Yoga in addition to standard care for patients with haematological malignancies

  • Review
  • Intervention




Haematological malignancies are malignant neoplasms of the myeloid or lymphatic cell lines including leukaemia, lymphoma and myeloma. In order to manage physical and psychological aspects of the disease and its treatment, complementary therapies like yoga are coming increasingly into focus. However, the effectiveness of yoga practice for people suffering from haematological malignancies remains unclear.


To assess the effects of yoga practice in addition to standard cancer treatment for people with haematological malignancies.

Search methods

Our search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to 4th February 2014), databases of ongoing trials (;, conference proceedings of the American Society of Clinical Oncology, the American Society of Hematology, the European Haematology Association, the European Congress for Integrative Medicine, and Global Advances in Health and Medicine. We handsearched references of these studies from identified trials and relevant review articles. Two review authors independently screened the search results.

Selection criteria

We included randomised controlled trials (RCTs) of yoga in addition to standard care for haematological malignancies compared with standard care only. We did not restrict this to any specific style of yoga.

Data collection and analysis

Two review authors independently extracted data for eligible studies and assessed the risk of bias according to predefined criteria. We evaluated distress, fatigue, anxiety, depression and quality of sleep. Further outcomes we planned to assess were health-related quality of life (HRQoL), overall survival (OS) and adverse events (AE), but data on these were not available.

Main results

Our search strategies led to 149 potentially relevant references, but only a single small study met our inclusion criteria. The included study was published as a full text article and investigated the feasibility and effect of Tibetan Yoga additional to standard care (N = 20; 1 person dropped out before attending any classes and no data were collected) compared to standard care only (N = 19). The study included people with all stages of Hodgkin and non-Hodgkin's lymphoma, with and without current cancer treatment. The mean age was 51 years.

We judged the overall risk of bias as high as we found a high risk for performance, detection and attrition bias. Additionally, potential outcome reporting bias could not be completely ruled out. Following the recommendations of GRADE, we judged the overall quality of the body of evidence for all predefined outcomes as 'very low', due to the methodical limitations and the very small sample size.

The influence of yoga on HRQoL and OS was not reported. There is no evidence that yoga in addition to standard care compared with standard care only can improve distress in people with haematological malignancies (mean difference (MD) -0.30, 95% confidence interval (CI) -5.55 to 4.95; P = 0.91). Similarly, there is no evidence of a difference between either group for fatigue (MD 0.00, 95% CI -0.94 to 0.94; P = 1.00), anxiety (MD 0.30, 95% CI -5.01 to 5.61; P = 0.91) or depression (MD -0.70, 95% CI -3.21 to 1.81; P = 0.58).

There is very low quality evidence that yoga improves the overall quality of sleep (MD -2.30, 95% CI -3.78 to -0.82; P = 0.002). The yoga groups' total score for the Pittsburgh Sleep Quality Index (PSQI) was 5.8 (± 2.3 SD) and better than the total score (8.1 (± 2.4 SD)) of the control group. A PSQI total score of 0 to 5 indicates good sleep whereas PSQI total score 6 to 21 points towards significant sleep disturbances. The occurrence of AEs was not reported.

Authors' conclusions

The currently available data provide little information about the effectiveness of yoga interventions for people suffering from haematological malignancies. The finding that yoga may be beneficial for the patients' quality of sleep is based on a very small body of evidence. Therefore, the role of yoga as an additional therapy for haematological malignancies remains unclear. Further high-quality randomised controlled trials with larger numbers of participants are needed to make a definitive statement.








