CC BY 4.0 · Journal of Health and Allied Sciences NU 2023; 13(03): 360-364
DOI: 10.1055/s-0042-1755583
Original Article

A Systematic Review Protocol on the Effect of Yoga Intervention on Inflammatory Biomarkers among Women with Breast Cancer

1   Department of Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
Fatima Dsilva
2   Department of Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be University), Paneer, Deralakatte, Mangalore, Karnataka, India
3   Department of Nursing, College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal, India
Sanal TS
4   Department of Biostatistics, JDC Hospital & Research Centre, Trivandrum, India
Caren D'Souza
5   Department of Surgery, K.S. Hegde Medical Academy, Nitte (Deemed to be University) Mangalore, Karnataka, India
6   Department of Psychiatry, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
› Author Affiliations
Funding None.


A systematic review protocol acts as a guide in the review process to prevent the introduction of bias, maintain transparency and allows reproducibility. Yoga intervention had been experimented on various health aspects such as physical functioning, health-related quality of life, psychosocial and emotional well-being among breast cancer populations, and the findings have been very encouraging. Studies are being performed on the effect of yoga intervention(s) at the molecular level by assessing the inflammatory cytokines and also stress hormones such as cortisol. This protocol is developed to escort in evaluating studies that have been performed on evidence-based yoga intervention at the level of cancer microenvironment, in women diagnosed with breast cancer, by assessing the inflammatory biomarkers and cortisol level, a primary stress marker, and a potent influence of inflammation. The findings will elucidate the picture of the cancer microenvironment as a result of yoga intervention.

Ethics and Dissemination

Institutional ethics clearance was not required as the data were collected from already conducted research studies. However, studies subjected to be included in this review should have ethics clearance.

Publication History

Article published online:
06 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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  • References

