Treatment Options for Lymphedema Patients

M. D. Anderson Cancer Center

Cancer Newsline Audio Podcast Series

Date: August 24, 2008

Duration: 0 / 12:44

 

Return to Cancer Newsline

 

Lisa Garvin:

 

Welcome to Cancer Newsline, a weekly podcast series from the University of Texas, M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today we're talking with Dr. Lorenzo Cohen, PhD. He's the Director of the Integrative Medicine Program here at M.D. Anderson. Welcome Dr. Cohen.

 

Dr. Lorenzo Cohen:

 

Thank you. Good to be here.

 

Garvin:

 

I understand that you're doing a study about Hatha Yoga and how it will help patients undergoing cancer treatment. Let's first talk about Hatha Yoga. What exactly is Hatha Yoga?

 

Dr. Lorenzo Cohen:

 

Well, Hatha Yoga is a form of yoga coming from the Indian tradition. It's been practiced for hundreds if not more years in the Indian subcontinent. And it really focuses on as the word "yoga" which comes from ancient Sanskrit, means as union or to join. And so it's really about trying to work with the mind and the body in unison to help achieve better balance and improve quality of life, outlook on life. Yoga incorporates gentle body movements, controlled breathing as well as meditation. Now Hatha Yoga is what most people think of when they hear the term "yoga." And if you go to your local YMCA or gym and they say they offer yoga, it's typically Hatha Yoga. What is often missing from the yoga that you see in the United States is the incorporation of meditation and mindfulness when people are actually practicing the asanas which is the postures. A lot of the focus in the west is on the postures and getting into the position and being in the correct position. But I would argue that the true benefits of yoga actually come from the process of doing yoga and not the ultimate static position that one would get in. And so when one is practicing yoga, one always needs to be working with the breath, working with the mind and working with the body in unison and then one is truly practicing yoga.

 

Garvin:

 

So apparently, you have been wanting to study the effects of Hatha Yoga on cancer patients here. What sort of things are you doing in that regard?

 

Cohen:

 

Well we've been working with different mind-body practices in fact for quite some time and yoga being one in particular. The first research actually that we did was looking at Tibetan yoga: so a form of yoga coming from the Tibetan tradition. And in that initial study we found that the Tibetan yoga resulted in better sleep quality for patients compared to the group of patients who weren't practicing the Tibetan yoga. And subsequent to that, we actually have an ongoing large study of the Tibetan yoga for women with breast cancer who are undergoing chemotherapy or in the first year after the end of chemotherapy. Within our Hatha Yoga research, we've been focusing on incorporating it into radiation treatment so our first study was for women with breast cancer undergoing radiotherapy. And they participated in yoga classes 2 times a week throughout their 6 weeks of radiation, so they had up to 12 weeks of yoga classes. And we reported at the American Society of Clinical Oncology a few years ago that women who are participating in the yoga program compared to those who were just receiving the standard of care had improved physical functioning by the end of radiation. And so they were able to engage in daily activities at a higher level than women who weren't participating in the yoga by the end of radiation. We also noted that 3 months later the participants in the yoga group reported increased levels of being able to find meaning in their illness, benefit finding in this traumatic experience in their life compared to women who hadn't participated in the yoga program. And now we have a larger ongoing study and an important next step where we're comparing the same form of Hatha Yoga to a group of patients who learn simple stretches and stretches that are recommended for breast cancer patients after surgery or to a third group which is receiving the standard of care. And from that type of study, we'll better understand, "Is there something really unique about this package of yoga compared to just simple stretching?"

 

Garvin:

 

Do you find that patients think that yoga is difficult? I think a lot of people see it you know on TV or whatever and think "I'll never be   able to do that." Is that something you have to overcome?

 

Cohen:

 

Well that's changed tremendously over the past half decade or so where when we first started this research, some people actually hadn't even heard of the word "yoga." Today that is not as common, but people often have the misconception that yoga is about getting your leg behind your head and being able to put your knees, your forehead to your knee. And in fact as I was mentioning earlier, yoga's about the process and not about the ultimate product. So it's important to educate people on the benefits that they can derive from yoga regardless of their level of ability. And in fact, when I first started taking yoga classes from my grandmother who was a yoga master, it was clear that even though I was beginner, I could be physically and mentally getting the same level of benefit from yoga as the next student who came to her who had been coming to her for 20 years because again it's about the process and what you're doing with your mind and your body. As an example, a gymnast can clearly do any yoga posture perfectly because of their agility and their flexibility. But they won't be necessarily doing yoga and getting any benefit from it if it's not done in the appropriate way. And the appropriate way is something that anyone can do again at any level.

