Last Updated:February 01, 2025, 10:24 IST

Guidelines from leading health bodies now strongly recommend Yoga as adjuvant therapy in cancer care as it can help in reducing every cancer-related symptom

Living with cancer and undergoing its treatment often involves encountering symptoms like fatigue, joint pain, insomnia, nausea, anxiety, depression, cognitive dysfunction, hot flashes, and others. My own journey of being a cancer warrior for nearly two decades was no different, but thankfully, I had Yoga and that made it easier. Yoga and meditation were able to provide relief at various points in time, in all of these and more.

And so, it was a heartening affirmation of belief when I got to know about “guidelines” from leading health bodies strongly recommending Yoga therapy in cancer care. National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO), I learned, had come up with evidence-based guidelines where Yoga was included in standard of care in cancer. To be used alongside standard medical treatments, of course, and not as a replacement.

What are NCCN, ASCO Guidelines?

Guidelines in clinical oncology are developed by expert panels from organisations like NCCN and ASCO. Based on the latest scientific research, these are recommendations that help doctors, patients and caregivers make informed decisions and choose the best treatments. Guidelines are continuously updated as more evidence emerges. ASCO’s endorsements are based on its research studies, like this one published in the Journal of Clinical Oncology. The NCCN focuses on developing and disseminating guidelines based on such research.

Combined NCCN and ASCO guidelines related to Integrative Oncology published in the journal Nature Reviews 2024* show Yoga and meditation work for every symptom. In comparison, other therapies — Acupressure/Acupuncture, Tai Chi/ Qigong, Massage/Reflexology, Hypnosis, Music therapy, Nutrition and Exercise — were found effective for a few symptoms but not all. Exercise, for instance, wouldn’t work for nausea and cognitive dysfunction; Acupressure/acupuncture fail in the case of anxiety-depression, sleep dysfunction and cognitive dysfunction; Tai Chi/Qigong can’t relieve pain, night sweats, nausea and cognitive dysfunction. And so on.

“We see Yoga listed for every cancer-related symptom — pain, fatigue, sleep dysfunction, nausea, anxiety/depression, cognitive dysfunction, hot flashes and night sweats, arthralgia — all suggesting that Yoga should be part of conventional cancer care,” explained Dr. Lorenzo Cohen, Director of Integrative Medicine at MD Anderson Cancer Center, Houston — the world’s largest cancer centre — at a recent conference “Yoga in Cancer Care” at Kaivalyadhama, Lonavala.

Dr Cohen, as the keynote speaker, talked about the evidence base for Yoga, the guidelines, and the implications for cancer care. A leading expert in integrative oncology, he has applied it to support his own recovery in his battle with Melanoma.

Here are edited excerpts from his talk and audience interaction:

Robust Data in Yoga for Cancer

There is so much research to support Yoga in cancer care, multiple reviews, multiple meta-analysis, systematic reviews. Data is so robust that they are all RCTS (randomised control trials) and many of them three-armed clinical trials (a three-armed trial allows for more nuanced comparisons between different interventions). Consistently, much better outcomes have been found for patients doing Yoga, both while undergoing treatment and in the cancer-survivorship stage.

Better Quality of Life, Better Meaning and Purpose in Life

Extensive evidence-based research studies have been carried out in the last two decades where Yoga was used as support therapy for patients of various cancers — breast, lung, head and neck and others. All showed vast improvement in physical functioning, general health, pain, stress, ability to engage in daily activities, healthy cortisol rhythm, etc.

Probably the most exciting finding is the one on finding meaning and purpose in life, or what we call “Eudaimonic purpose”. Studies show that for patients in the Yoga group, this stays above baseline levels over an extended period of time, whereas it decreased over time in the non-Yoga groups.

Medically Inappropriate to Not Include Yoga in Cancer Care

Now that we have the guidelines, it would be medically inappropriate to not include Yoga as an adjuvant. Just as it is necessary to offer surgery, radiotherapy, chemotherapy and other targeted therapy, it is equally necessary to have Yoga therapy in cancer care. Patients may or may not do Yoga practices, but from a hospital perspective, it needs to be offered because it is on the evidence-based guidelines.

The term ‘Yoga therapy’ is used carefully here. A Yoga therapist needs to administer it, someone with expertise in that condition, and not just any Yoga teacher or someone who has 200-hour certification.

When to Use Yoga in Surgery Cases

You could start aspects of Yoga even the next day while being careful about sutures and other things. Yoga is not just the physical component, but also the psycho-spiritual components, including pranayama, meditation, deep relaxation and this part of Yoga should be used throughout. Give it about a month before moving into the physical aspects of Yoga.

Dealing with Scepticism for Yoga

How do we get hospitals to integrate the guidelines? Patients, administrators, physician leaders, and all key stakeholders need to step forward and say they want to have Yoga as standard of care within their hospital systems. Those who are sceptical can be shown the evidence-based studies.

It’s important to understand that within medicine, we take an evidence-based approach. We look at clinical trials and other evidence and we say “this works and we need to incorporate it”. If people are still sceptical about Yoga, then they are not an evidence-based physician. It would be a challenge if that happens to be the president of the hospital or the decision-maker.

Need Financial Coverage or Insurance for Yoga

But at the end of the day, the people who pay for this, the insurance companies and governments, need to support it to the same degree as they support other services. If it is paid for, hospitals will support it. Even though Yoga is now in the guidelines, it is not paid for by any of the insurance companies, though they do pay for acupuncture, nutrition counselling, massage therapy and other forms of integrative services. So, all services that are there in the guidelines need to be paid for in some fashion because it’s ethically the right thing to do.

*Lopez, G., Narayanan, S. & Cohen, L. Integrative medicine in oncology: redefining the standard of care. Nat Rev Cancer 24, 739–740 (2024).

The author is a journalist, cancer survivor and certified yoga teacher. She can be reached at swatikamal@gmail.com.