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Article

Effect of Raja Yoga Meditation on the Distress and Anxiety Levels of Women with Breast Cancer

1
Department of Nursing, Universidade Federal do Piauí, Teresina 64049-550, PI, Brazil
2
Department of Nursing, Faculty of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza 60020-181, CE, Brazil
3
Department of Health Science, Universidade Estadual do Maranhão, São João dos Patos 65665-959, MA, Brazil
4
Department of Health Science, Universidade Federal do Espírito Santo, São Mateus 29075-910, ES, Brazil
*
Author to whom correspondence should be addressed.
Religions 2021, 12(8), 590; https://doi.org/10.3390/rel12080590
Received: 14 June 2021 / Revised: 15 July 2021 / Accepted: 20 July 2021 / Published: 31 July 2021
(This article belongs to the Special Issue Meditation and Spiritual Practice)

Abstract

:
Objective: To evaluate the effect of Raja yoga meditation on the level of distress and anxiety in women with breast cancer. Method: A randomized, controlled, clinical trial was carried out in a specialized center between February and December 2019. The patients in the intervention group (n = 25) participated in four group meditation sessions for one month, and the participants in the control group (n = 25) were exposed to an educational activity for the same period and frequency. Cohen’s d was used to evaluate the effect size. Results: A significant reduction in the level of distress and anxiety was found in the intervention group (p < 0.001). The effect of meditation was average in reducing distress, anxiety, depression, and vital signs. There was also an average effect on the increase in saturation of peripheral oxygen (SPO2). Conclusion: The practice of meditation reduced distress and anxiety more effectively than the usual care practices.

1. Introduction

Despite advances in the treatment of breast cancer, such as the improvement of surgical techniques, chemotherapy, and interdisciplinary assistance (Instituto Nacional de Câncer 2019), it still has negative repercussions on the lives of women, including changes in the physical, psychological, social, and sexual aspects (Maass et al. 2019). Many women perceive cancer as a devastating disease and as a punishment involving feelings that are difficult to manage such as social stigma, fear of death, sadness, and shame (Cavalcante et al. 2016; Pereira et al. 2017). Distress, a multifactorial and emotional suffering that can be psychological, social, or spiritual, can also be experienced, affecting the ability to deal effectively with cancer and its physical changes, symptoms, and treatment (Ownby 2019).
Due to the high prevalence of distress in cancer patients, the National Comprehensive Cancer Network (NCCN) (Bultz 2016) recommended its routine and systematic screening in health services using the distress thermometer (DT). The DT is a simple and self-applicable tool that helps to identify vulnerable patients and related problems preventing debilitating situations (Oliveira et al. 2017) such as anxiety, depression, panic syndrome, social isolation, and existential/spiritual crisis (Espino-Polanco and García-Cardona 2018; da Mata et al. 2016).
Distress has also been associated with decreased quality of life, poor adherence, and treatment abandonment (Miranda et al. 2020). It is known that breast cancer can be related to stress and stressful situations experienced in childhood, repression of feelings, depression, and anxiety (Bahri et al. 2019), with the latter being characterized by a feeling of intense, excessive, and persistent concern, with a negative influence on the quality of life (Regino et al. 2018). A study pointed out that 51.55% of cancer patients suffer from anxiety and 62.88% from depression, and that women are more likely to have these emotional problems (Veronese and Frade 2021).
Among the strategies to reduce the level of distress and anxiety in women with breast cancer, there is meditation, an ancient practice present in countless cultures and traditions used to calm the mind, balance the emotions, harmonize the mental state, and improve awareness, concentration, self-discipline, and self-care (Schlechta Portella et al. 2020). It is necessary to consider the existence of numerous meditative practices in the East and in the West, such as mindfulness. This meditative practice is aimed at reducing stress based on mindfulness (MBSR) (Schell et al. 2019), as described in the literature (Offidani et al. 2017; Johns et al. 2016; Boyle et al. 2017). There has been a beneficial effect of meditation on anxiety reduction (Johns et al. 2016), fatigue improvement (Johns et al. 2016), coping (Sarenmalm et al. 2017), pain relief (Saha et al. 2016), and reduced fear of recurrence (Soo et al. 2016) in women with breast cancer.
Raja yoga is one of the oldest systems of yoga and has been a well-known practice in India for millennia. It proposes building the spiritual world without requiring prior faith or belief (Vivekananda 2009; Agarwal et al. 2020), thus being accessible to people of all ages and contexts, without rituals or mantras, and can be practiced anywhere and at any time (Toutain et al. 2019).
Yoga is a practice used to silence the agitated mind and focus on positive thoughts to direct the mind’s flow and fill the being with an inner stillness (Vivekananda 2009). Therefore, the aim is to obtain a moment for reflection and silence, away from the hustle and bustle of everyday life that often leads the individual to experience stress and, consequently, to develop mental, emotional, and physical imbalances (Toutain et al. 2019). The practice of yoga is structured in eight steps: (1) Yama, which consists of self-restraints (non-violence, truthfulness, non-stealing, control of the senses, and non-acceptance of gifts); (2) Niyama, which consists of religious observances (cleanliness, contentment, austerity, self-study, and surrender to God’s will); (3) Asana, or yoga posture; (4) Pranayama, or control of prana (breathing exercises); (5) Pratyahara, or withdrawal of senses from objects; (6) Dharana, or progression in concentration; (7) Dhyana, or meditation; and (8) Samadhi, or achieving a superconscious state (Prabhavananda; Patanjali. 1981).
Most studies involving the practice of Raja yoga were developed in the United States (Nidich et al. 2009; Lengacher et al. 2012, 2014; Matchim et al. 2011; Hoffman et al. 2012; Charlson et al. 2014; Bower et al. 2015; Johns et al. 2016; Boyle et al. 2017), Denmark (Andersen et al. 2013), and Canada (Saha et al. 2016).
Studies already report several purposes for Raja yoga, including the improvement of chronic headache (Rajoria and Singh 2017); state of consciousness (Kiran et al. 2017); anxiety and stress reduction in patients undergoing myocardial revascularization surgery (Kiran et al. 2017); positive thinking, self-satisfaction, happiness, and prevention of relapses in individuals who use drugs (Mallik et al. 2019); and the happiness and well-being of older adults. Practicing Raja yoga (Pandya 2019) reduced glucose level in individuals with type 2 diabetes (Phatak et al. 2017). Despite this, there is still a gap in the literature regarding the existence of controlled and randomized clinical trials developed in the national and international context on the effect of Raja yoga meditation on women with breast cancer in terms of reducing stress and anxiety (Araújo et al. 2019).
However, Raja yoga is still little known and not widespread in the West. To date, no clinical trials have been identified using Raja yoga meditation to improve distress and anxiety in women with breast cancer. A previous study using interpretative phenomenological analysis conducted in the United States with breast cancer survivors found improvements in the participants’ emotional, physical, and spiritual well-being, as well as their resilience (Agarwal et al. 2020).
Despite being considered a simple, low-cost, and safe intervention without contraindication and feasible to being conducted in several scenarios (Gurgel et al. 2019; Rajoria and Singh 2017), there is still a need for scientific evidence to prove the effectiveness of this meditative practice (Abrahão et al. 2019). This study aimed to evaluate the effect of Raja yoga meditation on the level of distress and anxiety in women with breast cancer and, therefore, to fill in the gaps related to the needs of clinical trials on the topic under discussion.

2. Method

Design

A controlled, randomized, and blinded clinical trial was carried out in a high complexity oncology unit (UNACON in Portuguese) of a university hospital located in Teresina, Piauí, Brazil.

3. Ethical Aspects

The Research Ethics Committee of the of the university in which the study was undertaken approved the study (Certificate of Presentation for Ethical Consideration: 82/18; Brazilian Registry of Clinical Trials: RBR-7hxwxy). All participants included in the study signed an informed consent form.

