Cramer, H., Rabsilber, S., Lauche, R., Kummel, S., & Dobos, G. (2015). Yoga and meditation for menopausal symptoms in breast cancer survivors—A randomized controlled trial. Cancer, 121, 2175–2184. 

To evaluate the effects of a 12-week traditional Hatha yoga and meditation intervention on menopausal symptoms in survivors of breast cancer

• N = 40  
• MEAN AGE: 49.2 years (SD = 5.9 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: The study included survivors of breast cancer with no metastatic tumors after completing antineoplastic treatment, surgical chemotherapy, or radiotherapy. Women were aged 30-65 years, with or without antiestrogen medications.
• OTHER KEY SAMPLE CHARACTERISTICS: Patients scored 5 points or more, moderate score, on the Menopause Rating Scale (MRS). Antiestrogens, nonhormonal, and antidepressant medication were included if dose was fixed/stabilized and no changes in perspective were noted in 24 weeks.

• SITE: Single site    
• SETTING TYPE: Not specified    
• LOCATION: Department of Gynecology Certified Breast Cancer at Malteser Hospital St. Anna, Duisburg, Germany

• PHASE OF CARE: Transition phase after active treatment

Unicenter, open-labeled, randomized clinical trial with two groups: (a) the group with yoga and meditation intervention and (b) the control group with usual care

• Menopause Rating Scale (MRS)
• Quality of life was measured with Functional Assessment of Cancer Therapy-Breast (FACT-B)
• Fatigue measured with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
• Depression and anxiety were measured with Hospital Anxiety and Depression Scale (HADS)

Primary outcome: At week 12 and week 24, total menopausal symptoms were lower in the yoga group than in the usual care group (week 12: p = 0.004; week 24: p = 0.023). Regarding quality of life, significant group differences were observed at week 12 for the FACT-B total score (p = 0.002), and for the social (p = 0.024), emotional (p = 0.005), and functional well-being subscales (p = 0.024). There were no group differences for anxiety or depression. Women who received antiestrogen medication (n = 36) presented total menopausal symptoms lower in yoga group at week 12 (p = 0.013) but not at week 24 (p = 0.084). At week 24, no group differences were observed for any of the MRS subscales in the subgroup analysis (p = 0.075–0.352).

Yoga combined with meditation appears to be an effective intervention to relieve menopausal symptoms in survivors of breast cancer for at least three months after the end of the active neoplastic treatments. It can help reduce fatigue, and, for women who are receiving antiestrogen medication, yoga can have at least short-lasting effects.

• Small sample (less than 100)
• Risk of bias (no blinding)
• Risk of bias (sample characteristics)
• Unintended interventions or applicable interventions not described that would influence results 
• Key sample group differences that could influence results
• Intervention expensive, impractical, or training needs
• Groups can be different, as well as anxiety and depression scores at the beginning. Groups also can be contaminated one to another if there is contact.
• Previous experience in yoga was not controlled, and interventions are supposed to be adapted to the individual, so there can be differences in interventions for group members.
• It is unclear if there were individual or group yoga sessions.

Yoga is a good recommendation for patients with breast cancer to manage menopausal symptoms and to decrease fatigue. Intervention is effective to improve quality of life. Yoga does not have serious adverse events, and minor adverse events could be related to other causes.