2026 ECNP Congress

EP02-2062

Yoga for cancer-related fatigue and anxiety in pelvic malignancies: a systematic review and meta-analysis

Walquiria Parreira — A. Zuffo Yabrude, I. Gonçalves Baylão · Centro Universitário de Valença, Internal Medicine, Valença, Brazil

2026 ECNP Congress

Cancer-related fatigue and anxiety are prevalent and distressing symptoms in pelvic malignancies [4], frequently persisting beyond treatment completion and poorly responsive to pharmacotherapy alone. Yoga, integrating physical postures, breath regulation, and meditative focus, may modulate inflammatory cytokines, autonomic tone, and hypothalamic-pituitary-adrenal axis activity implicated in fatigue pathophysiology [2]. Despite biological plausibility, pooled evidence specific to pelvic cancer populations remains fragmented [3], and optimal implementation parameters are undefined. This systematic review and meta-analysis aimed to evaluate the effect of structured yoga interventions on fatigue severity in patients with pelvic malignancies during or after oncological treatment.We conducted a systematic review in accordance with PRISMA 2020 guidelines [5] and registered the protocol with PROSPERO. We searched PubMed, Embase, PsycINFO, Cochrane Library, and ClinicalTrials.gov from inception to 2025 without language restrictions. Eligible studies were randomised controlled trials of structured yoga (minimum four weeks, at least one session per week) versus waitlist, usual care, or educational control in adults with a current or previous diagnosis of cervical, ovarian, endometrial, or prostate cancer. The primary outcome was cancer-related fatigue total score post-intervention, measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) or Brief Fatigue Inventory (BFI). We extracted cancer type, treatment phase, yoga style, session frequency, duration, and attrition. Standardised mean differences were computed as Hedges’ g under random-effects models, with negative values indicating fatigue reduction favouring yoga. Risk of bias was assessed with the Cochrane risk-of-bias tool. Heterogeneity was quantified using I² and tau², with subgroup analysis by treatment phase.Of 1,203 records screened, six randomised controlled trials (N = 312 participants) met inclusion criteria: three in gynaecological cancers and three in prostate cancer. Yoga modalities included Hatha yoga (n = 2), restorative yoga (n = 2), and yoga therapy (n = 2); intervention duration ranged from six to twelve weeks, with two to three sessions per week and mean attrition of 18%. The pooled effect for fatigue reduction was Hedges’ g = −0.61 (95% confidence interval −0.98 to −0.24), I² = 48%, indicating a moderate-to-large, statistically significant reduction favouring yoga. Effects were more pronounced during active treatment (g = −0.78, 95% confidence interval −1.25 to −0.31; I² = 35%) than in post-treatment survivorship (g = −0.38, 95% confidence interval −0.79 to 0.03; I² = 62%). No serious adverse events were attributed to yoga [1]; minor musculoskeletal soreness was noted in two studies. Risk of bias was low in three studies and raised some concerns in two, primarily due to inherent performance bias from non-blindable yoga interventions and self-reported outcomes.These findings indicate that structured yoga produces a moderate, clinically meaningful reduction in cancer-related fatigue among patients with pelvic malignancies, with stronger effects observed during active treatment. Oncology rehabilitation programmes should consider yoga as a standard, low-risk component of supportive care. Future adequately powered multi-centre trials should identify optimal yoga styles, session dosing, and neurobiological mechanisms underlying fatigue modulation in mixed pelvic cancer cohorts.

References

  1. Bower, J.E., Garet, D., Sternlieb, B., Ganz, P.A., Irwin, M.R., Olmstead, R., et al., 2012. Yoga for persistent fatigue in breast cancer survivors: a randomised controlled trial. Cancer 118 (15), 3766-3775.
  2. Chandwani, K.D., Thornton, B., Perkins, G.H., Arun, B., Raghuram, N.L., Nagendra, H.R., et al., 2010. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J. Clin. Oncol. 28 (15), 2521-2527.
  3. Lin, K.Y., Hu, Y.T., Chang, K.J., Lin, H.F., Tsauo, J.Y., 2012. Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evid. Based Complement. Alternat. Med. 2012, 658408.
  4. Mustian, K.M., Sprod, L.K., Janelsins, M., Peppone, L.J., Mohile, S., 2013. Exercise recommendations for cancer-related fatigue, cognitive impairment, sleep problems, depression, pain, anxiety, and physical dysfunction: a review. Oncol. Hematol. Rev. 9 (1), 50-58.
  5. Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., et al., 2021. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71.