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Part 1: The Role of Yoga and Meditation in Improving Quality of Life for Cancer Patients Namaskar. Good morning. Greetings from the All India Institute of Medical Sciences, New Delhi, a tertiary care hospital in North India, often called the Harvard of the East. Yoga is derived from the Sanskrit word yoga, from the yuj dhātu, which means joṛnā (to join). In the true sense, the union (joṛnā) of ātmā (the individual self) with Paramātmā (the Supreme Self) is Yoga. It is a body-mind activity, a combination. We are here today to talk about its meanings. There are several studies—randomized trials and observational follow-ups—on cancer patients who were offered yogic intervention alongside their allopathic treatment (surgery, radiotherapy, chemotherapy). In some studies, a trained instructor taught patients various yogāsanas and prāṇāyāma. Reviewing the literature reveals that different authors used different types of yogāsana, prāṇāyāma, and meditation (dhyāna). Some used transcendental meditation as initiated by Maharṣi Maheśh Yogī, others used forms like the Art of Living by Śrī Śrī Ravi Śaṅkarjī, and various other meditation techniques combined with yoga. Therefore, when we claim "yoga does this or that," we must be clear about what we mean and read the fine print, just as we read the terms and conditions for a new product. We must note which specific yogic and meditative techniques were used, as these vary widely. Generally, yogic intervention helps relieve patient stress and thereby improves sleep. A cancer diagnosis often causes sleepless nights. Major operations are painful and disrupt sleep. Chemotherapy causes hair loss, loss of appetite, mouth ulcers, diarrhea, and vomiting, which is deeply distressing and further deteriorates sleep, physical fitness, and quality of life. Overall, yogic interventions alongside chemotherapy and radiotherapy seem to improve some of these issues. The literature suggests that long-term yogic intervention for cancer survivors may reduce cancer recurrence and death, but this data is sparse and not robust. We must keep this in mind when people claim that yoga or prāṇāyāma cures cancer. This is an opportunity for me to give a clear message and a humble request to yoga practitioners: Please do not give false hope that cancer will be cured. Do not say, "Kapāla Bhāti has cured so many cancers." Please do not do this. We suffer from such statements, which are prevalent in our country and perhaps neighboring nations. Every cancer patient wants to avoid surgery—a major mutilation—and stressful chemotherapy. If someone tells them, "We will fix it with yogāsana; our aunt was cured," or a yoga guru declares in a large sabhā (assembly) that they will fix it with prāṇāyāma, bhāvanā, and dhyāna, they are giving wrong assurance. For God's sake, you are committing a sin. If a practitioner claims that prāṇāyāma, dhyāna, and some Ayurvedic herbs like aloe vera and giloy can cure cancer, they are committing a grave sin against society, and we are all complicit. What happens then? Cancer patients come to us two years later. "What did you do?" For six months, they went to homeopathy. Then a new "benefit" came. A yoga guru said, "This will be cured. Eat this herb, meditate so much, do this much prāṇāyāma for six months." The disease progresses. Then they come to big hospitals: AIIMS, BHU, Lucknow, PGI Chandigarh, Tata Memorial Hospital. By then, the disease has advanced greatly; the cancer demon fights them completely, and the body is utterly exhausted. Then, no medicine in the world can cure it. This is a peculiar problem in some societies: yoga instructors give false hope and claim that yogic interventions, prāṇāyāma, and herbal preparations can cure cancer. The distressed patient, wanting to avoid the diagnosis and costly, distressing treatments like surgery and chemotherapy, follows this advice. They practice various prāṇāyāma for a time, only to realize it was false hope. The cancer grows, spreads, becomes painful, inoperable, and incurable. Only then do they land at a modern medical doctor's door. We need to be clear about this. I appreciate the feeling and bhāvanā (sentiment) of sarvabhūthite ratāḥ. In the Bhagavad Gītā, Lord Kṛṣṇa initiated this principle. In Chapter 5, Śloka 25, the Lord says: "sarvabhūt" means all beings—not only humans but all creatures, including animals and plants. "hite" means welfare, "rataḥ" means engaged. So, "ever engaged in the welfare of all." That should be the spirit, the bhāvanā of all therapists, whether you are a yoga practitioner, a prāṇāyāma practitioner, a dhyāna teacher, an instructor, an allopathic doctor, or a