3.1. Participants and Sample

One of the researchers recruited the participants after consulting the medical records from the nursing office of the UNACON outpatient clinic of the XXXX. Women diagnosed with breast cancer who were starting chemotherapy treatment at the hospital selected for the study were considered eligible. Inclusion criteria were women aged 18 to 65 years with a first diagnosis of breast cancer who were starting chemotherapy, and who had a good performance (0–1) on the Eastern Cooperative Oncologic Group (ECOG) scale, also called the Zubrod score, which runs from 0 to 5, with 0 denoting a fully active patient capable of carrying out all activities without restriction, and 1 an individual with restriction from physically strenuous activities who is able to carry out work of a light or sedentary nature (Polo and Moraes 2009).
Exclusion criteria were women with breast cancer on prophylactic hormone therapy, diagnosis of another type of associated cancer (except non-melanoma skin cancer), severe mental disability (depression, suicidal thinking, or bipolar disorder), continuous use of controlled medications (anxiolytics, antidepressants, or mood regulators), chronic or substance abuse (alcohol, smoking, or illicit drugs), cognitive impairment (hearing or language), and previous or current experience in meditation or yoga programs. As discontinuity criteria, we adopted absence in more than one of the group activities and changes in the participant’s clinical condition (ECOG > 1) (Polo and Moraes 2009) that could contraindicate the permanence in the activities.
The required sample size was based on the recommendations by Friston (2012), who considered that there is an optimal sample size for experimental studies in which there are statistically significant differences with clinical implications on the studied outcome. This sample size comprises a number between 16 and 32 participants. Initially, a sample calculation was performed based on the prevalence of stress among women with breast cancer, ranging from 25% to 45% (Oliveira et al. 2017; Villar et al. 2017). The parameters used were α of 0.05 (type I error), two-tailed, and β or power (type II error) of 0.80, and an estimated difference of 20% between the groups, resulting in a sample size of 25 patients.

3.2. Randomization, Allocation, and Blinding

From the 274 patients diagnosed with breast cancer and treated at UNCACON during the study period (February to December 2019), 85 women met the study’s eligibility criteria. Of these, 35 were excluded (23 did not meet the inclusion criteria, and 12 refused to participate in the study before starting the interventions). Thus, 25 participants were randomly allocated to the intervention group (IG), who participated in meditation practices, and 25 to the control group (CG), who participated in educational activities belonging to the integrative and complementary practices (ICPs) offered by the Brazilian Unified Health System (SUS) (Brasil 2018a). Throughout this study, there was no loss of follow-up or discontinuity, as shown in Figure 1.
The random allocation of participants was done with the aid of the Research Randomizer Quick Tutorial program available on the website https://www.randomizer.org/#randomize (accessed on 23 March 2019). This procedure was performed by a person with no clinical involvement in the study to ensure allocation confidentiality (Hulley et al. 2019). The generation of random sequences for each designation was placed individually in an opaque envelope, sealed, and numbered sequentially (Ferreira and Patino 2016). Block randomization was used using five blocks of varying sizes and named as follows: 08, 12, 10, 8, and 12. This randomization technique was used due to the specific characteristics of the proposed clinical trial, in which women should be undergoing chemotherapy. Therefore, it was necessary to wait for the start of therapy, which, in turn, was 15 to 30 days after the initial identification and selection of participants (Ferreira and Patino 2016).
The following research staff were blinded in the study: data collectors, primary/secondary outcome evaluators (IG and CG), the staff data scientist, and the statistician. It was not possible to blind the main researcher, as he was responsible for contacting the participants to inform them of the day, time, and place of the interventions, nor the oncologist nurse, as she had to adjust the chemotherapy schedule when it coincided with the intervention schedule. Participants were also not blinded, as they had to be informed about the intervention. In non-pharmacological clinical trials, it is difficult or even impossible to blind the participants, whether for technical or ethical reasons (Hulley et al. 2019).

3.3. Intervention Protocol

The IG members participated in Raja yoga meditation practices once a week for 40 to 50 min, with a one-month follow-up. In total, the intervention group participated in four guided meditative practices. It is necessary to highlight that practice at home was encouraged; however, it was not possible to assess the impact since some did not perform it during the study. According to the literature recommendation, the practices were directed by a qualified teacher with training in the meditation program and extensive experience in the area, with over 20 years of experience (Bower et al. 2015; Carlson et al. 2016). The practice was standardized with patients sitting in a supported chair in order to avoid discomfort or complications associated with the fully implantable central venous catheter (Zerati et al. 2017). The following steps were carried out: relaxation, concentration, contemplation, self-realization, and inner silence (Sharma et al. 2020). The intervention was carried out in a hospital meeting room.
CG participants participated in an educational activity conducted as part of the National Policy of Integrative and Complementary Practices (PNPIC in Portuguese) and the ordinances that expand these practices in Brazil (Brasil 2018b). The meetings lasted 40 to 50 min and were conducted over four weeks. The study’s main researcher exposed the educational activity topics using audiovisual resources and informational brochures.

3.4. Measuring Instruments

The following parameters were evaluated before and after the educational interventions/activities in both groups: heart rate (HR), systolic and diastolic blood pressure, and saturation of peripheral oxygen—pulse oximetry (SPO2), according to the current guidelines (Melo et al. 2020; Sociedade Brasileira de Cardiologia (SBC), 2019). A distress thermometer validated and adapted for use in Brazil in cancer patients was used to assess the level of distress (Decat et al. 2009). The Hospital Anxiety and Depression Scale (HADS) validated in Brazil for hospitalized patients was used to measure the level of anxiety (Botega et al. 1995). One of the advantages of the HADS scale is that it is self-administered and can assess anxiety in sick or healthy patients (Marcolino et al. 2007). Both instruments had good values of internal consistency and replicability in studies developed with cancer patients. The instruments were applied at the beginning and end of the follow-up.
The collection of socioeconomic, cultural, demographic, and clinical data, as well as variables related to breast cancer (treatment, staging, and classification) started after the start of chemotherapy. Before data collection, a pilot study was carried out with five women to organize the study and test the instruments. The pilot data were not used in this study. The research team was composed of the main researcher, an oncologist nurse from UNACON, and eight research assistants trained to apply the instruments and the research checklist and standard operating procedure.
The primary outcome was a score less than or equal to 3 (absence of distress), a score greater than or equal to 4 (presence of distress) (Oliveira et al. 2017), and a score equal to or greater than eight (presence of anxiety or depression) (Botega et al. 1995). The secondary outcome considered vital sign parameters as follows: normotension, systolic BP ≤ 120 mmHg, and diastolic BP ≤ 80 mmHg; hypertension, systolic BP = 140–159 mmHg, and diastolic BP = 90–99 mmHg (Sociedade Brasileira de Cardiologia (SBC) 2019); normocardia: HR = 50–100 bpm; bradycardia, HR < 50 bpm; tachycardia, HR > 100 bpm (Sociedade Brasileira de Cardiologia (SBC) 2016); normal oximetry, saturation of peripheral oxygen (SPO2) = 95–100%; and low oximetry, saturation of peripheral oxygen (SPO2) < 95% (Botega et al. 1995).

3.5. Data Analysis

Quantitative variables were described with medians and interquartile ranges, and qualitative variables were expressed as absolute numbers and percentages. The Shapiro–Wilk test was used to verify adherence to the normal distribution. The Student’s t-test for independent samples with normal distribution and the non-parametric Mann–Whitney U test were used for independent variables without normality assumption for comparison between the two groups.
The Chi-square or Fisher’s exact test was used for analysis involving independent categorical variables, whereas the McNemar test was used for dependent categorical variables. The paired t-test and the Wilcoxon test were used to compare distress and anxiety levels in women with breast cancer in both groups. The effect size was calculated based on the Cohen’s d index. The following values were considered: insignificant: less than 0.19, small: 0.20–0.49, medium: 0.50–0.79, large: 0.80–1.29, and very large: greater than 1.30 (Santo and Daniel 2017). The results were analyzed using the Statistical Package for Social Sciences (SPSS) version 21. A significance level of 5% (p < 0.05) was adopted for all analyses.

