title: Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with early stage breast cancer: a case series.
abstract: OBJECTIVE
  Adjuvant chemotherapy for women with breast cancer has significantly improved the cure rate; however, it has been associated with chemotherapy-related cognitive impact (CRCI). The literature provides preliminary support for the feasibility and efficacy of yoga interventions for the general cancer population, however, controlled trials are scarce and no studies have examined the effect of yoga on cognition for women with breast cancer during chemotherapy. This case series aims to identify the impact of yoga on measures of cognition, functional outcomes, and quality of life (QOL) for breast cancer survivors (BCS).
  
  
  METHODS
  Four women with a diagnosis of early-stage breast cancer prior to chemotherapy treatment were administered the following physiologic measures at baseline, 6, and 12 weeks during chemotherapy, and at one and three months after the conclusion of the study: Functional Reach test (balance) and Sit and Reach test (flexibility), and QOL, POMS (Mood) and FACT-B (QOL), at baseline. Primary outcomes of cognition were measured with the Perceived Cognition Questionnaire (PCQ) and CogState, a computerized measurement of cognition. Women attended an Iyengar-inspired yoga program twice a week for 12 weeks. Qualitative questionnaires were administered after the completion of the study to determine perceived benefits and challenges of the yoga program.
  
  
  RESULTS
  Four women with Stage II breast cancer ranged in age from 44-65 years. CogState computerized testing showed changes in varying domains of cognition through treatment and follow-up. Improved balance, flexibility, and QOL were also noted over time. No adverse events were observed. Analysis of qualitative data revealed the yoga classes were helpful and subjects continued the practice elements of yoga including relaxation, breathing, and stretching. The most challenging aspect of the study was physical limitations due to various medical complications and included fatigue, decreased range of motion, and pain.
  
  
  CONCLUSIONS
  This case series suggests that yoga may impact various aspects of cognition during and after chemotherapy administration as noted through quantitative measures. Women describe yoga as improving various domains of QOL through the treatment trajectory. This mind-body intervention may stave off CRCI; however, further investigation is needed for additional randomized controlled trials on the effects of yoga on cognition for women with breast cancer undergoing adjuvant chemotherapy treatment.
authors.affiliation: Richard Stockton College of NJ, Program in Physical Therapy, Pomona, NJ 08240, USA. Marylou.Galantino@stockton.edu
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Galantino
authors.forename: Laurie
authors.initials: L
authors.lastname: Greene
authors.forename: Laura
authors.initials: L
authors.lastname: Daniels
authors.forename: Brandon
authors.initials: B
authors.lastname: Dooley
authors.forename: Laura
authors.initials: L
authors.lastname: Muscatello
authors.forename: Laura
authors.initials: L
authors.lastname: O'Donnell
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D001945:Breathing Exercises; D003071:Cognition; D003072:Cognition Disorders / Q000139:chemically induced / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D009367:Neoplasm Staging; D018583:Pliability; D004856:Postural Balance; D011788:Quality of Life; D012064:Relaxation Therapy; D011795:Surveys and Questionnaires; D015013:Yoga
chemical_list: D000970:Antineoplastic Agents