1. Karen M. Mustian, Ph.D., M.P.H. Assistant Professor Director PEAK CORE Lab Department of Radiation Oncology University of Rochester Cancer Center Funding: NCI U10CA037420 & OCCAM U10 CA037420-20S1 YOCAS ® Yoga Significantly Improves Sleep, Fatigue and Quality of Life in 410 Cancer Survivors : A URCC CCOP Research Base RCT

2. Study Aims Primary Aim sleep qualityTo examine the efficacy of yoga for improving sleep quality in cancer survivors Secondary Aims fatiguequality of lifeTo examine the efficacy of yoga for improving fatigue and quality of life in cancer survivors

3. Central Illinois CCOP Columbia River CCOP Hematology-Oncology of CNY CCOP Santa Rosa CCOP Southeast Cancer Control Consortium Kansas City CCOP Grand Rapids CCOP Greenville CCOP Wichita CCOP URCC CCOPs URCC CCOP Research Base: YOCAS ® Recruitment Sites

4. Eligibility Criteria Study participants must: cancerHave cancer standard treatment for cancerHave undergone standard treatment for cancer completed all standard treatment between 2 and 24 months priorHave completed all standard treatment between 2 and 24 months prior sleep disturbance of a level 3Have sleep disturbance of a level 3 or greater EnglishRead English 21 years21 years or older consentGive written consent Study participants must not: regularly participated in yoga classes within 3 months priorHave regularly participated in yoga classes within 3 months prior sleep apneaHave sleep apnea metastaticHave metastatic cancer

5. Arm 1: Standard Care Arm 2: Yoga plus Standard Care EligibilitEligibility Consent On-study forms Assess sleep (PSQI), fatigue (MFSI), QOL (FACIT) Randomize Assess sleep, fatigue, QOL End study Study Week 1 (Baseline) Study Weeks 2–5 (Intervention) Study Week 6 (Post) Schema

6. YOCAS ® Intervention Yoga –Gentle Hatha Yoga –Restorative Yoga Components –Postures (asanas): seated, standing, transitional and supine –Breathing exercises (pranayama): slow, diaphragmatic –Mindfulness (awareness): meditation, visualization & affirmation Duration –4 weeks –2 times a week for 75 minutes Standardization –URCC CCOP Yoga Consultant –Yoga Alliance-Certified Instructors –Yoga Instructional DVD –Yoga Instructional Manual

7. YOCAS ® Intervention

8. Diagnosis –Breast: N =307 (75%) –Other: N =103 (25%) Baseline Sleep Quality* –Yoga = 9.0 –Control = 9.2 N = 204 Control, 206 Yoga Mean age = 54 years Female N = 393 (96%) Caucasian N = 383 (93%) Demographics (N=410) Both groups met the clinical cutoff criteria for impaired sleep quality (PSQI >5)

9. Compliance (N = 410) 86% > 5 sessions % Yoga Sessions Attended Yoga Sessions

10. Results (N = 410) -20-1001020304050 Percent Improvement Yoga  Sleep Medications Control Daytime Sleepiness Control Yoga  Sleep Quality Control Yoga  Fatigue Control Yoga  QOL Control Yoga   P < 0.05

11. Sleep quality –Yoga subjects improved sleep quality by 22% while control subjects improved by 12% (p<0.05) Sleep Quality (N = 410)

12. Baseline sleep quality –84% of the yoga subjects and 83% of the control subjects had clinically impaired sleep quality at baseline (PSQI > 5) Sleep quality recovery –31% of the yoga subjects recovered (PSQI < 5), while only 16% of the control subjects recovered (p<0.05) Sleep Quality Recovery (N = 410)

13. Fatigue –Yoga subjects reduced fatigue by 42% while control subjects reduced fatigue by 12% (p<0.05) Quality of life –Yoga subjects improved quality of life by 6% while control subjects improved quality of life by 0% (p<0.05) Fatigue, & QOL (N = 410)

14. Daytime sleepiness –Yoga subjects reduced daytime sleepiness by 29% while control subjects reduced daytime sleepiness by 5% (p<0.05) Sleep medication use –Yoga subjects reduced sleep medication use by 21% while control subjects increased sleep medication use by 5% (p<0.05) Daytime Sleepiness & Medication Use (N = 410)

15. YOCAS ® Yoga was found effective for improving –Sleep quality –Fatigue –Quality of life –Daytime sleepiness –Reducing Sleep Medication Use! Summary

16. Gary Morrow, Ph.D., M.S. Jim Atkins, M.D. Luke Peppone, Ph.D. Michelle Janelsins, Ph.D. Oxana Palesh, Ph.D., M.P.H. Lisa Sprod, Ph.D. Supriya Mohile, M.D. Charles Heckler, Ph.D. Jane Hickok, M.D. Marget Braun, R.Y.T. Leslie Gillies, C.R.C. Jennifer Yates, M.S. Jacque Lindke, C.R.C Ryan Jones Sebastian Estaque Ann Wiater NCI & OCCAM URCC CCOP Affiliates Acknowledgments

17. Yocas pictures