Integrative Cancer Therapies

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Beneficial Effects of Pranic Meditation on the Mental Health and Quality of Life of Breast Cancer
Survivors
Juarez I. Castellar, César A. Fernandes and C. Eduardo Tosta
Integr Cancer Ther published online 5 June 2014
DOI: 10.1177/1534735414534730

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534730
research-article2014
ICTXXX10.1177/1534735414534730Integrative Cancer TherapiesCastellar et al

Original Article
Integrative Cancer Therapies

Beneficial Effects of Pranic Meditation

1­–10
© The Author(s) 2014
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DOI: 10.1177/1534735414534730

of Life of Breast Cancer Survivors ict.sagepub.com

Juarez I. Castellar, MD1, César A. Fernandes, MSc1, and

C. Eduardo Tosta, MD, PhD1

Abstract
Background. Breast cancer survivors frequently present long-lasting impairments, caused either by the disease or
its treatment, capable of compromising their emotional health and quality of life. Meditation appears to be a valuable
complementary measure for overcoming some of these impairments. The purpose of the present investigation was to
assess the effect of pranic meditation on the quality of life and mental health of breast cancer survivors. Design. This study
was a prospective single-arm observational study using before and after measurements. Methods. The subjects were 75
women submitted either to breast cancer therapy or to posttherapy control who agreed to practice pranic meditation
for 20 minutes, twice a day, during 8 weeks, after receiving a formal training. The quality of life of the practitioners was
assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC BR-023
questionnaires, and the mental health status by the Goldberg’s General Health Questionnaire. Results. After 8 weeks of
pranic meditation practice, the subjects showed a significant improvement of their quality of life scores that included
physical (P = .0007), role (P = .01), emotional (P = .002), and social functioning (P = .004), as well as global health status
(P = .005), fatigue (P < .0001), pain (P = .007), sleep disturbances (P = .01), body image (P = .001), arm symptoms (P =
.007), and breast symptoms (P = .002). They also showed a reduction of the side effects of systemic therapy (P = .02) and
being upset by hair loss (P = .02). Moreover, meditation was associated with improvement of the mental health parameters
of the practitioners that included psychic stress (P = .001), death ideation (P = .02), performance diffidence (P = .001),
psychosomatic disorders (P = .02), and severity of mental disorders (P = .0003). The extension of the meditation period
from 8 to 15 weeks caused no substantial extra benefits in practitioners. Conclusions. The results of this pilot study showed
that breast cancer survivors presented significant benefits related to their mental health and quality of life scores after a
short period of practice of pranic meditation, consisting of simple and easy-to-learn exercises. However, because of the
limitations of the study, further research is required using a more rigorous experimental design to ascertain whether pranic
meditation may be an acceptable adjunct therapy for cancer patients.

Keywords
pranic meditation, breast cancer, quality of life, mental health, biometenergy, intentionality

Introduction the adoption of multidimensional therapies as adjunct to

Cancer characteristically affects all dimensions of human
health. The tumor growth compromises the physical health
by causing pain,1 and several cellular2 and organic dys-
functions,3 including impairment of the immune system.4
Cancer also affects the mental-emotional health, as mani-
fested by anxiety and depression and several distressing
feelings as sadness, fatigue, anger, hopelessness, fear,
resentment, bitterness, and guilt.5,6 These feelings, in turn,
may compromise the interpersonal health of cancer
patients7 and also their spiritual health.8 This multidimen-
sional impairment of the health of cancer patients supports
specific cancer therapy.9 Integrative therapies such as
mind-body interventions fit this role with excellence as has
been demonstrated by numerous clinical assays (see
reviews by Tacón,10 Astin et al,11 Carlson and Bultz,12
Daniels and Kissane,13 Monti et al,14 Ledesma and
1
Universidade de Brasília, Brasilia, Brazil
Corresponding Author:
C. Eduardo Tosta, Department of Pathology, Faculty of Medicine,
Universidade de Brasília, 70.910-100 Brasilia, DF, Brazil.
Email: cetosta@unb.br

