1
|
Armer JS, Lutgendorf SK. The Impact of Yoga on Fatigue in Cancer Survivorship: A Meta-Analysis. JNCI Cancer Spectr 2020; 4:pkz098. [PMID: 32368719 PMCID: PMC7190209 DOI: 10.1093/jncics/pkz098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mind-body approaches, particularly yoga, are used by cancer survivors to cope with treatment-related symptoms. Consistency of yoga-related effects on treatment-related symptoms are not known. This meta-analysis was designed to examine effects of yoga on pre- to postintervention improvements in fatigue among cancer patients. METHODS PubMed and PsycINFO were searched for peer-reviewed articles of yoga randomized controlled trials including cancer survivors and reporting at least one fatigue measure. Twenty-nine studies met inclusion criteria (n = 1828 patients). Effect sizes (Hedge's g) were calculated for fatigue, depression, and quality of life. Patient-related and intervention-related characteristics were tested as moderators of outcomes. All statistical tests were two-sided. RESULTS Yoga practice was associated with a small, statistically significant decrease in fatigue (g = 0.45, P = .013). Yoga type was a statistically significant moderator of this relationship (P = .02). Yoga was associated with a moderate decrease in depression (g = 0.72, P = .007) but was not associated with statistically significant changes in quality of life (P = .48). Session length was a statistically significant moderator of the relationship between yoga and depression (P = .004). Neither timing of treatment (during treatment vs posttreatment) nor clinical characteristics were statistically significant moderators of the effects of yoga on outcomes. The effect of yoga on fatigue and depression was larger when the comparator was a "waitlist" or "usual care" than when the control group was another active treatment (P = .036). CONCLUSIONS Results suggest yoga may be beneficial as a component of treatment for both fatigue and depression in cancer survivors.
Collapse
Affiliation(s)
- Jessica S Armer
- Department of Psychological & Brain Sciences
- Gynecologic Oncology, Obstetrics & Gynecology
| | - Susan K Lutgendorf
- Department of Psychological & Brain Sciences
- Gynecologic Oncology, Obstetrics & Gynecology
- Holden Comprehensive Cancer Center
- Department of Urology (SKL), University of Iowa, Iowa City, IA
| |
Collapse
|
2
|
Armer JS, Clevenger L, Davis LZ, Cuneo M, Thaker PH, Goodheart MJ, Bender DP, Dahmoush L, Sood AK, Cole SW, Slavich GM, Lutgendorf SK. Life stress as a risk factor for sustained anxiety and cortisol dysregulation during the first year of survivorship in ovarian cancer. Cancer 2018; 124:3401-3408. [PMID: 29905941 DOI: 10.1002/cncr.31570] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with ovarian cancer often report elevated anxiety at diagnosis that decreases posttreatment. However, a minority of patients experience sustained anxiety. Few studies have examined risk factors for persistent anxiety or its physiologic sequelae in ovarian cancer. Therefore, the authors investigated associations between prior life events, anxiety, inflammation (plasma levels of interleukin-6), and diurnal cortisol profiles in patients with ovarian cancer during the first year postdiagnosis. METHODS Participants (n = 337) completed surveys and had blood and salivary sampling prediagnosis, postchemotherapy (6 months), and 12 months after diagnosis. The Life Events and Difficulties Schedule was administered to a patient subset (n = 127) within 1 month of diagnosis. Linear mixed-effects models were used to analyze relations between anxiety and biologic variables over time. Linear regression models assessed whether anxiety trajectories mediated associations between prior stress exposure and biologic variables. Age, chemotherapy at 1 year, and cancer stage were covariates. RESULTS Decreased anxiety was associated with a more normalized cortisol slope over time (β = 0.092; P = .047). Early life adversity was related to flatter cortisol slopes over time (β = -0.763; P = .002); this relation was partially mediated by anxiety trajectory (P = .046). More danger-related events prediagnosis were associated with sustained anxiety (β = 0.537; P = .019) and flatter cortisol slopes over time (β = -0.243; P = .047); anxiety partially mediated the relation between danger and cortisol slope (P = .037). Neither anxiety nor prior stress exposure was related to levels of interleukin-6. CONCLUSIONS Because dysregulated cortisol has been related to fatigue, poorer quality of life, and shorter survival in patients with ovarian cancer, those who have prior life events and chronic anxiety during the first year postdiagnosis may be at risk for more negative outcomes. Cancer 2018. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Jessica S Armer
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | | | - Lauren Z Davis
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Michaela Cuneo
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Premal H Thaker
- Gynecologic Oncology, Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Michael J Goodheart
- Gynecologic Oncology, Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - David P Bender
- Gynecologic Oncology, Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - Laila Dahmoush
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Anil K Sood
- Gyneclogic Oncology, Cancer Biology, and Center for RNA Interference and Noncoding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven W Cole
- Hematology/Oncology, David Geffen School of Medicine, and the Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, California
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa.,Gynecologic Oncology, Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.,Department of Urology, University of Iowa, Iowa City, Iowa
| |
Collapse
|
3
|
Kinner EM, Armer JS, McGregor BA, Duffecy J, Leighton S, Corden ME, Gauthier Mullady J, Penedo FJ, Lutgendorf SK. Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results. JMIR Cancer 2018; 4:e1. [PMID: 29335233 PMCID: PMC5789163 DOI: 10.2196/cancer.8430] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/16/2017] [Accepted: 11/25/2017] [Indexed: 12/29/2022] Open
Abstract
Background Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors.
Collapse
Affiliation(s)
- Ellen M Kinner
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Jessica S Armer
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States
| | | | - Jennifer Duffecy
- Department of Clinical Psychiatry and Center on Depression and Resilience, University of Illinois at Chicago, Chicago, IL, United States
| | - Susan Leighton
- Ovarian Cancer Research Fund Alliance, Washington, DC, United States
| | - Marya E Corden
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Frank J Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susan K Lutgendorf
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States.,Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA, United States.,Department of Urology, University of Iowa, Iowa City, IA, United States.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States
| |
Collapse
|