homeopathic doctor. We should all work with the feeling of being ever engaged in the welfare of all. We should at no time do any harm. In allopathic medicine, we take the Hippocratic Oath and learn the principle "primum non nocere"—Latin for "First, do no harm." If you are a very learned yoga guru, simply state: if you follow the chemotherapy, radiotherapy, and surgery advised by an experienced doctor, along with this yogic intervention, you will have better treatment. That should be the spirit—not claiming that yoga alone will cure. Please keep this in mind, as many patients come to large hospitals. Professor Nayak from Bhubaneswar and we in Delhi are victims of these wrong claims. With that humble request in mind, what problems do we encounter when a patient develops cancer? Unfortunately, in our society, there are many reasons: modern living, Western lifestyle, increasing pollution in air, water, and food, rising stress levels, and very bad food habits. The Ayurvedic principle for staying healthy is to have the right āhāra (diet), vihāra (lifestyle/conduct), and vichāra (thought). If required, one may need auṣadhi (medicine) or śalya-kriyā (surgery). These are the principles for remaining healthy (svastha). In Bhagavad Gītā, Chapter 6, Śloka 17, Lord Kṛṣṇa enunciates the principle of appropriate food and appropriate lifestyle (vihāra): "Yukta āhāra vihārasya, yukta ceṣṭasya karmasu, yukta svapnāvabodhasya, yogo bhavati duḥkhahā." (For one who is moderate in eating and recreation, balanced in all actions, and regulated in sleep and wakefulness, Yoga destroys all sorrow.) "Early to bed and early to rise makes a man, and also a woman, healthy, wealthy, and wise." That was good advice from our ancestors. We are forgetting it. We stay awake until 12 or 1 AM, sending WhatsApp messages, and forget to go to bed early. Then we rise after sunrise. All the śāstras, Vedas, and Patañjali Yoga suggest rising two to three hours before sunrise—that time is Brahma Muhūrta, the best time for health. We have forgotten this. We lead very stressful lives. In big cities, people are career-oriented; they get an MBA and want to become CEO. Especially ladies, they delay marriage and, after marrying, delay their first childbirth. Studies show that if your first child is between 20-22 and you breastfeed for two to three years, your chance of breast and some other cancers goes down. But here, career-oriented women delay these natural, physiological protections and become victims of diseases like cancer. Combined with bad food habits, we are witnessing an increasing burden of cancer in our society, which is also true for Western society. The crab of cancer has captured Asian society as well. Breast cancer is now the commonest cancer in the human race, even in India. The factors I mentioned are the culprits. As soon as a cancer diagnosis is made, the entire family and the patient are distressed. There is lack of sleep, lack of appetite, low energy, mental depression, and often nausea and vomiting from anti-cancer drugs. Depending on the organ involved, there may be disability—removing a hand for hand cancer or a breast for breast cancer. These are some problems we encounter. So, how can regular use of yogic intervention, prāṇāyāma, and some yogāsanas under a trained instructor reduce these problems? Studies show improved blood flow to organs, improved general muscle function, and improved oxygen supply to all organs due to deep breathing. When vital capacity and tidal volume of the lung increase, more oxygen is taken in and distributed to sick organs. There is reduced mental stress and anxiety, very common in cancer patients. The practice of yogic activities and meditation induces a sense of well-being. Some studies show improved physical fitness. These are some mechanisms. There is also a suggestion that yogic exercises can boost immunity by improving the sense of well-being, pituitary and hypothalamus function in the brain, and increasing appetite. It may help you better combat the ill effects of chemotherapy, radiotherapy, and surgery, so healing power and immunity improve. Interestingly, these benefits are seen more in younger patients. This is particularly important for our country and Asian nations, where about 30-40% of patients are below 50 years old, as cancer onset in our society is 10-15 years earlier than in Caucasian populations of Europe, Germany, America, and England. We have younger victims. If yoga and prāṇāyāma have greater benefit for younger patients, that is beneficial. Yogic intervention may be particularly useful for patients in our country. The trend of cancer onset in our country shows about 30-40% of younger ladies affected