A 4-week structured yoga intervention improved overall mood disturbance, anxiety, and fatigue among cancer survivors, according to findings from a phase III randomized controlled trial that will be presented at the 2026 ASCO Annual Meeting (Abstract 12004). The analysis also suggested that reductions in mood disturbance and fatigue may partly explain why the intervention improved insomnia.
“There is no single gold standard behavioral treatment available to survivors for treating overall mood disturbance, anxiety, fatigue, and insomnia,” said lead study author Yuri Choi, PhD, MSN, RN, of the University of Rochester Medical Center, in a press briefing ahead of the meeting. “By demonstrating that [the] YOCAS intervention improves all four of these cancer-related side effects and showing how improvements in overall mood disturbance, anxiety, and fatigue influence yoga’s effect on insomnia, this trial helps to fill that gap.”
Mood disturbance and insomnia are common, difficult-to-treat issues in cancer survivorship. According to the researchers, up to 95% of cancer survivors experience sleep disturbances or insomnia at some point during or after cancer treatment, and more than half experience overall mood disturbance, anxiety, or fatigue.
Yoga for Cancer Survivors, or YOCAS, is a 4-week intervention that includes gentle hatha and restorative yoga postures, breathing exercises, and mindfulness. Previous research showed that YOCAS was effective for treating insomnia. In the current analysis, the investigators evaluated whether YOCAS could also improve mood disturbance, anxiety, and fatigue, and whether these changes helped explain improvements in insomnia.
Study Methods
The investigators conducted a nationwide, multisite, phase III randomized controlled trial through the University of Rochester Cancer Center NCI Community Oncology Research Program Research Base. Eligible participants were survivors of nonmetastatic cancer who were 2 to 24 months post–primary treatment, aged 21 years or older, had at least moderate sleep disruption, and had not participated in yoga within the prior 3 months.
A total of 410 survivors were recruited from 12 community-based oncology practices across the United States and randomly assigned to receive standard survivorship care alone or standard survivorship care plus YOCAS. The mean age was 54 years, 96% were female, 93% were White, and 75% were breast cancer survivors.
Participants assigned to YOCAS attended two 75-minute instructor-led yoga sessions per week for 4 weeks, in addition to at least 30 minutes of additional home-based yoga practice per week. The intervention included 18 gentle hatha and restorative yoga postures, breathing exercises, and mindfulness. Mood disturbance was assessed using the Profile of Mood States questionnaire, and insomnia was evaluated using the Insomnia Severity Index.
Key Findings
Compared with participants who received standard care alone, those who participated in YOCAS had significantly less overall mood disturbance, anxiety, and fatigue after the intervention. This included a 5.08-point lower total score for overall mood disturbance, corresponding to a moderate-to-large effect; a 0.72-point lower anxiety score, corresponding to a small-to-medium effect; and a 1.49-point lower fatigue score, corresponding to a medium-to-large effect.
Participants in the YOCAS group also had significant improvements from baseline to postintervention in overall mood disturbance, anxiety, and fatigue, whereas participants in the standard-of-care group did not. In mediation analyses, improvements in overall mood disturbance and fatigue each accounted for approximately 25% of the insomnia improvements associated with YOCAS.
Commenting on the study, Fumiko Chino, MD, Associate Professor in Breast Radiation Oncology at The University of Texas MD Anderson Cancer Center and an ASCO Expert in survivorship, said the findings support yoga as a potential nonpharmacologic option for managing survivorship symptoms.
“This large, randomized study shows that structured yoga may help relieve some of the most consistently reported and hard-to-treat issues in cancer survivorship, leading to decreased insomnia. It’s an important advance because it offers survivors, who are likely already managing multiple medications, a nonpharmaceutical solution for reducing four different side effects at once,” Dr. Chino said.
The findings are consistent with ASCO and Society for Integrative Oncology guidance recommending yoga as an integrative therapy for patients undergoing treatment and during survivorship.
The investigators concluded that clinicians should consider recommending gentle hatha and restorative yoga for cancer survivors who experience mood disturbance, anxiety, fatigue, or insomnia. Future research will examine the long-term effects of YOCAS and digital delivery methods to expand access, including online platforms and mobile apps.
DISCLOSURE: This clinical trial was funded by the National Cancer Institute. For full disclosures of the study authors, visit coi.asco.org.
