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Chaoul A, Milbury K, Spelman A, Basen-Engquist K, Hall MH, Wei Q, Shih YCT, Arun B, Valero V, Perkins GH, Babiera GV, Wangyal T, Engle R, Harrison CA, Li Y, Cohen L. Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer 2017; 124:36-45. [PMID: 28940301 DOI: 10.1002/cncr.30938] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 11/14/2016] [Revised: 05/23/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current randomized trial examined the effects of a Tibetan yoga program (TYP) versus a stretching program (STP) and usual care (UC) on sleep and fatigue in women with breast cancer who were undergoing chemotherapy. METHODS Women with stage (American Joint Committee on Cancer (AJCC) TNM) I to III breast cancer who were undergoing chemotherapy were randomized to TYP (74 women), STP (68 women), or UC (85 women). Participants in the TYP and STP groups participated in 4 sessions during chemotherapy, followed by 3 booster sessions over the subsequent 6 months, and were encouraged to practice at home. Self-report measures of sleep disturbances (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and actigraphy were collected at baseline; 1 week after treatment; and at 3, 6, and 12 months. RESULTS There were no group differences noted in total sleep disturbances or fatigue levels over time. However, patients in the TYP group reported fewer daily disturbances 1 week after treatment compared with those in the STP (difference, -0.43; 95% confidence interval [95% CI], -0.82 to -0.04 [P = .03]) and UC (difference, -0.41; 95% CI, -0.77 to -0.05 [P = .02]) groups. Group differences at the other time points were maintained for TYP versus STP. Actigraphy data revealed greater minutes awake after sleep onset for patients in the STP group 1 week after treatment versus those in the TYP (difference, 15.36; 95% CI, 7.25-23.48 [P = .0003]) and UC (difference, 14.48; 95% CI, 7.09-21.87 [P = .0002]) groups. Patients in the TYP group who practiced at least 2 times a week during follow-up reported better Pittsburgh Sleep Quality Index and actigraphy outcomes at 3 months and 6 months after treatment compared with those who did not and better outcomes compared with those in the UC group. CONCLUSIONS Participating in TYP during chemotherapy resulted in modest short-term benefits in sleep quality, with long-term benefits emerging over time for those who practiced TYP at least 2 times a week. Cancer 2018;124:36-45. © 2017 American Cancer Society.
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Affiliation(s)
- Alejandro Chaoul
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathrin Milbury
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy Spelman
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Qi Wei
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George H Perkins
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gildy V Babiera
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Rosalinda Engle
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carol A Harrison
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Milbury K, Chaoul A, Engle R, Liao Z, Yang C, Carmack C, Shannon V, Spelman A, Wangyal T, Cohen L. Couple-based Tibetan yoga program for lung cancer patients and their caregivers. Psychooncology 2014; 24:117-20. [PMID: 24890852 DOI: 10.1002/pon.3588] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Kathrin Milbury
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Cohen L, Spelman A, Engle R, Arun B, Wei Q, Harrison C, Perkins GH, Valero V, Babiera G, Wangyal T, Chaoul A. Randomized trial of Tibetan yoga in breast cancer patients undergoing chemotherapy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy Spelman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rosalinda Engle
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qi Wei
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol Harrison
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gildy Babiera
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Leal I, Engebretson J, Cohen L, Rodriguez A, Wangyal T, Lopez G, Chaoul A. Experiences of paradox: a qualitative analysis of living with cancer using a framework approach. Psychooncology 2014; 24:138-46. [PMID: 24831084 DOI: 10.1002/pon.3578] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 11/06/2013] [Revised: 04/12/2014] [Accepted: 04/18/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Life-threatening diseases such as cancer represent unique traumas-compared with singular, time-limited traumatic events-given their multidimensional, uncertain, and continuing nature. However, few studies have examined the impact of cancer on patients as a persistent stressor. The aim of this qualitative study is to explore patients' ongoing experiences of living with cancer and the changes encountered in this experience over time. METHODS Written reflections to three open-ended questions collected from 28 patients on their experience of cancer at two time points were analyzed to explore participants' experiences and perspectives over time. Content analysis using a framework approach was employed to code, categorize, and summarize data into a thematic framework. RESULTS Data analysis yielded the thematic framework-living with paradox, consisting of four interrelated themes: sources, experiences, resolution of paradox, and challenges with medical culture/treatment. The primary theme concerned moving through a dualistic and complex cancer experience of concurrently negative and positive emotional states across the course of cancer. CONCLUSIONS Respondents indicated that cycling through this contradictory trajectory was neither linear, nor singular, nor conclusive in nature, but reiterative across time. Recognition that patients' cancer experience may be paradoxical and tumultuous throughout the cancer trajectory can influence how practitioners provide patients with needed support during diagnosis, treatment, and recovery. This also has implications for interventions, treatment, and care plans, and adequately responding to the diversity of patient's psychosocial, physical, existential, and spiritual experience of illness.
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Affiliation(s)
- Isabel Leal
- School of Public Health, University of Texas, Houston, TX, USA; Integrative Medicine Program, Department of General Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Chaoul A, Milbury K, Engle R, Liao Z, Yang C, Carmack C, Shannon V, Spelman A, Wangyal T, Cohen L. Tibetan Yoga Can Help People with Lung Cancer and Their Caregivers. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5136.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alejandro Chaoul
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Kathrin Milbury
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Rosalinda Engle
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Zhongxing Liao
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Chunyi Yang
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Cindy Carmack
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Vickie Shannon
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Amy Spelman
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Tenzin Wangyal
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
| | - Lorenzo Cohen
- (1) University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
- (2) Ligmincha Institute, Shipman, VA, USA
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Milbury K, Chaoul A, Biegler K, Wangyal T, Spelman A, Meyers CA, Arun B, Palmer JL, Taylor J, Cohen L. Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial. Psychooncology 2013; 22:2354-63. [PMID: 23657969 DOI: 10.1002/pon.3296] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [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: 11/16/2012] [Revised: 03/15/2013] [Accepted: 03/27/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although chemotherapy-induced cognitive impairment is common among breast cancer patients, evidence for effective interventions addressing cognitive deficits is limited. This randomized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation (TSM) program to improve cognitive function and quality of life in breast cancer patients. METHODS Forty-seven breast cancer patients (mean age 56.3 years), who were staged I-III at diagnosis, 6-60 months post-chemotherapy, and reported cognitive impairment at study entry were recruited. Participants were randomized to either two weekly TSM sessions for 6 weeks or a wait list control group. Neuropsychological assessments were completed at baseline and 1 month post-treatment. Self-report measures of cognitive function (Functional Assessment of Cancer Therapy (FACT)-Cog), quality of life (SF-36), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep disturbance (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and spirituality (FACT-Sp) were completed at baseline, the end of treatment, and 1 month later. RESULTS Relative to the control group, women in the TSM group performed better on the verbal memory test (Rey Auditory Verbal Learning Test trial 1) (p = 0.06) and the short-term memory and processing speed task (Digit Symbol) (p = 0.09) and reported improved cognitive function (p = 0.06), cognitive abilities (p = 0.08), mental health (p = 0.04), and spirituality (p = 0.05) at the end of treatment but not 1 month later. CONCLUSIONS This randomized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short-term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients.
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Affiliation(s)
- K Milbury
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - A Chaoul
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - K Biegler
- Health Policy Research Institute, University of California, Irvine, CA, USA
| | - T Wangyal
- Ligmincha Institute, Shipman, VA, USA
| | - A Spelman
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C A Meyers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J L Palmer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Taylor
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L Cohen
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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