to have a positive effect on mood, and yoga is a low impact form of exercise that even those living with illness can do. Therefore, it makes sense to research the potential for yoga to improve the moods of those living with depression secondary to a cancer diagnosis.
While exercise is understood to have an elevating effect on mood, little research has been done to determine the difference in effect for different forms of exercise. Nor has much research been done to compare exercise to purely psychological intervention. Rao et al. (2015) aim to fill this gap in the literature by providing a comparative analysis of the effects of a specific form of exercise (yoga) against a specific form of psychological intervention (support groups) to determine a clear level of benefit for each in treating depression.
The study uses quantitative methods to compare depression scores for people from before the study began to after. The study was conducted on 98 patients with stage two or stage three breast cancer who were selected at random from a treatment facility. The patients were then separated into a two groups of 53 and 45 members. The group of 45 patients was the intervention group and was assigned to attend 60 minute yoga sessions daily for 11 weeks. The second group was provided supportive therapy sessions during their hospital visits lasting 30 minutes once every ten days. The subjects had the option to contact their counselor at any time between sessions. All patients involved were between the ages of 30 and 70 years of age and had recently been diagnosed with breast cancer and were scheduled to undergo surgery throughout the study. Potential participants were excluded from the study if they had any comorbid health problem that could could act as a confounding variable or which could alter the results of intervention (Rao et al., 2015).
Rao et al. (2015) describe the intervention group’s treatment as an “integrated yoga program” which emphasized stress reduction and the acceptance of life changes. The sessions began with ten minute lecture which outlined the basic philosophical concepts of yoga. Afterwards, participants were guided through 20 minutes of breathing exercises and yoga postures, and finally guided meditation that lasted 30 minutes. The subjects received audiotapes and were encouraged to practice yoga at home in between sessions. Subjects were fully immersed in yoga practice and theory.
The supportive therapy provided for the control group focused on education about their condition, peer support, and learning effective coping strategies. The sessions emphasized anxiety reduction by educating participants on the effectiveness of the treatments they were undergoing and on what to expect, thus removing the uncertainty that is often the cause for hopelessness, which in turn is the cause for depression. The sessions were conducted in an informal manner that allowed the counselor to shift focus to address client concerns as they arose. This provided a personally tailored feedback (Rao et al., 2015).
Patients completed Beck’s Depression Inventory before, during, and after treatment. A 31 item checklist was also used to measure the physical symptoms of breast cancer and the participants’ level of mental distress. This checklist helped establish that both groups had similar scores for their severity of symptoms and removed the confounding variable that the groups were not evenly distributed. An analysis of covariance was conducted using the mean depression scores from both groups. During the course of the study, 12 participants from the intervention group and 17 from the control group had dropped out. These participants scores were not included in the analysis (Rao et al., 2015).
Both the intervention and control groups showed marked improvement in their depressive symptoms over the course of the study. Yoga compared well to supportive therapy in reducing symptoms of depression, with findings being considered statistically significant. The greatest measured improvement of depression occurred following surgery for both groups, which indicates that part of their improved mood may have been the effective treatment of their condition. Further backing up this notion was the fact that a positive correlation was show between the severity of participants’ symptoms and their level of depression (Rao et al., 2015).
One possible confound still exists which is the fact that those in the intervention group are essentially in a support group of people experiencing the same thing. The researchers concluded that the positive mood effects seen in the intervention group are not merely due to being in a group of similar individuals, and that something in the exercise itself is specifically an antidepressant, but do not elaborate on what this might be. The intervention group had a larger improvement of depressive symptoms than the control group. One limitation of the study is that the control group only attended therapy once every 10 days while the intervention group attended yoga everyday and could practice at home. As a counterpoint, attending a support group once every 10 days is realistic to how supportive therapy groups work, whereas yoga can be done everyday. The aim of the study of comparing the two forms of therapy is still accomplished (Rao et al., 2015).
Considerations for Nursing
Nursing requires practices to be evidence-based before endorsing them as effective. Many proposed therapeutic interventions, especially those of the alternative medical field, are based in theory or anecdotal evidence and not scientific rigor. That is not to say that these therapies have no benefit for patients, but before nurses can endorse them, the proposed treatment needs to be proven effective in a research study. Nursing is a part of western scientific traditions which shy away from alternative medical theories, but nursing also values results over theory. Therefore, despite the fact that the exact method by which yoga is effective is not known, nursing can endorse it as a practice based on the results observed by Rao et al. (2015).
Rao et al. (2015) demonstrates that yoga can be effective at reducing depression for patients who are not undergoing psychological counseling. This study has strong implications for the nursing field. Not only can nurses recommend yoga to patients, but from an administrative point of view, yoga is less expensive than therapy. More research is needed before any change to depression management is made, and counseling should still be provided for patients if they wish, but the future of depression treatment for patients with breast cancer may look very different if these results are repeatable.
The article demonstrates the effectiveness in using yoga to manage depression secondary to a diagnosis of breast cancer. Rao et al. (2015) effectively account for a large number of possible confounding variables and accurately measure what they set out to measure. The study leaves little room for ambiguity in its effectiveness, and though things worked out well for the patients, more explanation of the ethical considerations would strengthen the article. The has implications for the future of depression management and provides a cheap alternative to counseling that patients can do on their own. The study effectively demonstrates complementary care for anyone interested in studying this subject.
Rao, R., Raghuram, N., Nagendra, H., Usharani, M., Gopinath, K., Diwakar, R., Bilimagga, R. (2015). Effects of an integrated yoga program on self-reported depression scores in breast cancer patients undergoing conventional treatment: A randomized controlled trial. Indian Journal of Palliative Care, 21(2), 174-181.