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2 Integrative Cancer Therapies 
Kumano,15 Cramer et al,16 and Culos-Reed et al17). These
interventions aim at providing patients with knowledge
and skills to cope with and achieve personal control over
their symptoms,18 and take advantage of the principle that
by learning how to focus the mind it is possible to control
the emotions and the bodily functions. Some mind–body
interventions used as complementary therapy have been
shown beneficial effects for controlling the clinical, emo-
tional, behavioral, and spiritual disorders associated with
cancer and its therapy, including relaxation,19 guided imag-
ery,20 yoga,21 tai chi,22 qigong,23 and meditation.15
Meditation encompasses an array of techniques and pro-
cedures that have in common the focusing of attention
either on breathing, visualizations, and mantras, or on the
practitioner’s own thoughts. This focused attention leads to
a state of quietness and relaxation that reduces anxiety and,
in some meditation techniques, facilitates achieving the
“meditative state,” when the practitioner loses the sensation
of space, time, and body, in association with the expansion
of consciousness.24 Meditation can benefit cancer patients
by reducing pain,10 ameliorating chemotherapy-induced
nausea and emesis,25 reducing cancer-associated immuno-
depression,26 improving quality of life,26 reducing fatigue,27
stabilizing mood,27 improving cognition,28 increasing cop-
ing,29 improving interpersonal relationships,30 and strength-
ening spirituality.31
It has been recognized that meditation techniques have
different purposes and, therefore, they differently affect
practitioners.32 Some techniques pursue the achievement of
relaxation and reduction of anxiety, whereas other go fur-
ther and seek self-knowledge. Very few meditation prac-
tices deal with the capture and balance of “subtle energies,”
known as prana by Indian tradition, qi or ch’i by Chinese
tradition, ki by Japanese tradition, and biofield or bioenergy
by Western science.33 The balance of these “energies” is
considered as essential for maintaining or recovering
health.34,35 Since they have attributes that make them differ-
ent from all the 4 known physical energies or forces in the
Universe,36 we coined the term biometenergy [bio = life +
met(a) = beyond + energy] to encompass them, and will use
it hereafter. Indeed, biometenergy is thought to have aston-
ishing properties: It is asserted that it is not limited by
space,37,38 is capable of crossing electromagnetic shields,38
and is influenced by human intention.39,40 Absorbing, con-
centrating, balancing, and projecting biometenergy are
important features of qigong or qi-training,41,42 and also of
pranic meditation.43
Pranic meditation is a novel method of secular medita-
tion developed by one of the authors (CET), and is based on
the ancient Vedic teachings that consider that the imbalance
of prana affects all dimensions of the human health: physi-
cal, mental/emotional, interpersonal, and spiritual.44 To
recover this balance, pranic meditation practitioners use
easy-to-learn techniques of concentration, breathing, and
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visualization. This meditation method has been submitted
to scientific evaluation by our multidisciplinary research
group at the Faculty of Medicine, University of Brasília,
over the past 6 years, using either healthy volunteers or
groups with special conditions as cancer, chronic pain, anx-
iety, or depression. We have found that the benefits associ-
ated with pranic meditation appear very early, usually after
a few weeks of practice, and are expressed by the increase
of vigor and mental concentration, improvement of physi-
cal and mental well-being, and quality of life, together with
reduction of pain, anxiety, and depression.45,46 Practitioners
of pranic meditation show a decrease of corticotrophin
plasma levels, a trend to reduction of plasma cortisol, and to
increase salivary melatonin levels, as well as a heightened
phagocytic capacity of their blood monocytes and neutro-
phils, and an increased production of hydrogen peroxide,
but not of nitric oxide, by these cells.47 These results have
been recently published43 or have been submitted for publi-
cation. In the present investigation, we evaluated the effect
of pranic meditation on the mental health and quality of life
of women surviving breast cancer.
Materials and Methods
Study Group
The subjects of the study were recruited among the oncol-
ogy outpatients from a university hospital and private clin-
ics from 2008 to 2009. The eligibility criteria were age ≥18
years, new/recurrent breast cancer (stages I-III) diagnosis
within previous 4 years, and not practicing any other medi-
tation or relaxation technique during the period of the inves-
tigation. A convenience sample of 75 women was selected
among the participants of training courses on pranic medi-
tation for breast cancer survivors ran at the University
Hospital of University of Brasília. The volunteers agreed to
practice pranic meditation daily for 20 minutes in the morn-
ing and in the evening during 8 or 15 weeks and to fill in a
log to record the actual duration of daily practices, and the
difficulties and feelings associated with them. The partici-
pants who missed 3 or more sessions of meditation were
excluded from the study.
The study group had the following demographic profile:
women, averaged 54.4 years old (range = 44.8-64.0 years),
married (55%), with a mean familiar monthly income of
US$3500 or more (68%), university schooling (70%), non-
smokers (96%), non–alcohol users (96%), followers of a
religion (66%), and receiving familiar support for dealing
with their health problem (86%). The diagnosis of primary
breast cancer had been confirmed between 3 and 4 years
earlier in 57% of the participants, between 2 and 3 years in
21%, between 1 and 2 years in 13%, and 1 year or less in
9% of them (average of 3.5 years). None presented metasta-
sis. All participants had been submitted to mastectomy,
Castellar et al
54% between 3 and 4 years earlier, 20% between 2 and 3
years, 12% between 1 and 2 years, and 14% 1 year earlier or
less. A total of 75% of the participants had been treated by
chemotherapy, 42% of them were under treatment or
received the last dose less than 1 year earlier. Radiotherapy
had been applied to 54% of the participants, 31% of them 1
year earlier or less.
The investigation was previously approved by the
Human Research Ethics Committee of the Faculty of
Medicine, University of Brasília, and informed consents
were obtained from all participants.
Study Design
This was a prospective single-arm observational study,
using before and after measurements. At the beginning
(first week) and by the end of the period of meditation
practice (eighth week), the 75 practitioners filled in self-
rated questionnaires for evaluating their quality of life
and mental health status. To investigate whether an exten-
sion of the period of meditation would influence the
effects of meditation, a subgroup of 25 practitioners were
further evaluated at the 15th week of practice using the
same instruments.
Intervention
Breast cancer survivors received a 30-hour training course
on pranic meditation, delivered by a qualified instructor
with more than 25 years of experience, consisting of a pre-
sentation on the theoretical grounds of the technique fol-
lowed by collective practices, with individual orientation.
The practices, which lasted a minimum of 20 minutes,
included exercises of concentration, breathing, and visual-
ization aiming at quieting the mind, and absorbing, balanc-
ing, and projecting prana. Pranic meditation is practiced in
the sitting position, with closed eyes, and comprises 3 basic
exercises. The purpose of the first exercise, the “growing
peace respiration,” is to increase concentration and relax-
ation, and to absorb prana by breathing (pranayama). It is
practiced by slowly and smoothly forcing the air out of the
lungs through the nose, by contracting the abdomen, when
the word peace is visualized; then breathing is held by a
few seconds, followed by slowly and smoothly breathing
in, by expanding the abdomen, when the word growing is
visualized, and again breathing is held by a few seconds,
before starting the next cycle of breathing out and in. In the
second exercise of relaxation, practitioners are encouraged
to imagine a blue light that, while slowly moving upward
from the feet to the head, impregnates the organs and tis-
sues it crosses, causing a feeling of deep peace and relax-
ation. When the blue light reaches the top of the head, it is
visualized as dissipating into the air, and carrying with it
our tensions, worries, and pains. In the third exercise,
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3
practitioners concentrate their attention on each of the 7
main chakras—vortices of prana—from the first, projected
on the perineum, to the last, on the top of the head, fol-
lowed by circulation of prana and mantra with intention. A
fourth exercise was introduced in the program of pranic
meditation for cancer survivors: a guided imagery that
aimed at strengthening the immune system. After being
presented to a sequence of images of tumor cells been
attacked and destroyed by the cells of the immune system,
the practitioners were encouraged to imagine a similar phe-
nomenon occurring in their body.
Evaluation of Quality of Life
For evaluating the effect of pranic meditation on the quality
of life of breast cancer survivors, 2 self-rated questionnaires
developed by the European Organization for Research and
Treatment of Cancer (EORTC) were used: the core module
EORTC QLQ-C30, for cancer patients, version 3.0, and the
breast cancer specific module EORTC BR-23.48,49 The 30
items of the EORTC QLQ-C30 comprise 5 multi-item func-
tional scales (physical, role, cognitive, emotional, and
social functioning), 3 multi-item symptom scales (fatigue,
nausea and vomiting, and pain), 6 single-item symptom
scales (dyspnoea, insomnia, appetite loss, constipation,
diarrhea, and financial difficulties), and a 2-item global
quality of life scale. The Brazilian Portuguese version of the
EORTC QLQ-C30 used in this investigation showed excel-
lent reproducibility when applied to Brazilian patients.50
The breast cancer module EORTC QLQ-BR23 comprises
23 items that include systemic therapy side effects, arm
symptoms, breast symptoms, body image, and sexual func-
tioning, evaluated by means of 5 multi-item scales, and 3
single items assessing sexual enjoyment, upset by hair loss,
and perspectives for the future.
Evaluation of Mental Health Status
The General Health Questionnaire (GHQ-60) developed by
Goldberg51 was used for evaluating the mental health status
of the practitioners at the beginning and by the end of the
period of meditation. It is a self-rating screening test for the
detection of current nonpsychotic mental disorders. The
questionnaire is composed of the following scales: psychic
stress (13 items), death ideation (8 items), performance dif-
fidence (17 items), sleep disorders (6 items), and psychoso-
matic disorders (10 items). The full version comprising 60
questions was chosen since it shows both sensitivity
(95.7%) and specificity (87.8%) higher than the 3 shorter
versions of the questionnaire, together with a high degree of
reliability and validity.52 The GHQ-60 was designed to
cover 4 elements of distress: depression, anxiety, social
impairment, and hypochondriasis (chiefly indicated by
organic symptoms). The version of the GHQ-60 used had
4 Integrative Cancer Therapies 