4. Results

The homogeneity and sociodemographic characteristics of the intervention and control groups are shown in Table 1. The median age of the participants was 47 years, with a predominance of white women (72%), living with a partner (54%), with a high school level of education (76%), having a paid occupation (64%), surviving on one minimum wage or less (66%), and Catholic (72%). The groups were homogeneous concerning marital status, education, income, and religion (p > 0.05).
Table 2 shows homogeneity in the distribution of participants in the two groups concerning the two quantitative variables and all qualitative variables. The participants’ median age at menarche was 13 (12.5–15%) years and at menopause 46 (44.8–49.3%) years. Among the main predictive factors for breast cancer in the population studied, the most prevalent were physical inactivity (76%), overweight (44%), and having a relative with breast cancer (22%).
Table 3 shows that the participants in both groups (IG and CG) were homogenous in the following characteristics: having breast surgery, affected breast, surgical information, current treatment, port-cath implantation, metastasis, purpose of chemotherapy, and TNM staging (p = 1.000).
Table 4 shows the level of distress before and after the intervention in the IG and CG. There was a reduction in the level of distress in the IG after practicing meditation and, therefore, a positive effect of meditation for reducing the level of distress in those women.
The two groups were homogeneous with respect to the presence of distress before the interventions. The most frequent problems/situations reported by the participants and related to distress were taking care of the house (67%), sadness (60%), worry (62%), memory/concentration disorders (54%), nervousness (48%), subsistence (48%), dry/itchy skin (48%), fear (46%), appearance-related problems (44%), fatigue (48%), loss of interest in usual activities (38%), breathing disorders (36%), health and financial problems (34.7%), and transportation difficulties (32%). There was statistical significance (p < 0.001) in the improvement of some problems associated with distress after the intervention in the IG, among them taking care of the house, spiritual/religious involvement, subsistence, and sleeping (p < 0.001). In the bivariate analysis, only the variable “ever having had children” (p < 0.005) was statistically associated with a reduction in the level of distress among the participants in the IG; therefore, the multiple regression was not performed.
A marked reduction in anxiety was identified in the IG. Therefore, a positive effect of meditation in reducing the level of anxiety in women with breast cancer in the IG was found, as well as an improvement in the percentage of symptoms related to anxiety (Table 5).
There was a statistical significance in the systolic blood pressure reduction after the interventions (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6, Figure 7, Figure 8 and Figure 9). A reduction in blood pressure was observed throughout the interventions.
At the end of the follow-up, there was an average effect of Raja yoga meditation on reducing distress, anxiety, depression, and all vital signs evaluated in the two groups. There was also an average effect on the increase of saturation of peripheral oxygen (SPO2), as shown in Table 6.

5. Discussion

The results of the present study show that distress was present in most participants in the IG. These results are consistent with a previous study (da Mata et al. 2016) that pointed out that such suffering is frequent among cancer patients. The study participants listed situations and emotions as possible causes of distress, including taking care of the house, taking care of young children, having feelings of sadness, having concerns, and having memory and concentration problems, fear, and nervousness.
Researchers explain that concerns involving children are frequent among women with cancer, and that those women often face difficulties in reconciling chemotherapy schedules, medical consultations, and exams with domestic chores and childcare (Miranda et al. 2020; Oliveira et al. 2017). The above-mentioned situations combined with symptoms such as fatigue, malaise, nausea, vomiting, and diarrhea generate distress in women with cancer who have children (Espino-Polanco and García-Cardona 2018). In the literature, there is a list of other problems associated with distress, such as prolonged waiting times to start treatment, family conflicts, lack of family support, young children, pain, sleep disorders, interruption of family projects, and financial problems (da Mata et al. 2016; Offidani et al. 2017).
A previous study found a possible relationship between distress and the emergence of breast cancer, such as the experience of stressful situations in childhood, the repression of feelings, tension, depression, and anxiety (Amorim and Siqueira 2017; Espino-Polanco and García-Cardona 2018). Researchers say that distress is also related to lower adherence to cancer treatment, loss of quality of life, and immunological alterations (da Mata et al. 2016; Miranda et al. 2020; Ownby 2019). Given these implications, the importance of screening distress in cancer patients is emphasized (Oliveira et al. 2017). Although the investigation of distress is complex and often neglected by oncology professionals, the importance of early identification of individuals at risk and who are vulnerable is emphasized in order to prevent complications such as post-traumatic stress, anxiety, depression, and suicidal thoughts (Bultz 2016; Santiago et al. 2019; Yee et al. 2017). In the present study, it was observed that most participants were young. The results obtained are in line with the literature. A higher prevalence of distress was found in a prior study among young women with a recent diagnosis of breast cancer and problems at work (Offidani et al. 2017).
In the present study, more than half of the women in the IG reported symptoms of anxiety before the intervention. Scientific evidence has pointed out that emotional problems such as anxiety and depression are frequent in cancer patients (Regino et al. 2018). A literature review that included 36 studies and 16,298 patients with breast cancer found a prevalence of anxiety in 41.9% of the participants (Hashemi et al. 2020). Thus, it is worth emphasizing the importance of tracking anxiety in women with breast cancer to prevent implications such as depression and post-traumatic stress disorder (Regino et al. 2018; Silva et al. 2017).
In the current study, there was an improvement in the percentage of symptoms related to anxiety after the intervention (IG), such as fear, worry, and the sensation of cold in the stomach. In a multicenter study conducted in Korea, an association of depressive symptoms with anxiety and quality of life was identified in women who survived breast cancer (Shim et al. 2020). Research has shown that women with a low level of education and patients undergoing chemotherapy are more likely to experience fatigue, depression, and anxiety (Li et al. 2020). Research shows that breast cancer survivors are at higher risk for depression and severe anxiety symptoms (Maass et al. 2019). It is necessary to emphasize that it is crucial to identify women at risk and therefore plan and implement interventions to prevent and better manage anxiety symptoms (Li et al. 2020).
Participants of a previous study (Bharshankar et al. 2015) were divided into an intervention group that practiced Raja yoga meditation and a control group that received an educational intervention offered by the Brazilian public health system. At the end of the four-week follow-up, there was a very large effect of Raja yoga meditation on reducing distress and a great effect on reducing anxiety in the IG, as well as improving symptoms related to distress, such as taking care of the house, fear, sadness, worry, memory, and concentration. The results obtained are consistent with the current literature (Phatak et al. 2017). In the present study, the positive results obtained can be related to the effect size, considered moderate for the variables of distress and diastolic blood pressure, and small for anxiety, depression, systolic blood pressure, and heart rate.
Raja yoga meditation has been applied in several scenarios, such as in the work environment, oncology, psychiatry, and others (Pillai et al. 2015; Goyal et al. 2018). This practice has been related to several beneficial effects, including satisfaction and happiness in life (Pandya 2019).
In the current study, it was found that the participants in the IG showed a reduction in blood pressure and heart rate, and an improvement in oxygen saturation levels. A study carried out in India with 90 participants found beneficial effects of Raja yoga on systolic and diastolic blood pressure parameters and on the respiratory function of individuals with type 2 diabetes (Chawla et al. 2020). Another study conducted in India found a significant reduction in blood glucose levels, glycated hemoglobin, total cholesterol, serum triglycerides, and stress in individuals practicing Raja yoga (Phatak et al. 2017). The literature points out that Raja yoga also contributes to improving leadership and crisis management (Pillai et al. 2015).
In a retrospective study conducted in Canada, 34% of psychiatric outpatients who participated in the Raja yoga meditation group had immediate and substantial improvement in well-being compared to standard psychotherapy (Bhopal et al. 2018). In a randomized clinical trial to evaluate the role of Raja yoga meditation in improving anxiety and reducing cortisol in patients undergoing coronary artery bypass graft surgery, it was observed that on the second postoperative day, patients who underwent Raja yoga presented a reduction in the level of anxiety compared to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, p < 0.05) and a reduction in the level of cortisol (Kiran et al. 2017).
In a review study, the beneficial effects of Raja yoga on the nervous, immune, circulatory, respiratory, digestive, and endocrine systems were presented as well as in the treatment and prevention of neurodegenerative, cardiovascular, and psychosomatic disorders, and in promoting an analgesic effect (Rajoria and Singh 2017). Longitudinal research in Brahmakumari centers located in India, Australia, Belgium, Botswana, Canada, France, Japan, South Africa, and the United States pointed out that Raja yoga has the potential to improve the reduction of anxiety and stress, and promote mental health, spiritual well-being, and awareness (Pandya 2019). Scholars highlight the importance of assessing spirituality to provide holistic care for people at risk of spiritual suffering (Martins et al. 2020). Researchers support integrating these self-care strategies into the patients’ treatment plans to improve emotions and reduce financial costs with health care (Agarwal et al. 2020). Thus, the importance of more consistent studies that prove the benefits and costs of meditation programs is reinforced (Gurgel et al. 2019; Pandya 2019). A clinical trial carried out in the United States to compare the effect of Raja yoga on the improvement of withdrawal crises compared to relaxation techniques and standard treatment showed that there were no significant differences in withdrawal among individuals who participated in relaxation and usual treatment (Mallik et al. 2019).
The practice of Raja yoga meditation has also been shown to be effective in controlling cardiopulmonary functions. It was found that individuals diagnosed with diabetes and practitioners of Raja yoga had significantly lower values of systolic and diastolic BP and HR when compared to individuals who did not practice meditation (p < 0.05). Variables related to respiratory function, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximum voluntary ventilation (MVV), expiratory reserve volume (ERV), forced expiratory flow (FEF 25–75%), and peak expiratory flow rate (PEFR) were considerably reduced in the group of diabetic individuals practicing Raja yoga compared to healthy and non-meditating individuals (p < 0.05) (Chawla et al. 2020).
Given the above, a minimum level of knowledge about integrative and complementary practices and its indications is expected from professionals working in oncology settings. The current study employed a meditative practice little known in Western countries but that is simple, safe, and without contraindications (Rajoria and Singh 2017), and that can be implemented in healthcare settings.
Some limitations of the study include the short follow-up period, justified by the difficulties reported by the participants in reconciling chemotherapy sessions, consultations, exams, domestic chores, and obstacles to traveling to the hospital. However, it should be noted that this limitation did not affect the study results, considering that the follow-up time of four to eight weeks was sufficient to assess the outcomes. Another limitation in the study was the non-blinding of participants in the groups, which is expected in non-pharmacological clinical trials due to ethical or technical issues.
One of the study’s strengths is the absence of a loss of participants in the intervention and control group during the study, as well as the absence of any type of adverse or undesirable event related to the intervention, which contributes to a better understanding of the importance of the systematic screening of distress and anxiety in women with breast cancer, as well as the need to incorporate meditation and other integrative practices into the routine of oncology services.

