Cancer survivors thrive in yoga therapy

The room is quiet and dimly lit, with two rose quartz lamps glowing softly. A lotus flower adorns the wall, and two ceiling fans lazily circulate. Nine students lay mats on the floor beside foam blocks and blankets.

The gathering looks like many other yoga classes in Asheville. But this Tuesday morning class at Asheville Community Yoga is called “Yoga for Cancer Recovery,” and the instructor, Dr. Robyn Tiger, is a trained yoga therapist as well as a physician.

For 75 minutes, she slowly guides students through the yoga poses called asanas. They point their feet up and draw circles in the air with their big toes; they roll their shoulders back and forth. They lunge forward on their mats and hold their arms to the ceiling for Warrior 1 pose, then bring their arms parallel to the floor as they transition to Warrior II pose.

“It doesn’t matter how much you move; it only matters how you move,” Tiger tells her students. “And only you can decide that.”

The class ends with Savasana, the final resting pose. Tiger gently unfolds blankets over her students, then pulls the curtains closed so the room is in darkness. “Be kind to one another and be kind to yourself,” she says gently.

Embodied benefits 

People begin yoga practice for many reasons: loosening tight necks, improving posture, looking more toned in skinny jeans. Lowering stress is another common entry point to the discipline, and research affirms that yoga offers mental health benefits for people with cancer as well. The practice has a stamp of approval from both the American Cancer Society and Breastcancer.org.

In a 2017 analysis of 24 studies about yoga and mental health in female breast cancer patients and survivors, the authors concluded that yoga improves health-related quality of life. A 2018 study found that yoga therapy can alleviate anxiety symptoms in cancer patients. And research published in 2021 determined that yoga therapy reduces the symptoms of cancer-related fatigue, with the biggest benefit for women with breast cancer.

Prior to Tiger’s class, ACY hadn’t offered yoga tailored to the unique needs of cancer survivors. While Asheville is brimming with yoga instructors, fewer practice yoga therapy, which requires extensive specialized training.

Anyone on the cancer journey can attend the class. However, most of its students are recovering from cancer, “which for many really is the most stressful time,” explains Tiger. “Because all of a sudden the doctor’s like, ‘OK, you’re good, we’re done!’ And there’s nobody watching them anymore.”

Recovery is an ideal time to practice yoga, she continues. “Chronic stress makes it so our immune system isn’t functioning to the capacity that it should,” she explains. “It’s really important to get that stress down, especially in that recovery period.”

Student Shoshana Slatky of Woodfin calls the class “a goddess-send.” She has attended Yoga for Cancer Recovery while facing recurrences of an aggressive cancer, including while undergoing chemotherapy and radiation.

“I dragged myself here even when it was really tough,” she says. “I was trying to survive. And I know that … doing healthful things for myself was going to help accomplish that goal.”

Trauma-informed care

The International Association of Yoga Therapists describes yoga therapy as “eliminating, reducing or managing symptoms that cause suffering; improving function; helping to prevent the occurrence or reoccurrence of underlying causes of illness; and moving toward improved health and well-being.”

Tiger came to the field after 15 years in mainstream medicine as a diagnostic radiologist; she often worked in women’s imaging, primarily looking for breast cancer. But what she saw from patients beyond the X-rays and MRI scans, she says, had the most impact.

“I saw physical, emotional psychological debilitation that was coming from them hearing ‘You have cancer,’” Tiger recalls. “I wanted to do more. I would go home and actually cry sometimes, [asking] what else can I do for people?”

The work took an emotional toll on her, and she felt consumed by anxiety and stress; she also lost three medical colleagues to suicide. Tiger turned to yoga practice to support her own mental health and eventually became certified as a yoga therapist in 2013. Some of her first students were cancer patients at the New Jersey location of Gilda’s Club, a nonprofit for people with cancer and their loved ones.

In addition to offering yoga therapy, Tiger is the founder of wellness practice StressFreeMD and works directly with burnt-out physicians. She describes her work as teaching people “how to manage their mind and how to work with their own physiology,” with a focus on self-care that she believes is missing from medical education.

Slow and steady

Tiger’s trauma-informed pedagogy in yoga therapy contrasts with regular yoga classes, where “the students are conforming to the teacher, independent of what’s going on with them,” she says. “I always let my students know that everything I share is an invitation for you to try. If something doesn’t feel good for you, that’s OK. If you want to rest, that’s OK.”

Those offerings include numerous modifications to traditional yoga moves that accommodate decreased range of motion and other challenges unique to cancer survivors. Some survivors may have injured muscles from breast reconstruction surgery, while others may have had lymph nodes removed. Students can have lymphedema, or swelling in the arms or legs; osteoporosis from decreased estrogen; neuropathy, which is numbness in the hands and feet as a side effect from chemo; or hot flashes from being forced into menopause.

Unlike in a regular yoga class where the teacher adjusts student poses, Tiger says, “I don’t touch — I use my words.” This hands-off approach helps her students, who may have decreased immune function, feel safer.

Slatky, who has experienced lymphedema and neuropathy, appreciates this care. “Sometimes her doctor side comes out more if you ask her certain questions, so I feel I can really trust how she’s leading us,” she says of Tiger. “I don’t have to worry, ‘Does this person know how to work with a cancer patient?’”

Student Barbara Michalove of Asheville recalls Tiger telling the class that “doing nothing is something,” explaining, “You can come to the class, and if you’re not feeling up to doing everything, you can just come and be a part of the class.” At one recent class, Michalove continues, she couldn’t participate but still sat among her classmates.

‘I felt very alone’ 

Students describe Yoga for Cancer Recovery as providing more than breathwork, exercise or meditation. The community formed among fellow travelers on the cancer journey is essential.

It’s a relief “to be around people that know the difficulties” of cancer, says Vicky DeKoster of South Asheville. “It’s easier to speak with people who’ve been through it and just say what you need to get out without worrying your friends or family.”

Michalove says Tiger encourages students not to feel  embarrassment about letting the tears flow during class. This openness is welcomed by a group who is repeatedly told they are strong, tough fighters and may feel they need to put on a brave face for loved ones.

“It’s kind of like a cleansing relief,” explains DeKoster, of the safe space to cry. “You don’t even realize you’ve got it bottled up in there.”

Tiger “says, ‘Let it out, let it out,’” adds Michalove. “Well, I’ve got that down really good.”

She is an older student and new to yoga practice. “I never thought that I would do yoga when it was mentioned to me,” Michalove tells Xpress. “And now, I think I’ll never not do yoga.”