Ratcliff Chelsea G, Milbury Kathrin, Chandwani Kavita D, Chaoul Alejandro, Perkins George, Nagarathna Raghuram, Haddad Robin, Nagendra Hongasandra Ramarao, Raghuram N V, Spelman Amy, Arun Banu, Wei Qi, Cohen Lorenzo
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Integr Cancer Ther. 2016 Sep;15(3):250-62. doi: 10.1177/1534735415624141. Epub 2016 Feb 11.
Hypothesis This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.Methods Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion Yoga may provide the greatest mental-health-related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health-related QOL by increasing ability to find benefit in the cancer experience.
假设 本研究调查了针对接受放射治疗的乳腺癌女性生活质量（QOL）结果的瑜伽干预的调节因素和中介因素。方法 接受6周放射治疗的女性被随机分为瑜伽组（YG；n = 53）、伸展组（ST；n = 56）或等待名单对照组（WL；n = 54）。在基线时测量抑郁症状和睡眠障碍。在基线、治疗结束时以及治疗后1个月、3个月和6个月评估中介变量（创伤后应激症状、益处发现和皮质醇斜率）和结果变量（36项简短形式[SF]-36心理和身体成分量表[MCS和PCS]）。结果 基线抑郁症状（P = .03）和睡眠障碍（P < .01）调节了组×时间对MCS的影响，但对PCS没有影响。YG组中基线抑郁症状较高的女性在3个月时的MCS略高于WL组的对应女性（P = .11）。YG组中基线睡眠障碍较高的女性在3个月时的MCS高于WL组的对应女性（P < .01），在6个月时的MCS高于ST组的对应女性（P = .01）。在整个随访期间，YG组比ST组和WL组产生了更大的益处发现（P = .01）。3个月时的益处发现部分介导了YG组对6个月时PCS的影响。创伤后应激症状和皮质醇斜率没有介导治疗对QOL的影响。结论 瑜伽可能为那些在放疗前经历睡眠障碍和抑郁症状的人提供最大的与心理健康相关的QOL益处。瑜伽可能通过提高在癌症经历中发现益处的能力来改善与身体健康相关的QOL。
