Academic journal article International Journal of Yoga

Influence of Yoga on Postoperative Outcomes and Wound Healing in Early Operable Breast Cancer Patients Undergoing Surgery

Academic journal article International Journal of Yoga

Influence of Yoga on Postoperative Outcomes and Wound Healing in Early Operable Breast Cancer Patients Undergoing Surgery

Article excerpt

Byline: Raghavendra. Rao, H. Nagendra, Nagarathna. Raghuram, C. Vinay, S. Chandrashekara, K. Gopinath, B. Srinath

Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results : Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay ( P = 0.003), days of drain retention ( P = 0.001) and days for suture removal ( P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion : The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.

After surgery, breast cancer patients experience particularly high levels of distress[sup] [1],[2],[3],[4] manifested as anxiety, depression and anger due to the effects of surgery and the disease itself on life expectancy, physical appearance and sexual identity.[sup] [5] Furthermore, concerns regarding one's physical condition, postoperative recovery, hospital admissions, anticipating painful procedures, image problems, confronting cancer diagnosis and worries about survival and recovery can contribute to the already prevailing distress and psychological reactions.[sup] [6] Numerous studies have shown that such preoperative distress is known to affect postoperative outcomes and delay recovery in both cancer and noncancer population.[sup] [7] In general, high preoperative stress or anxiety is predictive of greater pain intensity, longer hospital stays, more postoperative complications and poorer treatment compliance.[sup] [8],[9]

Apart from this, distress is also known to impede wound healing in early phases of wound repair through its effect on glucocorticoids and proinflammatory cytokines in blood such as TNF-alpha and IL-1.[sup] [10],[11],[12] Wound healing is important in this current context of breast surgery as exaggerated inflammation, infections and collection of seroma at the wound site lengthen hospital stay, warrant more medical attention, cause distress[sup] [13],[14] and lead to delayed wound closure.[sup] [15] Although the use of anesthetics and opioids for effective postoperative pain management has been shown to reduce plasma cortisol levels[sup] [16] related to poorer wound healing, they nevertheless cause distressing side effects such as headache, nausea and gastrointestinal distress and are not cost-effective.[sup] [17] Evidence suggests that in clinical practice, interventions to reduce the patient's psychological stress level may improve both wound repair and recovery following surgery. …

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