How Yoga Is Being Incorporated Into Cancer Center Offerings

By Carol Milano

A growing number of cancer patients are utilizing yoga as a means of coping with the physical and psychological impact of their disease. Yoga classes are being offered at medical and cancer centers around the country, as part of the incorporation of integrative medicine into the mainstream. Held in small groups and geared to patients' needs and limitations, the classes have proven to be extremely popular.

"We know about decreased pain, decreased anxiety, and better tolerance of chemotherapy with these mindful meditations," said David S. Rosenthal, MD, Medical Director of the Zakim Center of Integrative Therapy at DanaFarber Cancer Institute in Cambridge, MA. "We consider the yoga programs we run at the Center to be a definite plus."

A joint American Society of Clinical Oncology /American Cancer Society Educational Symposium on Complementary and Alternative Medicine will be held the day before ASCO's upcoming Annual Meeting in May in Orlando and will include information on yoga, said Dr. Rosenthal, who chairs the ACS's Advisory Committee on Complementary and Alternative Medicine.

Despite the strong supportive evidence of the benefits of yoga, Dr. Rosenthal warns that it is not for every patient. "Yoga is usually done in a group, with a leader," he noted. "Some people like that, others don't."

"Yoga provides a break from the stress of the illness," observed Barrie Cassileth, PhD Chief of Integrative Medicine Services at Memorial Sloan Kettering Cancer Center, where low-impact yoga classes -- from the gentle to the vigorous -- were introduced in 1999.


"'Slow deep breathing relaxes the emotional centers of the brain through the olfactory nerve, and shifts the nervous system from the adrenal sympathetic fight or flight' response to the parasympathetic relaxation response."

Low-Impact Version

There are many kinds of yoga, The low-impact version, known as Kripalu yoga, is the recommended form for cancer patients. It is not strenuous or forced, and puts minimal stress on the joints.

"The classes have become very popular," Dr. Cassileth said, pointing to two important measures of success: a high return rate and reports from patients of enhanced well-being. She has observed -- physical and psychological benefits, ranging from improved muscle tone to a renewed sense of empowerment among class participants. "Patients feel a sense of mastery when they realize there are things they can do despite what they are going through," she said.

Measuring the Benefits

Yoga practice calls for slow, regular breathing while holding a series of postures that stretch the muscles, lengthen the spine, and enhance the body's flexibility. Some responses are actually measurable. Tests conducted on practitioners as they perform their exercises have shown a decrease in blood pressure and slowed respiration and heart rates.

"Slow deep breathing relaxes the emotional centers of the brain through the olfactory nerve, and shifts the nervous system from the adrenal sympathetic 'fight or flight' response to the parasympathetic relaxation response," explained Jeffrey Migdow, MD, a holistic physician at the Kripalyu Center for Yoga and Health in Lenox, MA. He believes that the immune system becomes more active and efficient, as well. "Some research has shown that people release endorphins and enkephalins from their central nervous system after their yoga practice," he added.

Dr. Mingow also pointed to yoga's psychological benefits. "In my experience, cancer patients who practice yoga during their course of chemotherapy feel that they are taking a more active part in their treatment plan and are more confident that their bodies are helping the chemotherapy overcome the disease," he said.

"They report fewer side effects from cherno compared with other patients, and have much more energy and vitality. It also has no known side effects for this population."

Accommodating to Patients' Needs

When patients are unable to do floor exercises, Joanne Guerrerio, RN, Psychological Resource Nurse at BarnesJewish Hospital in St. Louis, provides a user-friendly alternative. "When a patient says, 'I can't do yoga because I can't get on the floor,' I give them a chair," she said. "This makes the experience less threatening."

At Mount Sinai Comprehensive Cancer Center in Miami Beach, patients borrow videotapes that were donated to the Center by yoga instructor Carol Dickman. The tapes are also used by many family members, who are often as stressed as the patients themselves.

Christine Pozo-Katerman, PhD the Co-Director of Psychosocial Services, advises patients to get an okay from their oncologist before starting yoga. "Being able to do something that makes them feel better gives patients a sense of control," she said. "Yoga helps reduce anxiety and fatigue and increases energy, especially after chemotherapy."


"Anything that decreases patients' anxiety levels or helps to calm them is certainly of great benefit. Yoga gives them time to focus and not think about their cancer."

Elisa Krill, MD, a medical oncologist at Mount Sinai, agrees. "Anything that decreases patients' anxiety levels or helps to calm them is certainly of great benefit. Yoga gives them time to focus, and not think about their cancer. For patients who don't have a lot of energy for exercise it's a form of physical activity, as well."

Let's Go to the Tape

GlaxoSmithKline has distributed 10,000 free copies of "Simple Relaxation Techniques For Cancer Patients," to oncologists and oncology nurses across the country. The 43-minute, low-impact tape is available through the company's sales representatives.

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