at age 30-40, the prime of youth. This is particularly important. In Delhi alone, the highest age-adjusted rate is very high; second is Chennai, Madras, Bangalore. These big cities have a very high incidence of cancer in younger patients. I have taken data from a large meta-analysis. A meta-analysis is a statistical tool for pooling data from several studies to increase the power to discern the truth. This analysis studied 16 papers, 13 of which were randomized trials. Twelve of these studied breast cancer patients, and one studied lymphoma patients (cancer of the lymph glands). Some studies were on patients undergoing therapy (chemotherapy/radiotherapy), some after therapy completion, and some included patients receiving or having just finished surgery, then offered a combination of yoga and prāṇāyāma. Some studies followed patients long-term, up to 5-6 years after completing cancer therapy. The average age of subjects ranged from 44 to 63. Since most studied breast cancer, 11 of the 13 studies involved ladies. The methodology in most was supervised intervention by a yoga teacher who instructed in yogāsana, prāṇāyāma, and dhyāna. Duration ranged from six weeks to six months, typically one hour daily. The control group consisted of patients waiting for chemotherapy, surgery, or radiotherapy who were not offered yogic intervention—only general coping advice. This control is necessary for comparison in medical research. The results, as seen in one table, showed statistically significant improvement (p < 0.01) in three parameters: physical function, distress level, and anxiety level. For those given yoga, prāṇāyāma, etc., physical work improved greatly, mental stress decreased, and anxiety decreased. Other parameters did not show much improvement. Part 2: Yoga, Prāṇāyāma, and Herbal Support in Cancer Care: A Research Proposal and Perspective We observed that depression and mental depression improved significantly, and the sense of overall quality of life also improved. There are scores for assessing overall quality of life that also improved significantly in these patients who were offered yoga and prāṇāyāma. In the group where yoga prāṇāyāma was done—what we call the quality of life of the whole body—it improved a lot, whereas the rest of the prāṇāyāma practices did not benefit as much. While examining these prāṇāyāma practices, we wish to make a proposal through AYUSH. Since our current data is not very powerful or statistically robust, we have a proposal for the AYUSH ministry to launch large, population-based intervention trials. We are working on aims in collaboration with the National Institute of Cancer Prevention. Professor Rath was chief of that center, ICPO, formerly called the Institute of Cancer Cytology and Preventive Oncology; now it’s called the National Institute of Cancer Prevention. It is an ICMR-funded, central government institute located in Noida City Center. Our doctors go there regularly and help in cancer screening and prevention trials. Therefore, we can perform a prevention trial under the National Institute of Cancer Prevention. My proposal is to have three groups of people from three villages, with about 30,000 people in each. I have already spoken with the chairman of the Maharṣi Āyurveda Corporation. They have offered to provide Maharṣi Amṛt Kalaś, which is a rich source of antioxidants, a combination of 50 herbs. It is called Maharṣi Amṛt Kalaś, a mixture of 50 herbs. Brahma Rasāyana, which was described in the Brahma Saṁhitā, is the form of Maharṣi Amṛt Kalaś. Over more than 20 years, scientific studies have been conducted in America and India. Professor Rath was himself involved. We have found that if you give Maharṣi Amṛt Kalaś along with chemotherapy to breast cancer patients, they show significant improvement. Their overall health improves, their appetite improves, their diarrhea and vomiting are reduced, their mouth ulcers also reduce, they have a better appetite, and they gain body weight. Generally, cancer patients on chemotherapy lose weight because they are not eating; they have ulcers in the mouth and vomiting, so they lose weight. But in this group, our randomized trial showed that women receiving chemotherapy and Maharṣi Amṛt Kalaś actually put on weight. This is statistically significant and published in medical journals; you can find it online. We are now proposing a prevention trial because numerous animal studies show that animals fed this product and then exposed to carcinogens did not get cancer. So it acts as a cancer-preventive herb. We propose a combination approach. It is said that many cancers occur due to stress levels, including stress in early childhood. There is