Phase III Trial Shows Structured Yoga Program Significantly Reduces Mood Disturbance, Anxiety, Fatigue, and Insomnia in Cancer Survivors
Key Insights
A nationwide phase III randomized controlled trial of 410 cancer survivors found that a 4-week structured yoga program (YOCAS) significantly reduced overall mood disturbance (search), anxiety (search), and fatigue (search) compared to standard care alone.
Participants in the yoga group experienced a 5.08-point reduction in mood disturbance (search) (moderate-to-large effect), a 0.72-point reduction in anxiety (search) (small-to-medium effect), and a 1.49-point reduction in fatigue (search) (medium-to-large effect).
Mediation analyses revealed that improvements in mood disturbance (search) and fatigue (search) each accounted for approximately 25% of the insomnia (search) improvements associated with the yoga intervention.
A large, multisite phase III randomized controlled trial has demonstrated that a structured 4-week yoga intervention can significantly improve mood disturbance (search), anxiety (search), fatigue (search), and insomnia (search) among cancer survivors, offering a nonpharmacologic approach to managing some of the most persistent and difficult-to-treat side effects of cancer treatment.
The findings were presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago (Abstract 12004) by lead investigator Yuri Choi, PhD, MSN, RN, of the Wilmot Cancer Institute at the University of Rochester Medical Center.
"There is no single gold standard behavioral treatment available to survivors for treating overall mood disturbance (search), anxiety (search), fatigue (search), and insomnia (search)," Dr. Choi said 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."
The Scope of the Problem
Mood disturbance (search) and insomnia (search) represent significant challenges 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 (search), or fatigue (search). These symptoms often persist long after primary treatment ends, yet no single behavioral treatment has been established as a gold standard for addressing them concurrently.
Study Design and Population
The nationwide trial was conducted through the University of Rochester Cancer Center NCI Community Oncology Research Program Research Base, recruiting 410 adult cancer survivors from 12 community-based oncology practices across the United States. 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.
The mean age of participants was 54 years, with 96% being female, 93% White, and 75% breast cancer (search) survivors. Participants were randomly assigned to receive either standard survivorship care alone or standard survivorship care plus the Yoga for Cancer Survivors (YOCAS) program.
The YOCAS Intervention
YOCAS is a 4-week structured program that includes gentle hatha and restorative yoga postures, breathing exercises, and mindfulness training. Participants assigned to the intervention attended two instructor-led 75-minute yoga sessions per week, incorporating 18 specific gentle hatha and restorative yoga poses, and were also expected to complete at least 30 minutes of additional home-based yoga practice per week.
Mood disturbance (search) was assessed using the Profile of Mood States questionnaire, and insomnia (search) was evaluated using the Insomnia Severity Index.
Key Efficacy Findings
Compared with participants who received standard care alone, those in the YOCAS group demonstrated statistically significant improvements across multiple endpoints. The yoga group showed a 5.08-point lower total score for overall mood disturbance (search), corresponding to a moderate-to-large effect; a 0.72-point lower anxiety (search) score, corresponding to a small-to-medium effect; and a 1.49-point lower fatigue (search) 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 (search), anxiety (search), and fatigue (search), whereas those in the standard-of-care group did not.
In mediation analyses, improvements in overall mood disturbance (search) and fatigue (search) each accounted for approximately 25% of the insomnia (search) improvements associated with YOCAS, suggesting that yoga's beneficial effect on sleep quality is partly driven by its impact on mood and fatigue.
"This indicates that cancer survivors have an option to alleviate these cancer-related side effects at the same time, without adding another drug," Dr. Choi told Fox News Digital.
Safety and Tolerability
The study did not reveal any major safety concerns or serious adverse events related to the yoga practice, supporting the tolerability of gentle hatha and restorative yoga in this patient population.
Expert Commentary
Fumiko Chino, MD, Associate Professor in Breast Radiation Oncology at The University of Texas MD Anderson Cancer Center and an ASCO Expert in survivorship, commented on the significance of the findings.
"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 (search). 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.
Limitations and Future Directions
The study has several important limitations. The findings are preliminary and have not yet been peer-reviewed for a medical publication. The sample was relatively homogeneous, with most participants being women (96%), breast cancer (search) patients (75%), Caucasian (93%), and having some college or higher education (82%). The research also excluded patients with metastatic cancer, and the total intervention period was only four weeks, meaning more research is needed to determine long-term benefits.
The investigators noted that the study did not evaluate whether other types of yoga, such as heated-room or rigorous-flow yoga, are safe or beneficial for cancer survivors.
Future research will examine the long-term effects of YOCAS and explore digital delivery methods to expand access, including online platforms and mobile apps. "We are adapting our intervention to reach all cancer patients and survivors, including the creation of a mobile app to reach people in rural communities," Dr. Choi noted.
The investigators concluded that clinicians should consider recommending gentle hatha and restorative yoga for cancer survivors who experience mood disturbance (search), anxiety (search), fatigue (search), or insomnia (search). Survivors are advised to seek certified yoga instructors who have experience working with cancer patients and to consult their oncology team for referrals to qualified instructors in their community.
The study was funded by the National Cancer Institute.