検索戦略として、Cochrane Central Register of Controlled Trials(CENTRAL)、MEDLINE(1950年~2014年2月4日)、進行中の試験のデータベース(controlled、、American Society of Clinical Oncology、American Society of Hematology, European Haematology Association、European Congress for Integrative Medicine、Global Advances in Health and Medicineの学会紀要を含めた。同定された試験および関連性のあるレビュー論文から得られたこれらの研究の参考文献をハンドサーチした。2名のレビュー著者が独立して、検索結果をスクリーニングした。






検索戦略により149件の関連する可能性がある参考文献が見つかったが、適格基準を満たしたのは1件の小規模研究のみであった。この選択した研究は、フルテキスト論文として発表され、標準ケアに併用したチベットヨガ(N = 20、1例はクラス参加前に脱落し、データは収集されなかった)を標準ケア単独(N = 19)と比較して実現可能性と効果を検討していた。研究は、組み入れ時点で癌治療中であるか否かを問わず、全ステージのホジキンおよび非ホジキンリンパ腫患者を対象としていた。平均年齢は51歳であった。


HRQoLおよびOSに対するヨガの影響は報告されていなかった。標準ケアに併用したヨガは標準ケア単独と比べて血液悪性疾患患者の苦痛を緩和する可能性を示すエビデンスはない(平均差(MD)-0.30、95%信頼区間(CI)-5.55 ~ 4.95、P = 0.91)。同様に、疲労(MD 0.00、95% CI -0.94 ~ 0.94、P = 1.00)、不安(MD 0.30、95% CI -5.01 ~ 5.61、P = 0.91)、抑うつ(MD -0.70、95% CI -3.21 ~ 1.81、P= 0.58)に関し、群間差を示すエビデンスはない。

ヨガが睡眠の全体的な質を改善するというエビデンスは非常に質が低い(MD -2.30、95% CI -3.78 ~ -0.82、 P = 0.002)。ヨガ群のPittsburgh Sleep Quality Index(PSQI)合計スコアは5.8 (± 2.3 SD)で、対照群の合計スコア(8.1 (± 2.4 SD))よりも良かった。 PSQI合計スコア0~5点は良好な睡眠を示し、PSQI合計スコア6~21点は重大な睡眠障害を示している。有害事象の発生は報告されていなかった。




《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Yoga in addition to standard care for people with blood or lymph node cancer


Blood and lymph node cancers are referred to as haematological malignancies. These are types of cancer that affect the blood, bone marrow and other parts of the lymphatic system. The most common ones are lymphomas, leukaemias and myelomas. Depending on the kind of cancer and how far it has spread, there are a lot of different options to manage the disease. Usually chemotherapy, radiotherapy or a combination of both is used to treat the disease. If the cancer is widespread, a transplantation of the patients’ own bone marrow cells combined with an aggressive chemotherapy can be a treatment option.

People with cancer most commonly experience high emotional distress, anxiety, fatigue, depression and sleeping problems. These symptoms can persist, even when the treatment has ended. In search of ways to manage and cope with such conditions, more and more patients are turning to complementary and alternative therapies.


Yoga, originating in a thousand year old Indian tradition, is becoming more and more popular. There are hundreds of different styles of yoga, but in the Western world, yoga training mostly consists of three main elements: physical postures, breathing exercises and meditation. An increasing number of cancer patients use yoga as an additional way to improve their well-being. However, a systematic evaluation about the effects of yoga in the management of haematological malignancies is still missing.


We reviewed the evidence about the effects of yoga on people with haematological malignancies. We also considered overall survival, distress, fatigue, depression, anxiety, sleep quality and adverse events as important outcomes. We compared people suffering from haematological malignancies treated with yoga and standard cancer care with those treated with standard cancer care only.


We included a single trial with 39 participants in the review (20 in the yoga group and 19 in the control group). The trial looked at a seven-week Tibetan Yoga program in a group of people with Hodgkin and non-Hodgkin's lymphoma. The average age was 51 years. The trial involved patients who were currently receiving anti-cancer therapy as well as patients who were not receiving active therapy. The trial found insufficient data to make a judgement about the efficacy of yoga on distress, fatigue, depression and anxiety compared with patients not practicing yoga. Yoga can improve the patients' quality of sleep. The trial gave no information about health-related quality of life, overall survival or adverse events.

On the basis of the GRADE criteria, we judged the overall quality of evidence for yoga concerning the outcomes distress, fatigue, anxiety, depression and quality of sleep as 'very low'.


There are not enough data to say how effective yoga is in the management of haematological malignancies. Therefore, the role of yoga for haematological malignancies remains unclear. Further large, high-quality randomised controlled trials are needed.