Table 1. Comparison of the Quality of Life Scores of 75 Breast Cancer Survivors, Before and After Daily Practices of Pranic
Meditation for 8 Weeks, using the European Organization for Research and Treatment of Cancer Core Module (EORTC QLQ-C30)
Questionnaire.

Before Meditation; Mean/ After Meditation; Mean/ Wilcoxon Sample

Scale Median (Quartiles) Median (Quartiles) Test P Value Size (n)a
Functioning scalesb
Physical functioning 72.09/80.00 (53.30-93.30) 80.89/86.70 (66.70-100.00) .0007 75
Role functioning 84.98/100.00 (66.67-100.00) 91.08/100.00 (83.30-100.00) .01 71
Emotional functioning 68.58/75.00 (50.00-91.67) 78.79/83.33 (66.67-100.00) .002 74
Cognitive functioning 72.37/83.33 (58.33-91.67) 77.40/83.33 (66.67-83.33) .09 73
Social functioning 84.95/100.00 (83.33-100.00) 92.82/100.00 (83.33-100.00) .004 72
Global health status/ 70.09/66.70 (54.15-83.30) 76.60/83.30 (66.70-91.70) .005 73
quality of life
Symptom scalesc
Fatigue 40.45/33.30 (22.20-55.60) 27.68/22.20 (0.00-44.40) <.0001 64
Nausea and vomiting 17.16/16.70 (0.00-33.30) 14.72/16.70 (0.00-16.70) .82 34
Pain 35.19/33.30 (16.70-50.00) 23.46/16.70 (0.00-37.48) .007 54
Single item symptomsc
Dyspnea 38.10/33.33 (16.67-50.00) 23.81/33.33 (0.00-33.33) .10 21
Sleep disturbance 48.66/33.30 (33.30-75.02) 32.65/33.30 (0.00-33.30) .01 50
Appetite loss 38.27/33.33 (0.00-66.67) 23.46/33.33 (0.00-33.33) .08 27
Constipation 52.08/33.33 (33.33-100.00) 30.21/33.33 (0.00-33.33) .03 32
Diarrhea 24.24/33.33 (0.00-33.33) 30.30/33.33 (0.00-33.33) .53 11
Financial difficulty 79.18/83.35 (66.70-100.00) 70.83/83.35 (33.30-100.00) .41 8
a
Number of respondents who referred the symptom before the intervention.
b
Higher scores correspond to better quality of life.
c
Lower scores correspond to better quality of life.

been previously adapted and validated for Brazilian
subjects.53
Statistical Analysis
Initially, the Kolmogorov–Smirnov test for evaluating the
normality of the distribution was used. Since our data pre-
sented a nonnormal distribution, the Wilcoxon rank sum
test for 2 samples (pre- and postintervention) was adopted.
The Prism GraphPad software package (GraphPad
Software, San Diego, CA), version 5.0, for Windows was
used for the statistical analysis.
Results
By the end of the 8-week period of pranic meditation, prac-
titioners showed a significant improvement of their quality
of life that included physical (P = .0007), role (daily life;
P = .01), emotional (P = .002), and social functioning (P =
.004), as well as their global health status (P = .005), fatigue
(P < .0001), pain (P = .007), and sleep disturbances (P =
.01), as evaluated by the EORTC QLQ-C30 (Table 1).
Although some individual practitioners showed improve-
ment of their cognitive functioning, no significant benefi-
cial influence could be demonstrated when the group was
evaluated as a whole (P = .09). The number of respondents
who referred to the occurrence of nausea and vomiting, dys-
pnea, appetite loss, constipation, diarrhea, and financial dif-
ficulty before the intervention was too low to allow for any
conclusion on the effect of meditation on these conditions.
We also found that after practicing pranic meditation, can-
cer survivors showed improvement of their body image
(P = .001), and of their arm (P = .007) and breast symptoms
(P = .002), together with decrease of the systemic therapy
side effects (P = .02), and upset by hair loss (P = .02), as
assessed by the EORTC QLQ-BR23 (Table 2). On the other
hand, as shown in Table 2, no association between medita-
tion and modification of sexual functioning (P = .83) or
future perspectives (P = .09) of practitioners could be
detected. No extra improvement of the quality of life scores
was demonstrated in a subgroup of 25 breast cancer survi-
vors who extended the period of meditation practice from 8
to 15 weeks, except for the physical functioning scale (mean
= 77.86 × 84.53; quartiles = 63.35-96.65 × 73.35-100.00; P
= .04, Wilcoxon test).
Cancer survivors who practiced pranic meditation also
showed improvement of their mental health parameters,
as assessed by the GHQ-60. These included psychic stress
(P = .001), death ideation (P = .02), performance diffi-
dence (P = .001), and psychosomatic disorders (P = .02).

