Felbel Steffen, Meerpohl Joerg J, Monsef Ina, Engert Andreas, Skoetz Nicole
Cochrane Haematological Malignancies Group, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Cochrane Database Syst Rev. 2014 Jun 12;2014(6):CD010146. doi: 10.1002/14651858.CD010146.pub2.
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.
Our search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to 4th February 2014), databases of ongoing trials (controlled-trials.com; clinicaltrials.gov), 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.
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.
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.
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.
血液系统恶性肿瘤是髓系或淋巴系的恶性肿瘤，包括白血病、淋巴瘤和骨髓瘤。为了应对疾病及其治疗在身体和心理方面的问题，像瑜伽这样的补充疗法越来越受到关注。然而，瑜伽练习对血液系统恶性肿瘤患者的有效性仍不明确。
评估除标准癌症治疗外，瑜伽练习对血液系统恶性肿瘤患者的影响。
我们的检索策略包括Cochrane对照试验中心注册库（CENTRAL）、MEDLINE（1950年至2014年2月4日）、正在进行的试验数据库（controlled-trials.com；clinicaltrials.gov）、美国临床肿瘤学会、美国血液学会、欧洲血液学协会、欧洲综合医学大会以及全球健康与医学进展的会议论文集。我们手工检索了这些已识别试验和相关综述文章的参考文献。两位综述作者独立筛选检索结果。
我们纳入了将瑜伽作为血液系统恶性肿瘤标准护理之外的补充治疗与仅采用标准护理进行比较的随机对照试验（RCT）。我们并未将其限制在任何特定的瑜伽风格上。
两位综述作者独立为符合条件的研究提取数据，并根据预定义标准评估偏倚风险。我们评估了痛苦、疲劳、焦虑、抑郁和睡眠质量。我们计划评估的其他结局是健康相关生活质量（HRQoL）、总生存期（OS）和不良事件（AE），但关于这些的数据不可用。
我们的检索策略得到了149篇潜在相关参考文献，但只有一项小型研究符合我们的纳入标准。纳入的研究以全文形式发表，研究了藏式瑜伽在标准护理之外的可行性和效果（N = 20；1人在参加任何课程之前退出，未收集数据），并与仅采用标准护理的组（N = 19）进行比较。该研究纳入了所有分期的霍奇金淋巴瘤和非霍奇金淋巴瘤患者，包括正在接受癌症治疗和未接受治疗的患者。平均年龄为51岁。我们判断总体偏倚风险较高，因为我们发现执行、检测和失访偏倚风险较高。此外，潜在的结果报告偏倚也不能完全排除。根据GRADE的建议，由于方法学局限性和样本量非常小，我们判断所有预定义结局的证据总体质量为“极低”。未报告瑜伽对HRQoL和OS的影响。没有证据表明，与仅采用标准护理相比，在标准护理基础上加用瑜伽能改善血液系统恶性肿瘤患者的痛苦（平均差（MD）-0.30，95%置信区间（CI）-5.55至4.95；P = 0.91）。同样，两组在疲劳（MD 0.00，95% CI -0.94至0.94；P = 1.00）、焦虑（MD 0.30，95% CI -5.01至5.61；P = 0.91）或抑郁（MD -0.70，95% CI -3.21至1.81；P = 0.58）方面也没有差异的证据。有质量极低的证据表明瑜伽能改善总体睡眠质量（MD -2.30，95% CI -3.78至-0.82；P = 0.002）。瑜伽组的匹兹堡睡眠质量指数（PSQI）总分是5.8（±2.3标准差），优于对照组的总分（8.1（±2.4标准差））。PSQI总分0至5表示睡眠良好，而PSQI总分6至21表示存在明显的睡眠障碍。未报告不良事件的发生情况。
目前可得的数据几乎没有提供关于瑜伽干预对血液系统恶性肿瘤患者有效性的信息。瑜伽可能对患者睡眠质量有益这一发现基于非常少的证据。因此，瑜伽作为血液系统恶性肿瘤辅助治疗的作用仍不明确。需要进一步开展有更多参与者的高质量随机对照试验才能得出明确结论。
