ASCO: Yoga Reduces Insomnia in Breast Cancer Patients Treated With Hormone Therapy

The use of a yoga program helped to reduce symptoms of insomnia among women with breast cancer undergoing hormonal therapy, and also resulted in an improved quality of life, according to new data presented at the annual meeting of the American Society of Clinical Oncology’s 2013 in Chicago.

“Sleep difficulties and insomnia are highly prevalent in breast cancer survivors on hormonal therapy, such as tamoxifen and aromatase inhibitors,” said Luke Peppone, PhD, MPH, of the University of Rochester Medical Center.

According to background information, more than 30% of breast cancer patients on aromatase inhibitors report reduced sleep quality and about 20% of those women exceed the threshold for clinically significant insomnia.

“Patients often turn to sleep medications, both prescription and non-prescription, which may lead to negative interactions with cancer therapeutics, dependency, rebound impairment after discontinuation, and are not curative,” Dr. Peppone said.

Dr. Peppone and colleagues conducted a multi-site, phase III study to determine the efficacy of yoga at decreasing insomnia and improving sleep quality among breast cancer patients on hormone therapy at the University of Rochester Community Clinical Oncology Program.

The researchers enrolled patients taking aromatase inhibitors (n = 95) or tamoxifen (n = 72) and randomly assigned them to standard care monitoring or a 4-week yoga program plus standard care. Yoga occurred twice a week and consisted of a 75-minute session focused on breathing exercises, 18 hatha and restorative yoga postures, and meditation.

“Surprisingly, women taking sleep medications had higher rates of impaired sleep and insomnia at baseline,” Dr. Peppone said.

This difference was statistically different, even when measured by three different sleep assessments: Insomnia Severity Index, the Pittsburgh Sleep Quality Index, and the Functional Assessment of Chronic Illness Therapy–Fatigue scale.

At the end of the study, patients assigned to the yoga program had significantly reduced insomnia and significantly improved quality of life as measured by all three scales. In addition, patients assigned yoga were also able to reduce the use of prescription sleep medications.

For patients on any sleep medication, those assigned to yoga had a −14.5% change score for sleep medication compared with −3.1% for the control group. Patients taking prescription sleep medications assigned to the yoga intervention had a −17.6% change score compared with −3.3% for the control group.

“Yoga is a safe intervention that may be an effective treatment for impaired sleep and insomnia for breast cancer patients on hormonal therapy,” Dr. Peppone said, adding that trials enrolling breast cancer patients on hormonal therapy are needed to confirm these findings.

In the meantime, Dr. Peppone said that health care providers should consider prescribing yoga, preferably with other treatments such as cognitive therapy or other exercise, for the treatment of sleep problems for breast cancer patients on hormonal therapy, as it has been shown to be safe and effective.