title: Development and validation of a need-based integrated yoga program for cancer patients: a retrospective study.
abstract: OBJECTIVE
  Complementary and alternative therapies (CAM) are gaining popularity amongst patients as add on to conventional medicine. Yoga stands third amongst all CAM that is being used by cancer patients today. Different schools of yoga use different sets of practices, with some using a more physical approach and many using meditation and/or breathing. All these modules are developed based on the needs of the patient. This paper is an attempt to provide the basis for a comprehensive need based integrative yoga module for cancer patients at different stages of treatment and follow up. In this paper, the holistic modules of the integrated approach of yoga therapy for cancer (IAYTC) have been developed based on the patient needs, as per the observations by the clinicians and the caregivers. Authors have attempted to systematically create holistic modules of IAYTC for various stages of the disease and treatment. These modules have been used in randomized trials to evaluate its efficacy and have shown to be effective as add-on to conventional management of cancer. Thus, the objective of this effort was to present the theoretical basis and validate the need based holistic yoga modules for cancer patients.
  
  
  METHODS
  Literature from traditional texts including Vedas, Ayurveda, Upanishads, Bhagavat Gita, Yoga Vasishtha etc. and their commentaries were looked into for references of cancer and therapeutic directives. Present day scientific literature was also explored with regards to defining cancer, its etiopathology and its management. Results of studies done using CAM therapies were also looked at, for salient findings. Focused group discussions (FGD) amongst researchers, experienced gurus, and medical professionals involved in research and clinical cancer practice were carried out with the objectives of determining needs of the patient and yoga practices that could prove efficient. A list of needs at different stages of conventional therapies (surgery, chemotherapy and radiation therapy) was listed and yoga modules were developed accordingly. Considering the needs, expected side effects, the energy levels and the psychological states of the participants, eight modules evolved.
  
  
  RESULTS
  The results of the six steps for developing the validated module are reported. Step 1: Literature review from traditional yoga and ayurveda texts on etiopathogenesis and management of cancer (arbuda), and the recent literature on cancer stem cells and immunology of cancer. Step 2: Focused group discussions and deliberations to compile the needs of patients based on the expected side effects, energy levels and the psychological state of the patient as observed by the caregivers and the clinicians. Step 3: Content validation through consensus by the experts for the eight modules of IAYTC that could be used as complimentary to conventional management of cancer at different stages during and after the diagnosis was created. Step 4: Field testing for safety and feasibility of the modules through pilot studies. Step 5: Compilation of the results of efficacy trials through RCTs and step 6: A review of our studies on mechanisms to offer evidence for action of IAYTC on psycho-neuro-immunological pathways in cancer.
  
  
  CONCLUSIONS
  The evidence from the traditional knowledge and recent scientific studies validates eight modules of integrated approach of yoga therapy for cancer that can be used safely and effectively as complimentary during all conventional cancer therapies.
authors.forename: Amritanshu
authors.initials: A
authors.lastname: Ram
authors.forename: Nagarathna
authors.initials: N
authors.lastname: Raghuram
authors.forename: Raghavendra M
authors.initials: RM
authors.lastname: Rao
authors.forename: Hemant
authors.initials: H
authors.lastname: Bhargav
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Koka
authors.forename: Satyam
authors.initials: S
authors.lastname: Tripathi
authors.forename: Raghuram V
authors.initials: RV
authors.lastname: Nelamangala
authors.forename: Gopinath S
authors.initials: GS
authors.lastname: Kodaganur
authors.forename: Nagendra Hongasandra
authors.initials: NH
authors.lastname: Ramarao
mesh_terms: D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006694:Holistic Health; D006801:Humans; D008603:Mental Health; D009369:Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016730:Program Development; D015397:Program Evaluation; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome; D015013:Yoga