6. Conclusions

The results indicate a beneficial effect of Raja yoga meditation conducted once a week for 40 to 50 min, with a one-month follow-up, on reducing distress and anxiety in women with breast cancer undergoing chemotherapy and on improving factors related to distress and anxiety. It was noticed that maintaining the usual care and participating in educational activities did not influence the level of distress and anxiety in women with breast cancer.

Author Contributions

Conceptualization, R.V.A., R.C.V.C. and I.S.N.; Data curation, R.V.A. and R.C.V.C.; Formal analysis, R.V.A. and R.C.V.C.; Funding acquisition, R.V.A. and I.S.N.; Investigation, R.V.A. and R.C.V.C.; Methodology, R.V.A., A.F.C.F., R.A.S. and I.S.N.; Software, R.V.A.; Supervision, A.F.C.F. and I.S.N.; Validation, R.V.A., A.F.C.F., R.A.S. and I.S.N.; Visualization, R.V.A., A.F.C.F., R.A.S. and I.S.N.; Writing—original draft, R.V.A., A.F.C.F., R.C.V.C., R.A.S. and I.S.N.; Writing—review & editing, R.V.A. and R.A.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Universidade Federal do Piauí (protocol code 82/18, 22 November 2018).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Abrahão, Camila Aparecida, Emilia Bomfim, Luiz Carlos Lopes-Júnior, and Gabriela Pereira-da-Silva. 2019. Complementary Therapies as a Strategy to Reduce Stress and Stimulate Immunity of Women with Breast Cancer. Journal of Evidence-Based Integrative Medicine 24: 1–7. [Google Scholar] [CrossRef][Green Version]
  2. Agarwal, Kanishtha, Luana Fortune, Jennifer C. Heintzman, and Lisa L. Kelly. 2020. Spiritual Experiences of Long-Term Meditation Practitioners Diagnosed with Breast Cancer: An Interpretative Phenomenological Analysis Pilot Study. Journal of Religion and Health 59: 2364–80. [Google Scholar] [CrossRef]
  3. Amorim, Mary Anne Pasta, and Keila Zaniboni Siqueira. 2017. Relationship Between The Experience of Stressor Factors and the Emergence of Breast Cancer. Psicologia Argumento 32: 2364–80. [Google Scholar] [CrossRef]
  4. Andersen, Signe R., Hanne Würtzen, Marianne Steding-Jessen, Jane Christensen, Klaus K. Andersen, Henrik Flyger, Cathy Mitchelmore, Christoffer Johansen, and Susanne O. Dalton. 2013. Effect of mindfulness-based stress reduction on sleep quality: Results of a randomized trial among Danish breast cancer patients. Acta Oncologica 52: 336–44. [Google Scholar] [CrossRef][Green Version]
  5. Araújo, Raquel Vilanova, Ana Fátima Carvalho Fernandes, Inez Sampaio Nery, Elaine Maria Leite Rangel Andrade, Lídya Tolstenko Nogueira, and Francisco Honeidy Carvalho Azevedo. 2019. Meditation Effect on Psychological Stress Level in Women with Breast Cancer: A Systematic Review. Revista da Escola de Enfermagem da USP 53: e03529. [Google Scholar] [CrossRef]
  6. Bahri, Narjes, Tahereh Fathi Najafi, Fatemeh Homaei Shandiz, Hamid Reza Tohidinik, and Abdoljavad Khajavi. 2019. The Relation Between Stressful Life Events and Breast Cancer: A Systematic Review and Meta-Analysis of Cohort Studies. Breast Cancer Research and Treatment 176: 53–61. [Google Scholar] [CrossRef]
  7. Bharshankar, Jyotsana R., Archana D. Mandape, Mrunal S. Phatak, and Rajay N. Bharshankar. 2015. Autonomic Functions in Raja-Yoga Meditators. Indian Journal of Physiology and Pharmacology 59: 396–401. Available online: https://pubmed.ncbi.nlm.nih.gov/27530006/ (accessed on 14 July 2021).
  8. Bhopal, Jaswant S., Kamyar Dahi, Rajesh Sharma, Larry Frisch, and Ming Yang. 2018. The Immediate Effect of Raja-Yoga Group Therapy on the Well-Being of Psychiatric Outpatients—An Exploratory Single-Center Retrospective Study. Journal of Psychiatry and Behaviour Therapy 1: 13–17. [Google Scholar] [CrossRef][Green Version]
  9. Botega, Neury J., Márcia R. Bio, Maria Adriana Zomignani, Celso Garcia Jr., and Walter A. B. Pereira. 1995. Transtornos do Humor em Enfermaria de Clínica Médica e Validação de Escala de Medida (HAD) de Ansiedade e Depressão. Revista de Saúde Pública 29: 555–63. [Google Scholar] [CrossRef][Green Version]
  10. Bower, Julienne E., Alexandra D. Crosswell, Annette L. Stanton, Catherine M. Crespi, Diana Winston, Jesusa Arevalo, Jeffrey Ma, Steve W. Cole, and Patricia A. Ganz. 2015. Mindfulness Meditation for Younger Breast Cancer Survivors: A Randomized Controlled Trial. Cancer 121: 1231–40. [Google Scholar] [CrossRef]
  11. Boyle, Chloe C., Annette L. Stanton, Patricia A. Ganz, Catherine M. Crespi, and Julienne E. Bower. 2017. Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. Journal of Consulting and Clinical Psychology 85: 397–402. [Google Scholar] [CrossRef]
  12. Brasil. 2018a. Portaria n° 702, de 21 de Março de 2018, Altera a Portaria de Consolidação nº 2/GM/MS, de 28 de Setembro de 2017, para Incluir Novas Práticas na Política Nacional de Práticas Integrativas e Complementares—PNPIC; Brasil: Ministério da Saúde.
  13. Brasil. 2018b. Portaria nº 04 de 23 de Janeiro de 2018. Aprova as Diretrizes Diagnósticas e Terapêuticas do Carcinoma de Mama; Brasil: Ministério da Saúde.
  14. Bultz, Barry D. 2016. Patient Care and Outcomes: Why Cancer Care Should Screen for Distress, the 6th Vital Sign. Asia-Pacific Journal of Oncology Nursing 3: 21–24. [Google Scholar] [CrossRef]
  15. Carlson, Linda E., Rie Tamagawa, Joanne Stephen, Elaine Drysdale, Lihong Zhong, and Michael Speca. 2016. Randomized-Controlled Trial of Mindfulness-Based Cancer Recovery Versus Supportive Expressive Group Therapy Among Distressed Breast Cancer Survivors (MINDSET): Long-term Follow-up Results. Psycho-Oncology 25: 750–59. [Google Scholar] [CrossRef][Green Version]
  16. Cavalcante, Marcia Luiza Ferreira, Fernanda Chaves, and Arlene Laurenti Monterrosa Ayala. 2016. Câncer de mama: Sentimentos e percepções das mulheres mastectomizadas. Revista de Atenção à Saúde 14: 41–52. [Google Scholar] [CrossRef]
  17. Charlson, Mary E., Joseph Loizzo, Alyson Moadel, Miles Neale, Chayim Newman, Erin Olivo, Emily Wolf, and Janey C. Peterson. 2014. Contemplative self healing in women breast cancer survivors: A pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complementary Medicine and Therapies 14: 349. [Google Scholar] [CrossRef][Green Version]
  18. Chawla, Tara G., Mrunal S. Phatak, and Rajendra G. Bhagchandani. 2020. Positive Effect of Raja Yoga Meditation on Cardiopulmonary Parameters in Type II Diabetes Mellitus. National Journal of Physiology, Pharmacy and Pharmacology 10: 1–5. [Google Scholar] [CrossRef]
