YOGA FOR CANCER

Dr R Nagarathna MD, FRCP (Edin)

MEDICAL DIRECTOR
Swami Vivekananda
Yoga Anusndhana Samsthana
 INDIA US workshop
on traditional medicine
MINISTRY OF AYUSH
3rd march 2016
New Delhi

Dr NAGARATHNA RAGHURAM
MD, FRCP, DSc(hon)
MEDICAL DIRECTOR
VYASA
 Objectives
Showcasing strengths of AYUSH
systems in managing cancer

Foster research collaborations

june o6 VYASA, BANGALORE 10

 Available evidences
prevent side effects of RT, CT -
surgery faster wound healing
and reduce hospital stay
Dr raghavendra raos work

yoga for nausea vomiting-4

publications
Dr R .Raos work and Dr Nadinis thesis jatharagni,
EGG and questionnaires.
yoga for better sleep Dr Cohen MDACC
june o6 VYASA, BANGALORE 11
 Yoga and cancer booklet
Compilation of publications of VYASA

yoga Reduced
fatigue,[ref,2 3,page 18]
Depression [ ref 1, p1,]
anxiety, [ref 12, p 99]
stress, mood, cortisol [ ref10.13, p 82.107]
Geno-toxicity due to RT [ref 17,p146]
june o6 VYASA, BANGALORE 12
yoga Improves
QOL during RT.[ ref 3,8,9; page
9,62,75]
NK cell count [ref 18,p 155]
Apoptotic index and DNA
damage [6.42]
Cortisol rhythm [ref 10.p82]
june o6 VYASA, BANGALORE 13
Effect of Yoga on QOL, Cortisol Rhythm, and HRV for
Women with Breast Cancer Undergoing Radiotherapy-
R21 CA102385
 Eligible patients approached
N=294

Participant Flow Consented and enrolled in study

n=191

Dropped or taken off study n=13

Randomized n=178

Dropped or taken off study prior to radiotherapy n=15

Yoga n=53 Stretch n=56 Control n=54

End of Treatment n=49 n=53 n=49

1 month after RT n=39 n=45 n=43

3 month after RT n=41 n=41 n=42

6 month after RT n=43 n=43 n=46

The Yoga Program
Breathing and loosening exercises

7 Postures, or asanas

Deep relaxation

Alternate Nostril Breathing

Meditation
Outcomes Assessed
Subjective measures
Health status and physical functioning (SF-36)
Sleep quality (PSQI)
Fatigue (BFI)
Benefit Finding
Spirituality (FACT-SP)
Depression (CES-D)

Objective measures
Cortisol rhythmicity (5 samples/day X 3 days)
Heart rate variability (HRV; 10 minute ECGs)
 Results
FATIGUE Log Cortisol post treatment
0.6 3
Yoga
Yoga Stretch
Stretch
0.4 Control 2.5
Wait list

0.2 log-cortisol
2
Change Score

0 1.5

-0.2 1

-0.4
0.5

-0.6
End of Treatment 1 Month Follow-Up 2 Month Follow-Up 3 Month Follow-Up 0
1 1 2 2 3 3 4 4 5 5 6

Chandwani KD, J Clin Oncol. 2014 Apr 1;32(10):1058-65.

First Phase III Trial on Yoga for Breast
Cancer
R21 CA102385
Effects of stress
on tumor
microenvironment