  • 1 Ghoncheh M, Pournamdar Z, Salehiniya H. Incidence and mortality and epidemiology of breast cancer in the world. Asian Pac J Cancer Prev 2016; 17 (S3): 43-46
  • 2 World Health Organization. Africa S. Breast cancer. World Health Organization. Breast Cancer 2021; 1-7. Accessed August 2, 2022 at:
  • 3 Shetty P. India faces growing breast cancer epidemic. Lancet 2012; 379 (9820): 992-993
  • 4 Rojas K, Stuckey A. Breast cancer epidemiology and risk factors. Clin Obstet Gynecol 2016; 59 (04) 651-672
  • 5 Ghoncheh M, Pournamdar Z, Salehiniya H. Incidence and mortality and epidemiology of breast cancer in the world. Asian Pac J Cancer Prev 2016; 17: 43-46
  • 6 DeSantis CE, Ma J, Gaudet MM. et al. Breast cancer statistics, 2019. CA Cancer J Clin 2019; 69 (06) 438-451
  • 7 Azamjah N, Soltan-Zadeh Y, Zayeri F. Global trend of breast cancer mortality rate: a 25-year study. Asian Pac J Cancer Prev 2019; 20 (07) 2015-2020
  • 8 Mehdi S, Hosein H, Tayebe R, Mahin A. Prevalence of anxiety among breast cancer patients: a systematic review and meta-analysis. Breast Cancer 2020; 27 (02) 166-178
  • 9 Tsaras K, Papathanasiou IV, Mitsi D. et al. Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors. Asian Pac J Cancer Prev 2018; 19 (06) 1661-1669
  • 10 Armaiz-Pena GN, Cole SW, Lutgendorf SK, Sood AK. Neuroendocrine influences on cancer progression. Brain Behav Immun 2013; 30 (30, Suppl) S19-S25
  • 11 Rao RM, Vadiraja HS, Nagaratna R. et al. Effect of yoga on sleep quality and neuroendocrine immune response in metastatic breast cancer patients. Indian J Palliat Care 2017; 23 (03) 253-260
  • 12 McGregor BA, Antoni MH. Psychological intervention and health outcomes among women treated for breast cancer: a review of stress pathways and biological mediators. Brain Behav Immun 2009Feb;23(02):159–66. Doi: 10.1016/j.bbi.2008.08.002. Epub 2008 Aug 22. PMID: 18778768; PMCID: PMC2660328
  • 13 Gosain R, Gage-Bouchard E, Ambrosone C, Repasky E, Gandhi S. Stress reduction strategies in breast cancer: review of pharmacologic and non-pharmacologic based strategies. Semin Immunopathol 2020; 42 (06) 719-734
  • 14 Kiecolt-Glaser JK, Loving TJ, Stowell JR. et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. 2015;62
  • 15 Hoge EA, Bui E, Palitz SA, Schwarz NR, Owens ME, Johnston JM, Pollack MH, Simon NM. The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Res 2018 Apr;262:328–332. Doi: 10.1016/j.psychres.2017.01.006. Epub 2017 Jan 26. PMID: 28131433; PMCID: PMC5526744
  • 16 Greenlee H, Balneaves LG, Carlson LE. et al; Society for Integrative Oncology. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014; 2014 (50) 346-358
  • 17 Lengacher CA, Reich RR, Paterson CL. et al. A large randomized trial: effects of mindfulness-based stress reduction (MBSR) for breast cancer (BC) survivors on salivary cortisol and IL-6. Biol Res Nurs 2019; 21 (01) 39-49
  • 18 Harder H, Parlour L, Jenkins V. Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review. Support Care Cancer 2012; 20 (12) 3055-3064
  • 19 Sharma M, Lingam VC, Nahar VK. A systematic review of yoga interventions as integrative treatment in breast cancer. J Cancer Res Clin Oncol 2016; 142 (12) 2523-2540
  • 20 Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. (Review) Cochrane Database Syst Rev 2017; 1 (01) CD010802
  • 21 Sharma M, Lingam V, Nahar V. Yoga as an integrative therapy for breast cancer. J Altern Complement Med 2016; 22 (06) A92
  • 22 Emerson D, Sharma R, Chaudhry S. Yoga Therapy in Practice. International Journal of Yoga Therapy 2009; 19 (19) 123-128
  • 23 McCall M. Yoga intervention may improve health-related quality of life (HRQL), fatigue, depression, anxiety and sleep in patients with breast cancer. Evid Based Nurs 2018; 21 (01) 9
  • 24 Jacobsen PB, Donovan KA, Vadaparampil ST, Small BJ. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol 2007; Nov 26 (06) 660-667
  • 25 Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017 May 6;67(03):194–232. Doi: 10.3322/caac.21397. Epub 2017 Apr 24. PMID: 28436999; PMCID: PMC5892208
  • 26 Vadiraja HS, Rao RM, Nagarathna R. et al. Effects of yoga in managing fatigue in breast cancer patients: a randomized controlled trial. Indian J Palliat Care 2017; 23 (03) 247-252
  • 27 Buffart LM, van Uffelen JGZ, Riphagen II. et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 2012; 12 (01) 559
  • 28 Thaker PH, Sood AK. Neuroendocrine influences on cancer biology. Semin Cancer Biol 2008; 18 (03) 164-170
  • 29 Butler A, Hall H, Copnell B. A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care. Worldviews Evid Based Nurs 2016; 13 (03) 241-249
  • 30 Riesenberg LA, Justice EM. Conducting a successful systematic review of the literature, part 1. Nursing 2014; 44 (04) 13-17
  • 31 Bettany-Saltikov J. Learning how to undertake a systematic review: part 1. Nurs Stand 2010; 24 (50) 47-55 , quiz 56
  • 32 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 33 Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial | Cochrane Training. In: Cochrane Training. Published online 2021:1–50.
  • 34 Sterne JA, Hernan MA, McAleenan A. et al. Assessing risk of bias in a non-randomized study | Cochrane Training. In: Cochrane Handb Syst Rev Interv. 2021; version 6.