  19. da Mata, Luciana Regina Ferreira, Giannina Marcela Chávez, Beatriz Simões Faria, Ana Cláudia Castro Antunes, Marcela Ribeiro da Silva, and Patrícia Peres de Oliveira. 2016. Self-esteem and Distress in Patients Undergoing Cancer Surgery: A Correlational Study. Online Brazilian Journal of Nursing 15: 664–74. [Google Scholar]
  20. Decat, Cristiane Sant’Anna, Jacob Arie Laros, and Tereza Cristina Cavalcanti Ferreira de Araujo. 2009. Distress Thermometer: Validation of a Brief Screening Instrument to Detect Distress in Oncology Patients. Psico-USF 14: 253–60. [Google Scholar] [CrossRef][Green Version]
  21. Espino-Polanco, Aydé Concepción, and Mercedes García-Cardona. 2018. Cáncer de Mama y su Relación Con el Manejo de las Emociones y el Estrés. Revista de Enfermería del Instituto Mexicano del Seguro Social 26: 145–55. Available online: https://www.medigraphic.com/pdfs/enfermeriaimss/eim-2018/eim182l.pdf (accessed on 14 June 2021).
  22. Ferreira, Juliana Carvalho, and Cecilia Maria Patino. 2016. Randomization: Beyond Tossing a Coin. Jornal Brasileiro de Pneumologia 42: 310–10. [Google Scholar] [CrossRef][Green Version]
  23. Friston, Karl. 2012. Ten ironic rules for non-statistical reviewers. NeuroImage 61: 1300–10. [Google Scholar] [CrossRef]
  24. Goyal, Atul Kumar, Jaimanti Bakshi, Sushma Rani, Bk Anita Didi, and Akshay Anand. 2018. Is Rajyoga Helpful in Maintaining Patient’s Biochemical and Hematological Profile during Breast Cancer Treatment? Journal of Complementary & Integrative Medicine 16: 1–7. [Google Scholar] [CrossRef]
  25. Gurgel, Isabela Oliva, Paola Miranda de Sá, Paula Elaine Diniz dos Reis, Mariângela Leal Cherchiglia, Ilka Afonso Reis, Ana Lúcia de Mattia, and Giovana Paula Rezende Simino. 2019. Prevalence of Integrative and Complementary Practices in Patients Undergoing Antineoplastic Chemotherapy. Cogitare Enfermagem 24: e64450. [Google Scholar] [CrossRef]
  26. Hashemi, Seyed-Mehdi, Hosein Rafiemanesh, Tayebe Aghamohammadi, Mahin Badakhsh, Mehrbanoo Amirshahi, Mahdieh Sari, Niaz Behnamfar, and Kamran Roudini. 2020. Prevalence of Anxiety among Breast Cancer Patients: A Systematic Review and Meta-Analysis. Breast Cancer 27: 166–78. [Google Scholar] [CrossRef]
  27. Hoffman, Caroline J., Steven J. Ersser, Jane B. Hopkinson, Peter G. Nicholls, Julia E. Harrington, and Peter W. Thomas. 2012. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: A randomized, controlled trial. Journal of Clinical Oncology 30: 1335–42. [Google Scholar] [CrossRef]
  28. Hulley, Stephen B., Steven R. Cummings, Warren S. Browner, Deborah G. Grady, and Thomas B. Newman. 2019. Delineando a Pesquisa Clinica, 4th ed. Porto Alegre: Artmed. [Google Scholar]
  29. Instituto Nacional de Câncer. 2019. A situação do câncer de mama no Brasil: Síntese de dados dos sistemas de informação. Rio de Janeiro: INCA, p. 85. [Google Scholar]
  30. Johns, Shelley A., Linda F. Brown, Kathleen Beck-Coon, Tasneem L. Talib, Patrick O. Monahan, R. Brian Giesler, Yan Tong, Laura Wilhelm, Janet S. Carpenter, Diane Von Ah, and et al. 2016. Randomized Controlled Pilot Trial Of Mindfulness-Based Stress Reduction Compared to Psychoeducational Support for Persistently Fatigued Breast and Colorectal Cancer Survivors. Supportive Care in Cancer 24: 4085–96. [Google Scholar] [CrossRef]
  31. Kiran, Kiran, Suruchi Ladha, Neeti Makhija, Poonam Malhotra Kapoor, Minati Choudhury, Sambhunath Das, Parag Gharde, Vishwas Malik, and Balram Airan. 2017. The Role of Rajyoga Meditation for Modulation of Anxiety and Serum Cortisol in Patients Undergoing Coronary Artery Bypass Surgery: A Prospective Randomized Control Study. Annals of Cardiac Anaesthesia 20: 158–62. [Google Scholar] [CrossRef]
  32. Lengacher, Cecile A., Kevin E. Kip, Michelle Barta, Janice Post-White, Paul B. Jacobsen, Maureen Groer, Brandy Lehman, Manolete S. Moscoso, Rajendra Kadel, Nancy Le, and et al. 2012. A pilot study evaluating the effect of mindfulness-based stress reduction on psychological status, physical status, salivary cortisol, and interleukin-6 among advanced-stage cancer patients and their caregivers. Journal of Holistic Nursing 30: 170–85. [Google Scholar] [CrossRef]
  33. Lengacher, Cecile A., Richard R. Reich, Kevin E. Kip, Michelle Barta, Sophia Ramesar, Carly L. Paterson, Manolete S Moscoso, Irina Carranza, Pinky H Budhrani, Seung Joon Kim, and et al. 2014. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biological Research for Nursing 16: 438–47. [Google Scholar] [CrossRef][Green Version]
  34. Li, Hongjin, Anna L. Marsland, Yvette P. Conley, Susan M. Sereika, and Catherine M. Bender. 2020. Genes Involved in the HPA Axis and the Symptom Cluster of Fatigue, Depressive Symptoms, and Anxiety in Women with Breast Cancer During 18 Months of Adjuvant Therapy. Biological Research for Nursing 22: 277–86. [Google Scholar] [CrossRef]
  35. Maass, S. W. M. C., M. Boerman, P. F. M. Verhaak, J. Du, G. H. de Bock, and A. J. Berendsen. 2019. Long-Term Psychological Distress in Breast Cancer Survivors and Their Matched Controls: A Cross-Sectional Study. Maturitas 130: 6–12. [Google Scholar] [CrossRef]
  36. Mallik, Debesh, Sarah Bowen, Yang Yang, Richard Perkins, and Emily K. Sandoz. 2019. Raja yoga meditation and medication-assisted treatment for relapse prevention: A pilot study. Journal of Substance Abuse Treatment 96: 58–64. [Google Scholar] [CrossRef]
  37. Marcolino, José Álvaro Marques, Fernando Mikio Suzuki, Luís Augusto Cunha Alli, Judymara Lauzi Gozzani, and Ligia Andrade da Silva Telles Mathias. 2007. Measurement of Anxiety and Depression in Preoperative Patients. Comparative Study. Revista Brasileira de Anestesiologia 57: 157–66. [Google Scholar] [CrossRef]
  38. Martins, Helga, Tiago Dias Domingues, and Sílvia Caldeira. 2020. Spiritual Well-Being in Cancer Patients Undergoing Chemotherapy in an Outpatient Setting: A Cross-Sectional Study. Journal of Holistic Nursing 38: 68–77. [Google Scholar] [CrossRef]
  39. Matchim, Yaowarat Matchim, Jane M. Armer, and Bob R. Stewart. 2011. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. Western Journal of Nursing Research 33: 996–1016. [Google Scholar] [CrossRef]
