Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors
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Background: Cancer-related fatigue (CRF) often co-occurs with sleep disturbance and is one of the most pervasive toxicities resulting from cancer and its treatment. We and other investigators have previously reported that yoga therapy can improve sleep quality in cancer patients and survivors. No nationwide multicenter phase III randomized controlled trial (RCT) has investigated whether yoga therapy improves CRF or whether improvements in sleep mediate the effect of yoga on CRF. We examined the effect of a standardized, 4-week, yoga therapy program (Yoga for Cancer Survivors [YOCAS©®]) on CRF and whether YOCAS©®-induced changes in sleep mediated changes in CRF among survivors. Study Design and Methods: Four hundred and ten cancer survivors were recruited to a nationwide multicenter phase III RCT comparing the effect of YOCAS©® to standard survivorship care on CRF and examining the mediating effects of changes in sleep, stemming from yoga, on changes in CRF. CRF was assessed by the Multidimensional Fatigue Symptom Inventory. Sleep was assessed via the Pittsburgh Sleep Quality Index. Between- and within-group intervention effects on CRF were assessed by analysis of covariance and 2-tailed t test, respectively. Path analysis was used to evaluate mediation. Results: YOCAS©® participants demonstrated significantly greater improvements in CRF compared with participants in standard survivorship care at post-intervention ( P < .01). Improvements in overall sleep quality and reductions in daytime dysfunction (eg, excessive napping) resulting from yoga significantly mediated the effect of yoga on CRF (22% and 37%, respectively, both P < .01). Conclusions: YOCAS©® is effective for treating CRF among cancer survivors; 22% to 37% of the improvements in CRF from yoga therapy result from improvements in sleep quality and daytime dysfunction. Oncologists should consider prescribing yoga to cancer survivors for treating CRF and sleep disturbance.
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The relationship between mindfulness and fatigue may be better mediated through another pathway, such as sleep.
“the relationship between mindfulness and fatigue may be better mediated through another pathway, such as sleep. 72”
From Mindfulness and Psychosocial Symptoms in People with Cancer: Testing Rumination and Experiential Avoidance as Mediators, and Sex as a Moderator. (2025) · cites this paper as [72]
The Methods (Yoga Intervention; page unavailable) say the yoga program included mindfulness exercises. The Results (Mediation Effect of Yoga-Induced Changes in Sleep on CRF; page unavailable) report that improved sleep partly mediated the program’s effect on cancer-related fatigue. The paper did not test mindfulness separately, so it does not establish sleep as a pathway specifically between mindfulness and fatigue. (LLM, conf=0.87)
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- Authors
- Lin, P.-J., Kleckner, I. R., Loh, K. P., Inglis, J. E., Peppone, L. J., Janelsins, M. C., Kamen, C. S., Heckler, C. E., Culakova, E., Pigeon, W. R., Reddy, P. S., Messino, M. J., Gaur, R., & Mustian, K. M.
- Affiliations
- University of Rochester Medicine (US)
- Wichita NCORP, Wichita, KS, USA
- Southeast Clinical Oncology Research Consortium (US)
- Genome Prairie (CA)
- Corresponding author
- Lin, Po-Ju
- ORCID
- Venue
- Integrative Cancer Therapies
- Publisher
- SAGE Publications
- Published
- 2019-01
- Volume
- 18
- Pages
- 1534735419855134-1534735419855134
- ISSN
- 1534-7354 (ISSN-L)
- 1552-695X
- PMC
- PMC6552348
- OpenAlex
- W2948200417
- Cited by
- 92
- References
- 58
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 23 · 2023: 15 · 2022: 17 · 2021: 8 · 2020: 5
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Integrative Cancer Therapies (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute (U10CA037420)
- National Cancer Institute (K07CA168886, K07CA168911, K07CA190529, K07CA221931, R01CA181064, R25CA102618, U10CA037420, UG1CA189961)
- Division of Cancer Prevention, National Cancer Institute (UG1CA189961)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- yoga therapy, cancer-related fatigue, sleep quality, sleep disorders, cancer survivors, mediation analysis, daytime dysfunction, napping, survivorship care, Pittsburgh Sleep Quality Index
- MeSH terms
- Cancer Survivors, Fatigue, Female, Humans, Male, Middle Aged, Neoplasms, Quality of Life, Sleep, Sleep Wake Disorders, Yoga, Meditation
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