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Castellar et al 5

Table 2. Comparison of the Quality of Life Scores of 75 Breast Cancer Survivors, Before and After Daily Practices of Pranic
Meditation for 8 Weeks, Using the European Organization for Research and Treatment of Cancer Specific Breast Cancer Module
(EORTC QLQ-BR23) Questionnaire.

Before Meditation; Mean/ After Meditation; Mean/ Wilcoxon Sample

Scale Median (Quartiles) Median (Quartiles) Test P Value Size (n)a
Symptom/functioning scales
Body imageb 73.36/83.33 (58.33-100.00) 83.10/91.67 (75.00-100.00) .001 71
Sexual functioningb 82.38/83.33 (66.67-100.00) 84.05/100.00 (66.67-100.00) .83 70
Arm symptomsc 31.94/22.22 (11.11-44.44) 20.95/22.22 (0.00-33.33) .007 48
Breast symptomsc 22.40/25.00 (8.33-33.33) 13.89/8.33 (0.00-23.61) .002 49
Systemic therapy 21.13/19.05 (4.76-28.57) 16.03/9.52 (4.76-19.05) .02 72
side effectsc
Single items
Upset by hair lossc 75.56/100.00 (66.67-100.00) 42.22/33.33 (0-66.67) .02 15
Sexual enjoymentb NDd NDd NDd 4
Future perspectiveb 75.81/66.67 (66.67-100.00) 80.73/66.67 (66.67-100.00) .09 66
a
Number of respondents who referred the symptom or the item before the intervention.
b
Higher scores represent better quality of life.
c
Lower scores represent better quality of life.
d
Not determined because of the reduced number of respondents.

Table 3. Comparison of Mental Health Scores of 75 Breast Cancer Survivors, Before and After Daily Practices of Pranic Meditation
for 8 Weeks, Using the Goldberg General Health Questionnaire (GHQ-60).

Before Meditation; After Meditation; Wilcoxon Sample

Mean/Median Mean/Median Test P Size
Scale Items (Quartiles) (Quartiles) Value (n)a
Psychic stress 13 1.77/1.69 (1.15-2.23) 1.54/1.46 (1.15-1.81) .001 61
Death ideation 8 1.23/1.00 (1.00-1.38) 1.14/1.00 (1.00-1.13) .02 66
Performance diffidence 17 1.87/1.79 (1.59-2.25) 1.61/1.59 (1.29-1.83) .001 62
Sleep disorders 6 1.54/1.33 (1.00-1.83) 1.40/1.17 (1.00-1.67) .06 67
Psychosomatic disorders 10 1.65/1.50 (1.30-2.00) 1.44/1.40 (1.20-1.60) .002 64
Severity of mental disorder 60 1.74/1.60 (1.43-2.08) 1.51/1.43 (1.30-1.63) .0003 43
a
Number of respondents who referred the symptom before the intervention.

GHQ-60 detected only a trend for improvement of sleep
disorders (P = .06). The general status of the mental
health of practitioners, based on all the 60 items of the
questionnaire, substantially improved after meditation (P
= .0003; Table 3). No extra improvement of the mental
health of breast cancer survivors could be demonstrated
in a subgroup of 25 practitioners who extended the period
of meditation practice from 8 to 15 weeks (Table 4).
Discussion
Breast cancer compromises the global health of patients
before, during, and after treatment. The side effects associ-
ated with the conventional treatment together with the emo-
tional involvement associated with the disease, frequently
lead to important medical and psychological impairments in
breast cancer survivors, considered as those who are living
after a cancer diagnosis.54 The main complaints of this
group are fatigue, sleep disorders, cognitive impairment,
pain, arm symptoms, depression, and anxiety.55,56 These
manifestations can last for years after treatment or can even
be lifelong,57 and pose a heavy toll on the quality of life of
these persons.
Yoga and mindfulness-based stress reduction (MBSR)
are meditation methods that have been widely used as
adjunct therapies for improving the quality of life of cancer
patients.10,12,15-17 MBSR is a standardized intervention that
incorporates mindfulness meditation and yoga, whose pur-
pose is to develop in the practitioner the capacity to be
relaxed and aware in each moment, while maintaining a
nonjudgmental attitude. It has been demonstrated that
MBSR improves the quality of life of cancer patients by
reducing fatigue, sleep disorders, anxiety, and depres-
sion.27,55 Yoga is an ancient doctrine originated from India
that comprises a wide range of practices whose ultimate
intent is to allow the practitioner attaining self-realization