  40. Melo, Saulo Maia d’Avila, Marília Ferraz de Oliveira Macedo, and Juliana Silva Santana Pereira. 2020. Agreement Among four Portable Wireless Pulse Oximeters and In-Office Evaluation of Peripheral Oxygen Saturation. Jornal Brasileiro de Pneumologia 47: e20200251. [Google Scholar] [CrossRef]
  41. Miranda, Talita Prado Simão, Sílvia Caldeira, Harley Francisco de Oliveira, Denise Hollanda Iunes, Denismar Alves Nogueira, Erika de Cássia Lopes Chaves, and Emília Campos de Carvalho. 2020. Intercessory Prayer on Spiritual Distress, Spiritual Coping, Anxiety, Depression and Salivary Amylase in Breast Cancer Patients During Radiotherapy: Randomized Clinical Trial. Journal of Religion and Health 59: 365–80. [Google Scholar] [CrossRef]
  42. Nidich, Sanford I., Jeremy Z. Fields, Maxwell V. Rainforth, Rhoda Pomerantz, David Cella, Jean Kristeller, John W. Salerno, and Robert H. Schneider. 2009. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integrative Cancer Therapies 8: 228–34. [Google Scholar] [CrossRef]
  43. Offidani, Emanuela, Janey C. Peterson, Joseph Loizzo, Anne Moore, and Mary E. Charlson. 2017. Stress and Response to Treatment: Insights from a Pilot Study Using a 4-week Contemplative Self-Healing Meditation Intervention for Posttraumatic Stress in Breast Cancer. Journal of Evidence-Based Complementary & Alternative Medicine 22: 715–20. [Google Scholar] [CrossRef][Green Version]
  44. Oliveira, Magda A., Carla Sousa, André Ferreira, and Andreia Cruz. 2017. Screening for Distress, the Sixth Vital Sign in Oncology: Preliminary Data of Newly Diagnosed Cancer Outpatients of Oporto Hospital CUF. Gazeta Médica 4: 1–7. [Google Scholar] [CrossRef][Green Version]
  45. Ownby, Kristin K. 2019. Use of the Distress Thermometer in Clinical Practice. Journal of the Advanced Practitioner in Oncology 10: 175–79. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750919/ (accessed on 14 June 2021).
  46. Pandya, Samta P. 2019. Meditation for Meaning in Life and Happiness of Older Adults: A Multi-City Experiment of the Brahma Kumaris’ Raja Yoga Practice. Journal of Religion, Spirituality & Aging 31: 282–304. [Google Scholar] [CrossRef]
  47. Pereira, Graziele Batista, Alice Madalena Silva Martins Gomes, and Riza Rute de Oliveira. 2017. Impact of Breast Cancer Treatment on the Self-Image and Affective Relationships of Matectomized Women. Life Style 4: 99–119. [Google Scholar] [CrossRef]
  48. Phatak, Mrunal S., Tara G. Chawla, and Pallavi S. Phatak. 2017. Effect of Raja Yoga Meditation on Glycaemic Status in Type 2 Diabetes Mellitus. International Journal of Research in Medical Sciences 5: 4385–88. [Google Scholar] [CrossRef][Green Version]
  49. Pillai, Radhakrishna R., Anil Kumar G., and Krishnadas Nanath. 2015. Role of Self-managing Leadership in Crisis Management: An Empirical Study on the Effectiveness of Rajayoga. IIM Kozhikode Society & Management Review 4: 15–37. [Google Scholar] [CrossRef]
  50. Polo, Larissa Helena Vitoriano, and Marcia Wanderley de Moraes. 2009. The Zubrod Performance Status and the Karnofsky Index in Quality of Life Evaluation of Children with Cancer. Einstein 7: 314–21. Available online: http://apps.einstein.br/revista/arquivos/PDF/1241-Einstein%20v7n3p314-21_1.pdf (accessed on 14 June 2021).
  51. Portella, Caio Fábio Schlechta, Isabel Cristina Espósito Sorpreso, Alanda Silva Menezes de Assis, Luiz Carlos de Abreu, José Maria Soares Junior, Edmund Chada Baracat, Sandra Dircinha Teixeira de Araujo Moraes, and Ana Cristina D’Andretta Tanaka. 2020. Meditation as an Approach to Lessen Menopausal Symptoms and Insomnia in Working Women Undergoing the Menopausal Transition Period: A Randomized Controlled Trial. Advances in Integrative Medicine 26: 1–26. [Google Scholar] [CrossRef]
  52. Rajoria, Kshipra, and Sarvesh Kumar Singh. 2017. Therapeutic Benefits of Raj Yoga—A Review. Indian Journal of Traditional Knowledge 16: 88–95. Available online: http://nopr.niscair.res.in/bitstream/123456789/42275/1/IJTK%2016%28Suppl%29%2088-95.pdf (accessed on 14 June 2021).
  53. Regino, Patrícia Afonso, Thaís Cristina Elias, Caroline Freitas Silveira, Cristina Wide Pissetti, Gilberto de Araújo Pereira, and Sueli Riul da Silva. 2018. Anxiety, Depression and Quality of Life of Patients with Breast and Gynecological Cancer in Face of the Effects of Antineoplastic Chemotherapy. Ciência, Cuidado e Saúde 17: 1–6. [Google Scholar] [CrossRef][Green Version]
  54. Saha, Felix J., Alexander Brüning, Cyrus Barcelona, Arndt Büssing, Jost Langhorst, Gustav Dobos, Romy Lauche, and Holger Cramer. 2016. Integrative Medicine for Chronic Pain: A Cohort Study Using a Process-Outcome Design in the Context of a Department for Internal and Integrative Medicine. Medicine 95: 41–52. [Google Scholar] [CrossRef] [PubMed]
  55. Santiago, Lucas, Pedro Reggiani Anzuatégui, José Paulo Agner Ribeiro, Maurício Carrilho Filon, Glauco José Pauka Mello, and Ana Valéria Brunetti Rigolino. 2019. Assessing psychosocial Distress in bone metastases treated with endoprosthesis. Acta Ortopedica Brasileira 27: 257–60. [Google Scholar] [CrossRef][Green Version]
  56. Santo, Helena Espirito, and Fernanda Daniel. 2017. Calculating and Reporting Effect Sizes on Scientific Papers (1): P < 0.05 Limitations in the Analysis of Mean Differences of two Groups. Revista Portuguesa de Investigação Comportamental e Social 1: 3–16. [Google Scholar] [CrossRef]
  57. Sarenmalm, Elisabeth Kenne, Lena B. Mårtensson, Bengt A. Andersson, Per Karlsson, and Ingrid Bergh. 2017. Mindfulness and its Efficacy for Psychological and Biological Responses in Women with Breast Cancer. Cancer Medicine 6: 1108–22. [Google Scholar] [CrossRef]
  58. Schell, Lisa K., Ina Monsef, Achim Wöckel, and Nicole Skoetz. 2019. Mindfulness-based Stress Reduction for Women Diagnosed with Breast Cancer. Cochrane Database of Systematic Reviews 3: CD011518. [Google Scholar] [CrossRef] [PubMed]
  59. Sharma, Kanishka, Peter Achermann, Bhawna Panwar, Shrikant Sahoo, Ramakrishnan Angarai, Roberto D. Pascual-Marqui, and Pascal Faber. 2020. Brain-electric Activity During Eyes Open Brahma Kumaris Rajayoga Meditation. MindRxiv. [Google Scholar] [CrossRef]