The evidence is up-to-date as of 4 February 2014.

Laički sažetak

Joga uz standardnu skrb za oboljele od karcinoma krvi ili limfnih čvorova


Karcinomi krvi i limfnih čvorova nazivaju se zloćudnim bolestima hematološkog sustava. Postoje tipovi karcinoma koji pogađaju krv, koštanu srž i ostale dijelove limfnog sustava. Najčešći su limfomi, leukemije i mijelomi. Ovisno o vrsti karcinoma i tome koliko se proširio, postoji mnogo različitih mogućnosti za liječenje bolesti. Inače se za liječenje bolesti koriste kemoterapija, radioterapija ili kombinacija obje. Ako karcinom zahvaća veće područje, može se razmotriti transplantacija pacijentovih stanica koštane srži kombinirana s agresivnom kemoterapijom.

Ljudi s karcinomom najčešće pate od visokog emocionalnog stresa, tjeskobe, nesvjestice, depresije i problema spavanja. Ovi simptomi mogu ostati, čak i nakon što je terapija završila. U potrazi za načinima liječenja i nošenja s ovakvim stanjima, sve više i više pacijenata se okreće komplementarnim i alternativnim načinima liječenja.


Joga, koja potječe od tisuću godina stare indijske tradicije, postaje sve popularnija. Postoje stotine različitih stilova joge, ali u Zapadnom svijetu treninzi joge se uglavnom sastoje od tri glavna elementa: fizičkih poza, vježba disanja i meditacije. Sve veći broj pacijenata s karcinomom koristi jogu kao dodatni način na koji bi poboljšali svoje zdravstveno stanje. Ipak, sustavna procjena učinaka joge u rješavanju hematoloških malignosti još uvijek nije napravljena.


Pregledani su dokazi o učincima joge na ljude s hematološkim malignostima. Kao važne ishode autori su procijenili i ukupno preživljenje, bol, nesvjesticu, depresiju, kvalitetu spavanja i ostale nuspojave. Uspoređeni su ljudi koji pate od hematoloških malignosti koji su se liječili jogom i standardnom skrbi za karcinom i onih koji su se primali samo standardnu skrb za karcinom.


U Cochrane sustavnom pregledu autori su uključili jedno istraživanje s 39 sudionika (20 u joga skupini i 19 u kontrolnoj skupini). Istraživanje je promatralo sedmo-tjedni tibetanski program joge u skupini ljudi s Hodgkinovim i ne-Hodgkinovim limfomom. Prosječna dob je bila 51 godina. Istraživanje je uključivalo pacijente koji su tada primali anti-karcinomsku terapiju kao i pacijente koji nisu primali aktivnu terapiju. Istraživanjem se došlo do nedovoljnog broja podataka za stvaranje prosudbe o djelotvornosti joge na bol, nesvjesticu, depresiju i tjeskobu uspoređujući s pacijentima koji ne prakticiraju jogu. Pokazalo se da joga može poboljšati pacijentovu kvalitetu spavanja. Istraživanje nije dalo nikakvih informacija o kvaliteti života povezanoj sa zdravljem, ukupnom preživljenju ili nuspojavama.

Na temelju GRADE kriterija, ukupna kvalitetu dokaza koji dokazuju da joga djeluje na posljedice kao što su bol, vrtoglavica, tjeskoba, depresija i kvaliteta spavanja procijenjena je kao „vrlo niska“.


Ne postoji dovoljno dokaza koji bi potvrdili koliko je joga djelotvorna u liječenju hematoloških malignosti. Stoga, uloga joge za hematološke malignosti ostaje nerazjašnjena. Potrebna su nova, veća, visoko-kvalitetna randomizirana kontrolna istraživanja na ovu temu.

Analizirani dokazi objavljeni su do 4. veljače 2014.