CANCER
PROGRESSION

Antoni M K, et. al.,

, 2009
Psycho-Oncology -
Interventions
Cancer Cancer
Cancer Cancer
Diagnosis Treatment
Diagnosis Treatment
STRES QUALITY OF
STRES QUALITY OF
S LIFE
S Intervention LIFE
Intervention
Programs
Programs
Psychotherapy
Psychotherapy
Support groups
Support groups
Yoga/Exercise
Physiological Yoga/Exercise
Physiological
variables; Emotional expression
variables; Emotional expression
Music Therapy
Immune & endocrine Music Therapy
Immune & endocrine
function;
function;
Angiogenesis;
Angiogenesis;
DNA damage; Treatment
DNA damage;
Apoptosis. Treatment
Response
Apoptosis. Response
Disease
Disease
Progression
Progression
Survival
Psycho-Oncology -
Mechanisms
Intervention
Intervention
Psychosocial
Psychosocial
Programs Factors:
Programs
Psychotherapy Factors:
Coping, social
Psychotherapy
Support groups Coping, social
support, optimism,
Support groups support, optimism,
Yoga/Exercise finding meaning,
Yoga/Exercise
Emotional expression
finding growth,
positive meaning,
Emotional expression positive growth,
spirituality, etc.
Music Therapy
Music Therapy spirituality, etc.
PANCHAKOSA VIVEKA
PSYCHOSOMATIC
CAUSATION
SELYES MODEL PERCEPTION PHYSICAL/SYMPTOM
COPING ATIC DISTRESS
PSYCHOLO PAIN
GIC HOPELESSNES CINV
DISTRESS S MUCOSITIS
HELPLESS SLEEP PROBLEMS
FATIGUE
AVOIDANCE
ADHIS VYADHIS
Etiology of Cancer A Hypothesis

Perception of Stress
Speed

Emotion Response to stress

Looping

Fast Intrusive Repetitions

SAM
HPA
Amplification Information Molecular
Imbalance
Chronic
Thought
Inflammation
Amp
icatio lif
n
Pathological
Thought Inflammation

Bliss Knowledge Mind BAD HEALTH CANCE

BEHAVIOURS
R
 What is cancer?

IMBALANCE

MULLTIPLICATION DESTRUCTION
SAMATVAM
YOGA
Mind-body Programs
Cognitive behavioral therapy
Individual and group
psychotherapy
Relaxation, guided imagery,
hypnosis
Social support
Humor
Biofeedback
Yoga, tai chi, qigong
Meditation
Emotional expression
Expressive arts
What kind of
Yoga?
FLEXIBILITY OF BODY
Or

FLEXIBILITY OF MIND
 Defining Yoga
Manah Prasamanah
Upayah||
Yoga Vasishta

Yogah Chitta Vritti Prasama

Integrate (yuj)
Nirodhah|| na
Patanjali Yoga Sutra
To
Various
Control
Practice
Samatvam Yoga the
s
Uchyate|| mind
Yoga Karmasukousalam||
Bhagavat Gita
 Yoga Concepts

Concept of Disease Concept of PRANA or

PANCHAKOSHA ENERGY
Adhi- Vyadhi PSYCHOSOM

Anna
Prana
Manas
Vijnana
Ananda
Concept of Prana in management
of CINV
FOR CINV
IMPAIRMENT OF UTTANAPADASANA

SAMANA

PAVANAMUKTASANA

BHUJANGASANA

SUPPRESSION

SHASHANKASANA

SITALI PRANAYAMA

OF UDANA AND SHEETAKARI PRANAYAMA

APANA
PRACTICES

FEAR OF
DISTRESSF
DEATH, DEPRESSIO HAPPINESS
DENIAL ANXIETY UL
RECURREN N ANALYSIS
SYMPTOMS
CE

CM MSRT MEMT PET

VISAK ANAMS
ASANAS, PRANAYAMA, RELAXATION, MEDITATION
 YOGA INTERVENTION
Nutrition Pranayama Meditation

Asana MSRT MIRT Relaxation

 ROLE OF YOGA IN ONCOLOGY :
AN EVIDENCE BASED APPROACH
Nagarathna Raghuram
Raghavendra Rao M
MD, MRCP, FRCP
BNYS, PhD Dean, Division of Life Sciences
Head, CAM Program
SVYASA University
Health Care Global Enterprises ltd.
Bangalore, India. Bangalore, India.
Email: raghav.hcgrf@gmail.com Email: rnagaratna@gmail.com