  60. Shim, Eun-Jung, Donghee Jeong, Hyeong-Gon Moon, Dong-Young Noh, So-Youn Jung, Eunsook Lee, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, and Jung Eun Lee. 2020. Profiles of Depressive Symptoms and the Association with Anxiety and Quality of Life in Breast Cancer Survivors: A Latent Profile Analysis. Quality of Life Research 29: 421–29. [Google Scholar] [CrossRef] [PubMed]
  61. Silva, Araceli Vicente da, Eliana Zandonade, and Maria Helena Costa Amorim. 2017. Anxiety and coping in women with breast cancer in chemotherapy. Revista Latino-Americana de Enfermagem 25: e2891. [Google Scholar] [CrossRef][Green Version]
  62. Sociedade Brasileira de Cardiologia (SBC). 2016. III Diretrizes Da Sociedade Brasileira de Cardiologia sobre análise e emissão de laudos Eletrocardiográficos. Arquivos Brasileiros de Cardiologia 106: 1–38. [Google Scholar] [CrossRef]
  63. Sociedade Brasileira de Cardiologia (SBC). 2019. 7th Brazilian Guideline of Arterial Hypertension: Chapter 2—Diagnosis and Classification. Arquivos Brasileiros de Cardiologia 107: 1–104. [Google Scholar] [CrossRef]
  64. Soo, Mary Scott, Jennifer A. Jarosz, Anava A. Wren, Adrianne E. Soo, Yvonne M. Mowery, Karen S. Johnson, Sora C. Yoon, Connie Kim, E. Shelley Hwang, Francis J. Keefe, and et al. 2016. Support Care cancer imaging-guided core-needle breast biopsy: Impact of meditation and music interventions on patient anxiety, pain, and fatigue. Journal of the American College of Radiology 13: 526–34. [Google Scholar] [CrossRef]
  65. Toutain, Thaise Graziele L. O., Raphael Rosário, Carlos Maurício Cardeal Mendes, and Eduardo Pondé de Sena. 2019. Alfa no estado alterado de consciência: Meditação raja yoga. Revista de Ciencias Medicas e Biologicas 18: 38–43. [Google Scholar] [CrossRef]
  66. Veronese, Felipe, and Marcelo Nonaka Frade. 2021. Prevalência de ansiedade e depressão em pacientes submetidos à quimioterapia e/ou radioterapia. Fag Journal of Health (FJH) 3: 38–43. [Google Scholar] [CrossRef]
  67. Villar, Raquel Rey, Salvador Pita Fernández, Carmen Cereijo Garea, Maria Teresa Seoane Pillado, Vanesa Balboa Barreiro, and Cristina González Martín. 2017. Quality of life and anxiety in women with breast cancer before and after treatment. Revista Latino-Americana de Enfermagem 25: e2958. [Google Scholar] [CrossRef]
  68. Vivekananda, Swami. 2009. Raja Yoga—O Caminho Real. Available online: https://docplayer.com.br/19729837-Raja-yoga-o-caminho-real.html (accessed on 14 July 2021).
  69. Yee, Melissa K., Susan M. Sereika, Catherine M. Bender, Adam M. Brufsky, Mary C. Connolly, and Margaret Q. Rosenzweig. 2017. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 123: 2061–69. [Google Scholar] [CrossRef] [PubMed][Green Version]
  70. Zerati, Antonio Eduardo, Nelson Wolosker, Nelson de Luccia, and Pedro Puech-Leão. 2017. Totally Implantable Venous Catheters: History, Implantation Technique and Complications. Jornal Vascular Brasileiro 16: 128–39. [Google Scholar] [CrossRef] [PubMed][Green Version]
Figure 1. Follow-up of study participants according to the CONSORT 2010 flowchart.
Figure 1. Follow-up of study participants according to the CONSORT 2010 flowchart.
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Figure 2. Median values of systolic blood pressure (SBP) before and after the four interventions in the IG (Raja yoga meditation).
Figure 2. Median values of systolic blood pressure (SBP) before and after the four interventions in the IG (Raja yoga meditation).
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Figure 3. Median values of diastolic blood pressure (DBP) before and after the four interventions in the IG (Raja yoga meditation).
Figure 3. Median values of diastolic blood pressure (DBP) before and after the four interventions in the IG (Raja yoga meditation).
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Figure 4. Median values of heart rate (HR) before and after the four interventions in the IG (Raja yoga meditation).
Figure 4. Median values of heart rate (HR) before and after the four interventions in the IG (Raja yoga meditation).
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Figure 5. Median values of pulse oximetry (SPO2) before and after the four interventions in the IG (Raja yoga meditation).
Figure 5. Median values of pulse oximetry (SPO2) before and after the four interventions in the IG (Raja yoga meditation).
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Figure 6. Median values of systolic blood pressure (SBP) before and after the four interventions in the CG (educational activity).
Figure 6. Median values of systolic blood pressure (SBP) before and after the four interventions in the CG (educational activity).
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Figure 7. Median values of diastolic blood pressure (DBP) before and after the four interventions in the CG (educational activity).
Figure 7. Median values of diastolic blood pressure (DBP) before and after the four interventions in the CG (educational activity).
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Figure 8. Median values of heart rate (HR) before and after the four interventions in the CG (educational activity).
Figure 8. Median values of heart rate (HR) before and after the four interventions in the CG (educational activity).
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Figure 9. Median values of pulse oximetry (SPO2) before and after the four interventions in the CG (educational activity).
Figure 9. Median values of pulse oximetry (SPO2) before and after the four interventions in the CG (educational activity).
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Table 1. Characterization and homogeneity of the participants in the intervention and control groups.
Table 1. Characterization and homogeneity of the participants in the intervention and control groups.
VariablesTotal
n = 50
Groupp-Value
Intervention
n = 25
Control
n = 25
Median (P25–P75)Median (P25–P75)Median (P25–P75)
Age (years)47 (40.8–56)46 (38.5–56)47 (43.5–55.5)0.4311 1
n (%)n (%)n (%)
Ethnicity 0.2082 2
White36 (72.0)16 (64.0)20 (80.0)
Non-white14 (28.0)9 (36.0)5 (20.0)
Marital status 0.7772 2
Living with a partner27 (54.0)14 (56.0)13 (52.0)
Living without a partner23 (46.0)11 (44.0)12 (48.0)
Educational level 1.0002 2
Low12 (24.0)6 (24.0)6 (24.0)
High *38 (76.0)19 (76.0)19 (76.0)
Occupation 0.2392 3
Unpaid18 (36.0)11 (44.0)7 (28.0)
Paid32 (64.0)14 (56.0)18 (72.0)