Bilješke prijevoda

Hrvatski Cochrane ogranak.
Prevela: Ivana Novak

Laienverständliche Zusammenfassung

Yoga zusätzlich zur Standard-Versorgung von Menschen mit Blut- oder Lymphknotenkrebs


Blut- und Lymphknotenkrebs werden als maligne hämatologische Erkrankungen bezeichnet. Dies sind Arten von Krebs, die das Blut, Knochenmark und andere Teile des lymphatischen Systems betreffen. Die häufigsten Arten sind Lymphome, Leukämien und Myelome. Abhängig von der Art und Ausbreitung des Krebses, gibt es viele verschiedene Möglichkeiten, um die Krankheit zu behandeln. In der Regel werden Chemotherapie, Strahlentherapie oder eine Kombination aus beiden verwendet, um die Krankheit zu behandeln. Wenn der Krebs sehr gestreut hat, kann eine Transplantation von patienteneigenen Knochenmarkszellen in Kombination mit einer aggressiven Chemotherapie eine Behandlungsoption sein.

Menschen mit Krebs leiden häufig unter hohen emotionalen Stress, Angst, Müdigkeit, Depressionen und Schlafstörungen. Diese Symptome können selbst dann bestehen bleiben, wenn die Behandlung beendet ist. Auf der Suche nach Möglichkeiten zur Behandlung und Bewältigung dieser Symptome wenden sich immer mehr Patienten ergänzenden und alternativen Therapien zu.


Yoga entspringt einer tausend Jahre alten indischen Tradition, und wird immer beliebter. Es gibt Hunderte von verschiedenen Arten von Yoga, aber in der westlichen Welt besteht Yoga vor allem aus drei Hauptelementen: Körperhaltungen, Atemübungen und Meditation. Eine wachsende Zahl von Krebspatienten verwendet Yoga als zusätzliche Methode, um ihr Wohlbefinden zu verbessern. Allerdings wurden die Wirkungen von Yoga in der Behandlung von malignen hämatologischen Erkrankungen noch nicht systematisch evaluiert.


Wir haben die Evidenz über die Wirkung von Yoga auf Patienten mit malignen hämatologischen Erkrankungen untersucht. Wir haben auch Gesamtüberleben, seelische Belastung, Müdigkeit, Depressionen, Angstzustände, Schlafqualität und Nebenwirkungen als wichtige Endpunkte erfasst. Wir verglichen Menschen mit malignen hämatologischen Erkrankungen, die zusätzlich zur Standardbehandlung gegen Krebs mit Yoga behandelt wurden, mit Patienten, die ausschließlich mit Standardbehandlung gegen Krebs behandelt wurden.


Wir schlossen eine einzige Studie mit 39 Teilnehmern in diesem Review ein (20 in der Yoga-Gruppe und 19 in der Kontrollgruppe). Die Studie beobachtete ein siebenwöchiges tibetisches Yoga-Programm in einer Gruppe von Patienten mit Hodgkin und Non-Hodgkin-Lymphom. Das Durchschnittsalter lag bei 51 Jahren. Die Studie schloss Patienten ein, die zur gleichen Zeit eine Krebstherapie erhielten sowie Patienten, die nicht aktiv behandelt wurden. Die Studie fand keine ausreichenden Daten, um ein Urteil über die Wirksamkeit von Yoga auf Stress, Müdigkeit, Depressionen und Angstzustände, verglichen mit Patienten, die kein Yoga praktizierten, zu machen. Yoga kann die Schlafqualität der Patienten verbessern. Die Studie enthielt keine Informationen über gesundheitsbezogene Lebensqualität, das Gesamtüberleben oder Nebenwirkungen.

Auf der Grundlage der GRADE Kriterien beurteilten wir die Qualität der Evidenz für Yoga für die Endpunkte Stress, Müdigkeit, Angst, Depression und der Schlafqualität als "sehr gering".

Schlussfolgerung der Autoren

Es gibt nicht genügend Daten, um die Wirksamkeit der Behandlung mit Yoga für hämatologische maligne Erkrankungen zu bewerten. Daher bleibt die Bedeutung von Yoga für hämatologische maligne Erkrankungen unklar. Weitere große, qualitativ hochwertige randomisierte kontrollierte Studien sind erforderlich.

Die Evidenz ist auf dem Stand vom 4. Februar 2014.

Anmerkungen zur Übersetzung

I. Töws, Koordination durch Cochrane Schweiz.

















《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。