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6 Integrative Cancer Therapies 
Table 4. Comparison of Mental Health Scores of 25 Breast Cancer Survivors, After 8 Weeks or 15 Weeks of Pranic Meditation
Practices, Using the Goldberg General Health Questionnaire (GHQ-60).
Before Meditation;
Mean/Median
Scale Items (Quartiles)
Psychic stress 13 1.46/1.38 (1.15-1.77)
Death ideation 8 1.07/1.00 (1.00-1.00)
Performance diffidence 17 1.54/1.47 (1.29-1.79)
Sleep disorders 6 1.30/1.17 (1.00-1.58)
Psychosomatic disorders 10 1.46/1.45 (1.10-1.60)
Severity of mental disorder 60 1.56/1.47 (1.40-1.60)
a
Number of respondents who referred the symptom before the intervention.
and enlightenment,58 in other words, to achieve the union
with the Whole.59 Although there is a tendency in the
Western world to understand yoga in terms of physical pos-
tures and controlled breathing, yoga is basically an exercise
of meditation, when properly practiced. The use of yoga as
a complementary intervention for cancer survivors has
shown several benefits, including a significant improve-
ment of vitality, and physical, mental, social, and spiritual
well-being.60-62
Pranic meditation is rooted in the principles of yoga but
uses different techniques. It is practiced in a static sitting
position, uses exercises of focusing attention to quiet the
mind and attain serenity, and allow practitioners to master
their ability to absorb, concentrate, balance, and project
prana, and to use it toward the recovery and maintenance of
their health. We found that breast cancer survivors showed
an expressive reduction of most of their physical and men-
tal/emotional impairments after a short period of 8 weeks of
meditation practice. Based on the responses to 3 validated
questionnaires at the beginning and by the end of the inter-
vention period, practitioners showed improvement of their
mental health, assessed by the reduction of psychic stress,
death ideation, performance diffidence, and psychosomatic
disorders, and also amelioration of their quality of life, as
expressed by the improvement of the physical, role, emo-
tional, and social functioning, and of the global health sta-
tus, fatigue, pain, sleep disturbances, body image, arm and
breast symptoms, and systemic therapy side effects, upset
by hair loss. These gains were maintained, with a little
improvement, when meditation practices were extended
from 8 to 15 weeks, suggesting that the beneficial effects of
the practices had nearly reached their maximum by the
eighth week. Some practitioners showed improvement of
their cognitive functioning, but this condition could not be
demonstrated in the group as a whole.
The evaluation of the daily log of meditation practice
allowed monitoring the difficulties and progresses of the
practitioners during the program of meditation. As
expected, during the first weeks of practice the complaints
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After Meditation; Wilcoxon Sample
Mean/Median Test P Size
(Quartiles) Value (n)a
1.43/1.15 (1.15-1.61) .73 21
1.03/1.00 (1.00-1.00) .52 19
1.60/1.65 (1.38-1.82) .29 21
1.52/1.17 (1.00-2.08) .20 17
1.38/1.48 (1.40-1.65) .73 18
1.54/1.47 (1.40-1.60) .94 7
of difficulty to concentrate the attention and to be skilled at
the techniques, together with of discomfort at the sitting
position were frequent. In some cases, these limitations
caused a degree of anxiety in the practitioners and the
length of the practices was less than ideal. However, usu-
ally starting from the third week of practice, these difficul-
ties were progressively diminishing, and the first benefits
soon manifested as increasing in serenity and focusing of
attention, together with improvement in the quality of
sleep, stabilization of humor, enthusiasm, and joyfulness.
Different mechanisms could explain the beneficial
effects of the pranic meditation program on breast cancer
survivors. The focusing of attention, by means of the breath-
ing and visualization techniques, leads to the reduction of
anxiety, which could positively affect fatigue, sleep distur-
bances, pain, depression, psychosomatic disorders, and
immunity.63-66 Moreover, the expectancy of the practitio-
ners that meditation represented an instrument for improv-
ing their health and quality of life, and the fact that they
could use it autonomously in their benefit, probably
prompted them to increase their self-assurance and hopes,
which might have contributed toward the reduction of their
psychic stress, death ideation, performance diffidence, and
improvement of their physical, role, emotional, and social
functioning, as we observed. Practitioners of pranic medita-
tion learn how to absorb, concentrate, balance, and project
prana (biometenergy) and how to use it toward the recovery
and maintenance of their health. A growing body of evi-
dence supports the action of biometenergy on biological
systems,34,67,68 and their use to deal with clinical situations
is presently a reality.69-71
The most impressive feature of biometenergy is the fact
that it can be submitted to intentionality,39,40,72,73 either for
reducing pathological manifestations (eg, pain, inflamma-
tion, discomfort, anxiety, depression) or for enhancing
some beneficial conditions (eg, immunity, vigor, sleep,
serenity, self-assurance). The role played by intentionality
in the process of healing, including that proceeded at a dis-
tance, has been increasingly acknowledged.73-75 In fact,
Castellar et al
intentionality has been considered as an essential condition
for achieving healing.76 Our investigation reinforces the
beneficial role played by volition, as a manifestation of
positive intentionality, in the process of cure: we observed
that those practitioners who presented a higher degree of
volition, expressed by their strong commitment to the prac-
tice of meditation, achieved the best scores of quality of life
and mental health (data not shown).
Although our study showed very promising results that
support the practice of pranic meditation by breast cancer
survivors, there are several possible limitations to be
considered.
1. Selection: Since the subjects were self-selected to
participate in a study that required a great deal of
time commitment, they were presumably also highly
motivated, which could represent a possible selec-
tion bias. However, motivation and commitment are
necessary requirements for those engaging in mind–