 

Garvin:

 

Yeah I think sometimes westerners are focused on the physical aspect of it all as you mentioned earlier, not the meditation and the controlled breathing and so forth.

 

Cohen:

 

Exactly, and really getting connected to your body. And what I believe is quite remarkable about something like yoga and in fact I would argue any of the mind-body practices is it gives you more awareness of your body. And you'll see that not only are you -- if you practice for a regular period of time which some say is preferably a daily practice for up to 6 months, is that you'll notice not only physical changes in your body, but you'll notice changes in the way you think. You'll notice changes in the way different foods make you feel because that large French fries all of a sudden doesn't feel so good half an hour later because you are more aware of your body. So you'll notice that you're changing your diet to become more healthful, that you're having better interactions with individuals, the stress and anxiety that a negative interaction would have had previously may not -- your body won't respond as negatively because of these practices.

 

Garvin:

 

Do you think or do you know if these patients are carrying yoga practices into their post treatment life after they leave M.D. Anderson or leave cancer treatment?

 

Cohen:

 

Well, that's one of the challenges that we experience with our research is to get patients to continue the practice after our studies are over. So our studies are typically for an acute period of time. During radiation they'll come 2 or 3 times a week for the yoga. Some of the work we did in China with Chi-Gong - a Chinese based movement therapy - they actually practice 5 days a week for their 6 weeks of radiotherapy. But then they don't have any classes from us anymore and we see what is typical of people who start to engage in healthful behaviors that weren't part of their lives originally is that unfortunately the majority will drop the healthful habit. The typical New Year's resolution that you're going to exercise and modify your diet and it's usually about 3 to 6 months later that people will stop that healthful behavior. And so one of the challenges is "What can we do to encourage people to continue past that point?" Because there's evidence from the exercise literature - and not so much from the mind-body literature because it's newer - but certainly from the exercise literature that on average, it's at least 3 and in some cases 6 months before you notice and have a profound effect on the person's physiology and biology. And the majority of people will drop off before 6 months so you haven't made it over that point where you've really changed the way your body's functioning. And if people can make it past that 6 month mark with something like physical activity, then their body's going to send them signals that they're craving it. And I believe the same is true for these mind-body practices. Once you get beyond the 6 month point, your brain is going to be signaling to you that they want that hour break: that the brain needs to be quieted for a period of time and not constantly have the monkey mind chattering where you're always jumping from one thought to another. So the key -- and I encourage people to stick it out. Six months of our lives is actually a very short period of time considering the number of years most of us are on this planet. So getting healthful behaviors incorporated and getting past that 6 months is very important to feel the benefits.

 

Garvin:

 

Is there anything you would like to say to wrap up our conversation about Hatha Yoga?

 

Cohen:

 

Well I think this applies to Hatha Yoga but I would argue to any mind-body practices, that it's really important for cancer patients to understand that what they think, how they feel has a profound effect on their physiology of their body. We know that it impacts your stress hormones. It impacts the immune system. It has an impact of course on outlook on life and optimism and we know that these types of mind-body programs such as yoga are very helpful at improving patients' quality of life. And that people should be encouraged to incorporate something into their lives along these lines. And yoga I believe is particularly useful because it incorporates visual imagery. It incorporates movement. It incorporates stretching. It incorporates diaphragmatic breathing and controlled breathing which is very important because most people do not typically breathe in an appropriate manner. And yoga may not be for everyone however. And so people can try Tai-Chi. People can try Zen Meditation. There's many things out there. People just need to go and try different things and if it resonates and it works for you, then make it part of your life.

 

Garvin:

 

Great, thank you Dr. Cohen. And always remember to talk to your doctor before starting any sort of mind-body-spirit program just to make sure that you are physically able to do so. If you have questions about anything you've heard today on Cancer Newsline, contact Ask M.D. Anderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.

 

Return to Cancer Newsline