Family income 0.7652 3
Up to 1 minimum wage33 (66.0)17 (68.0)16 (64.0)
>1 minimum wage17 (34.0)8 (32.0)9 (36.0)
Religion 0.5292 2
Catholic36 (72.0)17 (68.0)19 (76.0)
Protestant14 (28.0)8 (32.0)6 (24.0)
1 Mann–Whitney U test; 2 Chi-square test; 3 Fisher’s exact test; P25–P75: interquartile range; minimum wage: USD 1045.00. * High school or higher.
Table 2. Predictive factors for breast cancer in the participants.
Table 2. Predictive factors for breast cancer in the participants.
VariablesTotal
n = 50
Groupp-Value
Intervention
n = 25
Control
n = 25
Median (P25-P75)Median (P25-P75)Median (P25-P75)
Age at menarche13 (12.5–15)14 (13–14)13 (12–15)0.8621
Age at menopause46 (44.8–49.3)46 (45–50.0)45 (39–49)0.2751 1
n (%)n (%)n (%)
Ever having had children 1.000 2
Yes38 (76.0)19 (76.0)19 (76.0)
No12 (24.0)6 (24.0)6 (24.0)
First pregnancy after 30 years 0.699 3
Yes7 (15.7)3 (13.0%)4 (18.2%)
No38 (84.4)20 (87.0%)18 (81.8%)
Ever having breastfed 0.488 3
Yes38 (95.0)19 (90.5)19 (100.0)
No2 (5.0)2 (9.5)0 (0.0)
Use of oral contraceptives 0.564 2
Yes20 (40.0)11 (44.0)9 (36.0)
No30 (60.0)14 (56.0)16 (64.0)
Physical activity 0.508 2
Yes12 (24.0)5 (20.0)7 (28.0)
No38 (76.0)20 (80.0)18 (72.0)
BMI 0.447 2
Adequate14 (28.0)5 (20.0)9 (36.0)
Overweight22 (44.0)12 (48.0)10 (40.0)
Obesity14 (28.0)8 (32.0)6 (24.0)
Habits 0.429 3
Smoking4 (57.1)2 (100.0)2 (40.0)
Alcohol drinking3 (42.9)0 (0.0)3 (60.0)
Having a relative with breast cancer 0.306 2
Yes11 (22.0)7 (28.0)4 (16.0)
No39 (78.0)18 (72.0)21 (84.0)
1 Mann–Whitney U test; 2 Chi-square test; 3 Fisher’s exact test.
Table 3. Data related to the disease, treatment, and staging.
Table 3. Data related to the disease, treatment, and staging.
VariablesTotal
n (%)
Groupp-Value
Intervention
n (%)
Control
n (%)
Having breast surgery
Yes7 (14.0)3 (12.0)4 (16.0)1.00
No43 (86.0)22 (88.0)21 (84.0)
Affected breast
Right26 (52.0)13 (52.0)13 (52.0)1.00
Left24 (48.0)12 (48.0)12 (48.0)
Surgery information
Total mastectomy2 (4.0)1 (4.0)1 (4.0)1.00
Quadrandectomy1 (2.0)0 (0.0)1 (4.0)
Sectorectomy3 (6.0)2 (8.0)1 (4.0)
Lymphaticectomy5 (10.0)3 (12.0)2 () 8.0
Breast reconstruction1 (2.0)1 (4.0)0 (0.0)
Current treatment
Chemotherapy48 (96.0)23 (92.0)25 (100.0)1.00
Radiotherapy4 (8.0)2 (8.0)2 (8.0)
Surgery5 (10.0)2 (8.0)3 (12.0)
Hormone therapy4 (8.0)3 (12.0)1 (4.0)
Immunotherapy4 (8.0)1 (4.0)3 (12.0)
Port-cath implantation
Yes21 (42.0)10 (40.0)11 (44.0)
No29 (59.0)15 (60.0)14 (56.0)
Metastasis
Yes7 (14.0)4 (16.0)3 (12.0)1.00
No43 (86.0)21 (84.0)22 (88.0)
Purpose of chemotherapy
Neoadjuvant37 (74.0)18 (72.0)19 (76.0)1.00
Adjuvant6 (12.0)3 (12.0)3 (12.0)
Palliative7 (14.0)4 (16.0)3 (12.0)
TNM staging
IA—T1 N0 M01 (2.0)0 (0.0)1 (4.0)1.00
IIA—T1 N1 M0 1 (2.0)0 (0.0)1 (4.0)
IIA—T2 N0 M011 (22.0)5 (20.0)6 (24.0)
IIB—T2 N1 M08 (16.0)2 (8.0)6 (24.0)
IIB—T3 N0 M05 (10.0)1 (4.0)4 (16.0)
IIIA—T2 N2 M0 2 (4.0)0 (0.0)2 (8.0)
IIIA—T3 N1 M0 7 (14.0)6 (24.0)1 (4.0)
IIIA—T3 N2 M1 (2.0)1 (4.0)0 (0.0)
IIIB—T4N0 1 (2.0)1 (4.0)0 (0.0)
IIIB—T4N13 (6.0)3 (12.0)0 (0.0)
IIIB—T4N22 (4.0)2 (8.0)0 (0.0)
IV—TX NX M18 (16.0)4 (16.0)4 (16.0)
Chi-square test.
Table 4. Comparison of distress levels before and after interventions between the two groups. Teresina, Piauí, Brazil. 2020.
Table 4. Comparison of distress levels before and after interventions between the two groups. Teresina, Piauí, Brazil. 2020.
Assessment of Distress LevelIntervention GroupControl Group
Total
n (%)
Presence of Distress afterAbsence of Distress afterp-Value *Total
n (%)
Presence of Distress afterAbsence of Distress afterp-Value *
Presence of distress before23 (100)13 (56.5)10 (43.5)0.00221 (100)21 (100.0)0 (4.0)1.000
Absence of distress before2 (100)0 (0.0)2 (100.0) 4 (100)0 (0.0)4 (100.0)
* McNemar test.
Table 5. Comparison of the level of anxiety before and after the intervention in the two groups.
Table 5. Comparison of the level of anxiety before and after the intervention in the two groups.
AnxietyIntervention GroupControl Group
Total
n (%)
Presence of Anxiety after
n (%)
Absence of Anxiety after
n (%)
p-Value *Total
n (%)
Presence of Anxiety after
n (%)
Absence of Anxiety after
n (%)
p-Value *
Presence of anxiety before9 (100)1 (11.1)8 (88.9)0.0088 (100.0)7 (87.5)1 (12.5)1.000
Absence of anxiety before16 (100)0 (0.0)16 (100.0) 17 (100.0)1 (5.9)16 (94.1)
* McNemar test.
Table 6. Effect size (Cohen’s d) of the interventions on the level of distress, anxiety, SBP, DBP, HR, and SPO2 in the two groups.
Table 6. Effect size (Cohen’s d) of the interventions on the level of distress, anxiety, SBP, DBP, HR, and SPO2 in the two groups.
Variables Intervention GroupControl Group Cohen’s dEffect Size
Distress thermometer1st moment6.52 (± 2.23)6.70 (± 2.49)−0.079−0.03
2nd moment3.72 (± 1.54)6.75 (± 2.41)−1.49−0.59
Anxiety1st moment6.32 (± 4.62)6.24 (± 4.69)0.0170.008
2nd moment3.12 (± 2.55)6.20 (± 4.70)−0.814−0.37
Depression1st moment5.48 (± 4.32)5.16 (± 4.20)0.0750.03
2nd moment3.16 (± 2.62)5.76 (± 4.17)−0.746−0.34
Systolic blood pessure1st moment121.64 (± 19.28)132.40 (± 19.85)−0.549−0.26
2nd moment117.8 (± 15.53)132.24 (± 11.68)−1.05−0.46
Diastolic blood pressure1st moment70.08 (± 19.98)78.12 (± 17.01)−0.433−0.21
2nd moment72.28 (± 9.57)85.20 (± 7.57)−1.497−0.59
HR1st moment82.92 (±12.43)79.62 (±10.80)0.2830.14
2nd moment79.08 (±9.52)85.50 (±9.78)−0.66−0.31
SPO21st moment97.72 (±1.02)97.12 (±2.17)0.3530.17
2nd moment97.80 (±0.70)97.25 (±0.94)0.6630.31
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Araújo, R.V.; Fernandes, A.F.C.; Campelo, R.C.V.; Silva, R.A.; Nery, I.S. Effect of Raja Yoga Meditation on the Distress and Anxiety Levels of Women with Breast Cancer. Religions 2021, 12, 590. https://doi.org/10.3390/rel12080590

AMA Style

Araújo RV, Fernandes AFC, Campelo RCV, Silva RA, Nery IS. Effect of Raja Yoga Meditation on the Distress and Anxiety Levels of Women with Breast Cancer. Religions. 2021; 12(8):590. https://doi.org/10.3390/rel12080590

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Araújo, Raquel Vilanova, Ana Fátima Carvalho Fernandes, Regina Célia Vilanova Campelo, Renan Alves Silva, and Inez Sampaio Nery. 2021. "Effect of Raja Yoga Meditation on the Distress and Anxiety Levels of Women with Breast Cancer" Religions 12, no. 8: 590. https://doi.org/10.3390/rel12080590

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