body interventions. It would be impossible to reach
any result if nonmotivated and noncommitted sub-
jects were included in the investigation simply
because they would quit the program before it had
finished.
2. Experimental design: Our investigation had been
designed as a randomized wait-list control study.
However, at the enrollment in the program, the
majority of volunteers referred that they would pre-
fer to start immediately the meditation training,
instead of been assigned to the waiting list, which
meant the need to wait for more than 15 weeks, till
the next training course would begin. In respect for
their choice, the investigators decided to change the
design to a prospective single-arm observational
study, using before and after measurements. This
pre–post design is considered a suitable experimen-
tal strategy for assessing the impact or effectiveness
of an intervention.77
3. Lack of control group: It has been amply acknowl-
edged that controlled assays present higher strength
than noncontrolled ones. However, it has also been
acknowledged that experimental designs have to be
submitted to ethical constraints. Since we had
already shown that pranic meditation improved the
quality of life of the practitioners, we decided that it
would be unethical to invite distressed cancer survi-
vors to act as controls and, therefore, impeding or
postponing such benefits. The consequence of not
including a control group in the experimental design
is the possibility that some of the benefits reported
as associated with the meditation practice could
actually be caused by confounding factors such as
the participant expectancy (placebo effect), social
interactions, and group support due to being
Downloaded from ict.sagepub.com at UNIVERSITE LAVAL on June 9, 2014
7
members of a group. Since these factors will be
always present in meditation programs, this ques-
tion becomes a theoretical rather than a practical
issue.
4. Sample size: A bigger sample size would allow for a
proper stratification of the subjects of the study and,
therefore, to respond to questions that were kept
unanswered as “what was the impact of meditation
on recently diagnosed subjects as compared with
those formerly diagnosed?”
5. Losses: From the initial group of 109 subjects
enrolled in the program, only 75 (69%) were
included in the study. The reasons for the reduction
of the sample size were
(a) failure to complete or to return the questionnaires
(b) exclusion from the study of those who missed
three or more sections of meditation, usually
due to coincidence with their sections of che-
motherapy or radiotherapy, or to the discomfort
caused by their side effects
(c) unwillingness to make an effort to learn the
techniques
(d) dropping out because of difficulties to perform
meditation techniques or to doubts about their
benefits
(e) dropping out because of self-sabotage, which
usually occurred when the initial gains of medi-
tation became evident. No case of death or
worsening of the disease occurred; neither
among the dropouts nor among the subjects of
the study during the period of the investigation.
High numbers of dropouts, as found in the pres-
ent investigation, are frequently found in stud-
ies involving application of complementary
therapies in cancer patients (see Targ and
Levine31 and Moadel et al78), probably because
of the clinical–psychological characteristics of
this group. Moreover, the frequency of 31% of
dropouts found in our study with cancer survi-
vors was not essentially different from that of
28% usually observed in the programs of pranic
meditation directed to the healthy community.
6. Lack of blinding of subjects and instructors: This is
an unavoidable limitation of the study because of
the nature of the intervention.
7. Lack of immunological data: A technique of guided
imagery that aimed at strengthening the immune
system was included in this program of pranic medi-
tation directed to breast cancer survivors, but its
impact on the subjects was not evaluated.
8. Limited follow-up: The follow-up of our study was
restricted to a period of 7 weeks after completing the
8-week program. It would be interesting to extend
the length of the follow-up period to assess the
8 Integrative Cancer Therapies 
sustainability of the favorable effects of meditation,
both in those who continued meditating and in those
who had given up.
9. Confrontation of results: Since the present study is
the very first one to use pranic meditation for treat-
ing cancer patients, no data from other researchers
are available to allow for a confrontation with our
results.
10. Setting: The meditation program was administered
in an academic setting; the feasibility and benefits
of its administration in a different setting remains to
be determined.
Conclusion
We found that breast cancer survivors showed an expressive
reduction of most of their physical and mental/emotional
impairments and improvement of their quality of life after a
short period of eight weeks of pranic meditation practice,
consisting of simple and easy-to-learn exercises. The bene-
fits included a significant improvement of the physical,
role, emotional, and social functioning, the global health
status, fatigue, pain, sleep disorders, body image, arm and
breast symptoms, and reduction of the side effects of sys-
temic therapy, and upset by hair loss. Moreover, practitio-
ners also showed improvement of their mental health
parameters, which included psychic stress, death ideation,
performance diffidence, psychosomatic disorders, and
severity of mental disorders. These astonishingly favorable
outcomes were probably because of the ability of practitio-
ners to absorb, concentrate, balance, and project prana, a
metenergy considered as essential for maintaining and
recovering health, and that can be endowed with intention-
ality. However, because of the limitations of the study, fur-
ther research is required utilizing a more rigorous
experimental design, to ascertain whether pranic meditation
may be an acceptable adjunct therapy for cancer patients.
Acknowledgments
The authors thank the participants of the research for their high
commitment to the project and to truth. We also express our grati-
tude to Harco Ofugi and Cristina Gobbi for their dedication in
organizing the pranic meditation sessions. Juarez I. Castellar and
Cesar A. Fernandes are students of the Post-graduation Program in