data that in breast cancer, girls who experience stress early in life are more likely to develop breast cancer later. If that is true, then we can offer them de-stressing prāṇāyāma and dhyāna, bhavatī dhyāna or transcendental meditation as initiated by our yoga gurus. That combination will reduce stress along with yogic activities, and some herbal products in collaboration may act in reducing cancer incidence. This is one such proposal. We may study the incidence of a number of cancers: cancer of the breast, oral cavity, cervix, and ovaries. They are all related to stress and the modern way of living. Along with that, it may also reduce non-communicable diseases such as diabetes and hypertension. Because if you have good āhāra (diet), vihāra (lifestyle/recreation), and vicāra (thought), you will reduce all bad diseases. It may also reduce the commonly increasing problem of metabolic syndrome and overweight, and of course, it will reduce psychological diseases such as depression and anxiety. In summary, Honorable Chairpersons, my teacher Prof. Raj, Prof. Nayak, Gurujī, I humbly submit that most data in the literature suggest a strong beneficial effect in reducing stress levels, anxiety, and depression in cancer patients if they are offered yogāsana and prāṇāyāma. The effect on reducing and improving fatigue and emotional-social function is less pronounced, and there is a small effect on improving functional well-being. Studies have failed to show any significant improvement in physical function and sleep. So, in summary, as far as research has been done, it seems there is significant benefit for mental stress. We need more robust studies with larger samples, which are statistically powerful and possibly nationwide. Population-based studies are required. I also noted that most studies used different yogic interventions and different types of prāṇāyāma and meditation regimens. If all studies used the same yogic intervention and the same meditation, we might demonstrate a better effect with statistical power. If only one type of meditation and prāṇāyāma is taught to everyone, we will be able to say with more certainty which yoga method, which prāṇāyāma, or which meditation method benefits us the most. Thank you. Part 3: Yoga and Palliative Care in Advanced Cancer In that condition, without food or anything, we simply administered morphine and advised some yogic principles. You can see the change. We gave morphine for only seven days. He returned for morphine tablets and evaluation. Compare this face to this face; there is a significant transformation in just seven days. Although the patient suffers from advanced cancer, yoga has helped him. The sickness from endorphins, combined with the morphine we provided, has been beneficial. You can see that yoga can prevent suffering. At the very least, it can transform a person back to themselves. It is the combined effect of morphine and yoga; both should be prescribed. This is a follow-up visit after two weeks. You can see he has become much more like a normal man, talking jovially with our team members. You cannot tell he is suffering from cancer because he is so cheerful. The pain is gone, and his mind is calm from practicing yoga. He was a rickshaw puller from Bhadrak and returned to his profession. He passed away about seven to eight months later, but he was working until then. He was not dependent, and his family was not burdened. Because of both morphine and yoga, his anxiety dissipated, and he was comfortable. He died a peaceful death; his body left this world in a state of peace, causing no problem for himself or his family. Another patient with fungating cancer received palliative care, morphine, and yoga. You can see the spine in this photo, taken about one month before death. This again shows that combined therapy—yoga and allopathic medicine—can be administered. As I mentioned, yoga can prevent cancer at three levels. At the primary level, through proper screening, vaccinations, and prevention, it can reduce the incidence of cancer. At the secondary level, with early diagnosis and prompt treatment, it can halt disease progression. Even if cancer is diagnosed, catching it early allows for a cure and removal from the body. At the tertiary level, which is my domain, when the patient has advanced disease and the cancer cannot be removed, we can at least alleviate suffering and pain. This prevents distress not only for the patient but also for the family, making everyone more comfortable. Yoga is uniquely applicable to all three stages. Therefore, I believe we should apply yoga for prevention: primary, secondary, and tertiary. That concludes my presentation. Thank you very much.