Medical Sciences, Faculty of Medicine, University of Brasília.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Downloaded from ict.sagepub.com at UNIVERSITE LAVAL on June 9, 2014
References
1. Zaza C, Baine N. Cancer pain and psychosocial factors: a
critical review of the literature. J Pain Symptom Manage.
2002;24:526-542.
2. Modica-Napolitano JS, Singh KK. Mitochondrial dysfunction
in cancer. Mitochondrion. 2004;4:755-762.
3. Shani D, Brand DA, Patrick PA. Unrecognized thyroid
dysfunction in patients with cancer. Support Care Cancer.
2003;11:63-65.
4. Whiteside TL. Immune suppression in cancer: effects on
immune cells, mechanisms and future therapeutic interven-
tion. Semin Cancer Biol. 2006;16:3-15.
5. Ancoli-Israel S, Liu L, Marler MR, et al. Fatigue, sleep, and
circadian rhythms prior to chemotherapy for breast cancer.
Support Care Cancer. 2006;14:201-209.
6. Fann JR, Thomas-Rich AM, Katon WJ, et al. Major depres-
sion after breast cancer: a review of epidemiology and treat-
ment. Gen Hosp Psychiatry. 2008;30:112-126.
7. Ransom S, Sacco WP, Weitzner MA, et al. Interpersonal fac-
tors predict increased desire for hastened death in late-stage
cancer patients. Ann Behav Med. 2006;31:63-69.
8. Mako C, Galek K, Poppito SR. Spiritual pain among patients
with advanced cancer in palliative care. J Palliat Med.
2006;9:1106-1113.
9. Geffen JR. Integrative oncology for the whole person: a mul-
tidimensional approach to cancer care. Integr Cancer Ther.
2010;9:105-121.
10. Tacón AM. Meditation as a complementary therapy in cancer.
Fam Community Health. 2003;26:64-73.
11. Astin JA, Shapiro SL, Eisenberg DM, et al. Mind-body medi-
cine: state of the science, implications for practice. J Am
Board Fam Pract. 2003;16:131-147.
12. Carlson LE, Bultz BD. Mind-body interventions in oncology.
Curr Treat Options Oncol. 2008;9:127-134.
13. Daniels J, Kissane DW. Psychosocial interventions for cancer
patients. Curr Opin Oncol. 2008;20:367-371.
14. Monti DA, Sufan M, Peterson C. Potential role of mind-
body therapies in cancer survivorship. Cancer. 2008;112
(11 suppl):2607-2616.
15. Ledesma D, Kumano H. Mindfulness-based stress reduc-
tion and cancer: a meta-analysis. Psychooncology. 2009;18:
571-579.
16. Cramer H, Lange S, Klose P, Paul A, Dobos G. Yoga for
breast cancer patients and survivors: a systematic review and
meta-analysis. BMC Cancer. 2012;12:412.
17. Culos-Reed SN, Mackenzie MJ, Sohl SJ, Jesse MT, Zahavich
AN, Danhauer SC. Yoga & cancer interventions: a review
of the clinical significance of patient reported outcomes
for cancer survivors. Evid-Based Complement Altern Med.
2012;2012:642576.
18. Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B. Mind-
body treatments for the pain-fatigue-sleep disturbance symp-
tom cluster in persons with cancer. J Pain Symptom Manage.
2010;39:126-138.
19. Luebbert K, Dahme B, Hasenbring M. The effectiveness of
relaxation training in reducing treatment-related symptoms
and improving emotional adjustment in acute non-surgical
cancer treatment. Psychooncology. 2001;10:490-502.
Castellar et al
20. Roffe L, Schmidt K, Ernest E. A systematic review of guided
imagery as an adjuvant cancer therapy. Psychooncology.
2005;14:607-617.
21. Chandwani KD, Thornton B, Perkins GH, et al. Yoga
improves quality of life and benefit finding in women under-
going radiotherapy for breast cancer. J Soc Integr Oncol.
2010;8:43-55.
22. Reid-Arndt SA, Matsuda S, Cox CR. Tai Chi effects on neu-
ropsychological, emotional, and physical functioning follow-
ing cancer treatment: a pilot study. Complement Ther Clin
Pract. 2012;18:26-30.
23. Oh B, Butow PN, Mullan BA, et al. Effect of medical Qigong
on cognitive function, quality of life, and a biomarker of
inflammation in cancer patients: a randomized controlled
trial. Support Care Cancer. 2012;20:1235-1242.
24. Lehmann D, Faber PL, Achermann P, Jeanmonod D, Gianotti
LR, Pizzagalli D. Brain sources of EEG gamma frequency
during volitionally meditation-induced, altered states of
consciousness, and experience of the self. Psychiatry Res.
2001;108:111-121.
25. Raghavendra RM, Nagarathna R, Nagendra HR, et al. Effects
of an integrated yoga programme on chemotherapy-induced
nausea and emesis in breast cancer patients. Eur J Cancer
Care (Engl). 2007;16:462-474.
26. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C,
Durazo-Arvizu R, Mathews HL. Effect of mindfulness based
stress reduction on immune function, quality of life and cop-
ing in women newly diagnosed with early stage breast cancer.
Brain Behav Immun. 2008;22:969-981.
27. Carlson LE, Garland SM. Impact of Mindfulness-Based Stress
Reduction (MBSR) on sleep, mood, stress and fatigue symp-
toms in cancer outpatients. Int J Behav Med. 2005;12:278-
285.
28. Biegler KA, Chaoul A, Cohen L. Cancer, cognitive impair-
ment, and meditation. Acta Oncol. 2009;8:18-26.
29. Ando M, Morita T, Akechi T, Ifuku Y. A qualitative study
of mindfulness-based meditation therapy in Japanese cancer
patients. Support Care Cancer. 2011;19:929-933.
30. Horowitz S. Health benefits of meditation. What the newest
research shows. Altern Complement Ther. 2010;16:223-228.
31. Targ EF, Levine EG. The efficacy of a mind-body-spirit
group for women with breast cancer: a randomized controlled
trial. Gen Hosp Psychiatry. 2002;24:238-248.
32. Hankey A. Studies of advanced stages of meditation in the
Tibetan Buddhist and Vedic traditions. I: a comparison
of general changes. Evid Based Complement Altern Med.
2006;3:513-521.
33. Benor DJ. Spiritual Healing. Scientific Validation of a Healing
Revolution. Southfield, MI: Vision Publication; 2001.
34. Litscher G, Wenzel G, Niederwieser G, Schwartz G. Effects
of qigong on brain function. Neurol Res. 2001;23:501-505.
35. Lee MS, Rim YH, Kang CW. Effects of external qi-therapy
on emotions, electroencephalograms, and plasma cortisol. Int
J Neurosci. 2004;114:1493-1450.
36. Tiller WA. What are subtle energies? J Sci Exploration.
1993;7:293-304.
37. Yan X, Lu F, Jiang H, et al. Certain physical manifestation and
effects of external qi of Yan Xin Life Science Technology. J
Sci Exploration. 2002;16:381-411.
Downloaded from ict.sagepub.com at UNIVERSITE LAVAL on June 9, 2014
9
38. Radin D, Hayssen G, Emoto M, Kizu T. Double-blind test
of the effects of distant intention on water crystal formation.
Explore. 2006;2:408-411.
39. Shao L, Zhang J, Chen L, Zhang X, Chen KW. Effects of exter-
nal qi of qigong with opposing intentions on proliferation of
Escherichia coli. J Altern Complement Med. 2009;15:567-571.
40. Ohnishi ST, Ohnishi T. Philosophy, psychology, physics
and practice of Ki. Evid Based Complement Altern Med.
2009;6:175-183.
41. Lee MS, Kang C-W, Ryu H, Moon SR. Endocrine and
immune effects of qi-training. Int J Neurosci. 2004;114:529-
537.
42. Manzaneque JM, Vera FM, Rodriguez FM, Garcia GJ,
Leyva L, Blanca MJ. Serum cytokines, mood and sleep after
a qigong program: is qigong an effective psychobiological
tool? J Health Psychol. 2009;14:60-67.
43. Fernandes CA, Nóbrega YKM, Tosta CE. Pranic meditation
affects phagocyte functions and hormonal levels of recent
practitioners. J Altern Complement Med. 2012;18:1-8.
44. Mishra LC. Scientific Basis of Ayurvedic Therapies. Boca
Raton, FL: CRC Press; 2004.
45. Camelo LG. Effects of Pranic Meditation on the Physical and
Emotional Well-Being of Recent Practitioners [master’s the-
sis]. Brasilia, Brazil: University of Brasília; 2011.
46. Fernandes da Silva CA. Effects of Biometenergy of
Practitioners of Pranic Meditation on the Evolution of Pain,
Anxiety and Depression [dissertation]. Brasilia, Brazil:
University of Brasília; 2014.
47. Fernandes da Silva CA. Impact of Pranic Meditation on the
Function of Phagocytes and the Hormonal Levels of Recent
Practitioners [master’s thesis]. Brasilia, Brazil: University of
Brasília; 2010.
48. Aaronson NK, Ahmedzai S, Bergman B. The European
Organization for Research and Treatment of Cancer QLQ-
C30: a quality-of-life instrument for use in international clini-
cal trials in oncology. J Natl Cancer Inst. 1993;85:365-376.
49. Aaronson NK, Cull A, Kaasa S, Sprangers MAG. The EORTC
modular approach to quality of life assessment in oncology.
Int J Mental Health. 1994;23:75-96.
50. Franceschini J, Jardim JR, Fernandes AL, Jamnik S, Santoro
IL. Reproducibility of the Brazilian Portuguese version of
the European Organization for Research and Treatment of
Cancer core Quality of Life Questionnaire used in conjunc-
tion with its lung cancer-specific module. J Bras Pneumol.
2010;36:595-602.
51. Goldberg DP. The Detection of Psychiatric Illness by
Questionnaire. New York, NY: Oxford University Press;
1972.
52. McDowell I. Measuring Health: A Guide to Rating Scales and
Questionnaires. 3rd ed. New York, NY: Oxford University
Press; 2006.
53. Pasquali L, Gouveia VV, Andriola WB, Miranda FJ, Ramos
ALM. Goldberg Health Questionnaire (GHQ): Brazilian
adaptation. Psicol Teoria Pesq. 1994;10:421-437.
54. Ganz PA. Survivorship: adult cancer survivors. Prim Care
Clinic Office Pract. 2009;36:721-741.
55. Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ. Chronic
pain in the cancer survivor: a new frontier. Pain Med.
2007;8:189-198.
10
56. Bower JE. Behavioral symptoms in breast cancer patients and
survivors: fatigue, insomnia, depression, and cognitive distur-
bance. J Clin Oncol. 2008;26:768-777.
57. Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM,
Wain G. Breast cancer survivors’ supportive care needs 2-10
years after diagnosis. Support Care Cancer. 2007;15:515-523.
58. Feuerstein G. The Encyclopedia of Yoga and Tantra. Boston,
MA: Shambhala; 2011.
59. Iyengar BKS. Light on Yoga. New York, NY: Allen & Unwin;
1976.
60. Danhauer SC, Mihalko SL, Russell GB, et al. Restorative
yoga for women with breast cancer: findings from a random-
ized pilot study. Psychooncology. 2009;18:360-368.
61. Chandwani KD, Thornton B, Perkins GH, et al. Yoga
improves quality of life and benefit finding in women under-
going radiotherapy for breast cancer. J Soc Integr Oncol.
2010;8:43-55.
62. Kovačič T, Kovačič M. Impact of relaxation training accord-
ing to Yoga In Daily Life® system on perceived stress after
breast cancer surgery. Integr Cancer Ther. 2011;10:16-26.
63. Wood C. Mood change and perceptions of vitality: a compari-
son of the effects of relaxation, visualization and yoga. J R
Soc Med. 1993;86:254-258.
64. Brown RP, Gerbarg PL. Sudarshan Kriya Yogic breathing in
the treatment of stress, anxiety, and depression. Part II: clini-
cal applications and guidelines. J Altern Complement Med.
2005;11:711-717.
65. Kjellgren A, Bood SA, Axelsson K, Norlander T, Saatcioglu
F. Wellness through a comprehensive yogic breathing pro-
gram. A controlled pilot trial. BMC Complement Altern Med.
2007;7:43.
66. Dhruva A, Miaskowski C, Abrams D, et al. Yoga breathing
for cancer chemotherapy–associated symptoms and quality
of life: results of a pilot randomized controlled trial. J Altern
Complement Med. 2012;18:473-479.
Downloaded from ict.sagepub.com at UNIVERSITE LAVAL on June 9, 2014
Integrative Cancer Therapies 
67. Shah S, Ogden AT, Pettker CM, Raffo A, Itescu S, Oz MC.
A study on the effect of energy healing on in vitro tumor cell
proliferation. J Altern Complement Med. 1999;5:359-365.
68. Kiang JG, Ives JA, Jonas WB. External bioenergy-induced
increases in intracellular free calcium concentrations are
mediated by Na+/Ca2+ exchanger and L-type calcium channel.
Mol Cell Biochem. 2005;271:51-59.
69. Lee MS, Jang JW, Jang HS, Moon SR. Effects of Qi-therapy
on blood pressure, pain and psychological symptoms in the
elderly: a randomized controlled pilot trial. Complement Ther
Med. 2003;11:159-164.
70. Benor DJ. Energy medicine for the internist. Med Clin North
Am. 2002;86:105-125.
71. Hibdon SS. Biofield considerations in cancer treatment.
Semin Oncol Nurs. 2005;21:196-200.
72. Radin D, Taft R, Yount G. Effects of healing intention on
cultured cells and truly random events. J Altern Complement
Med. 2004;10:103-112.
73. Radin D, Stone J, Levine E, et al. Compassionate intention
as a therapeutic intervention by partners of cancer patients:
effects of distant intention on the patient’s autonomic nervous
system. Explore. 2008;4:235-243.
74. Dossey L. How healing happens: exploring the nonlocal gap.
Altern Ther Health Med. 2002;8:103-110.
75. Schlitz M, Hopf HW, Eskenazi L, Viten C, Radin D. Distant
healing of surgical wounds: an exploratory study. Explore.
2012;8:223-230.
76. Zahourek RP. Healing: through the lens of intentionality.
Holist Nurs Pract. 2012;26:6-21.
77. Kumar R. Research Methodology: A Step-by-Step Guide for
Beginners. Thousand Oaks, CA: Sage; 2005.
78. Moadel AB, Shah C, Wylie-Rosett J, et al. Randomized con-
trolled trial of yoga among a multiethnic sample of breast
cancer patients: effects on quality of life. J Clin Oncol.
2007;25:4387-4395.