“Doctor’s Orders” is a new feature in the collaboration between Medpage Today and ABC News. We’ll be exploring medical issues of interest to physicians and their patients. In this first monthly segment, we look at the increasing body of research into the effects of yoga yoga in a variety of conditions as interest in this form of therapy grows.

At major cancer centers across the country, patients are putting themselves in a better ‘position’ to cope with their cancer.

Some of the biggest names in cancer care — M.D. Anderson, Memorial Sloan-Kettering, and Dana Farber among them — now offer their patients classes in yoga.

In the past, physicians may have written off the therapy as merely a trendy yuppie pasttime. But today, researchers — mainly psychologists — are asking questions about the benefits of yoga in a variety of conditions, including cancer, asthma, sleep disorders, depression, and attention disorders.

Generally, the studies have shown that yoga improves quality of life and relieves stress and anxiety associated with these conditions. Some researchers say the Ayurvedic therapy may have physiological mechanisms, like reducing cortisol levels, but those theories are still under evaluation.

A word of caution, though: The studies that have been done so far have yielded soft findings, with little hard data to back up the conclusions. That said, there is no denying that yoga is becoming a presence even in the ivory towers of academic medicine.

Yoga for Cancer Patients

Alyson Moadel, PhD, of Albert Einstein College of Medicine in Bronx, N.Y., has been tracking the effects of yoga on breast cancer patients at Montefiore Medical Center for the past eight years.

In 2007, Moadel reported early findings from the study in the Journal of Clinical Oncology: Patients who did yoga saw improvements in social and emotional well-being, compared with those who didn’t.

When data on patients undergoing chemotherapy were excluded, yoga also significantly improved overall quality of life.

“I think it’s going to be an important complementary modality,” Moadel said. “I don’t think it’s the only one, but I think it is an important one for dealing with stress and anxiety.”

Yoga classes are offered three times a week at Montefiore. Patients gather in a conference room for the seated yoga sessions, which include stretching in a mix of seated and standing poses for the first hour of the class. Then the instructor dims the lights for meditation, breathing and relaxation.

The doctor doesn’t look like much of a crusader, bent over the frail frame of 90-year-old Alberta Scott.

He has a lavender stethoscope strung round his neck and some serious bedside manner at work on this stubborn nonagenarian who wants to be anywhere but where she is: in a nursing home bed, hoping to heal and get back home.

“Squeeze my hand,” Dr. Peter Boling prods. “Squeeze my hand. Come on. Hard!”

This is Boling’s day job, providing medical care to some of Richmond’s oldest and sickest patients. A geriatrician and head of general medicine at Virginia Commonwealth University Medical Center, he visits nursing home patients with a smile and an encouraging word, and he leads a team of specialists who take to the road, medical bags in hand, to see patients where and when they need it most — in their own homes, before a crisis lands them in the ER or a nursing facility.

Boling and his team make house calls.

And now he is on a mission: To convince Congress that the old-fashioned house call could be a fresh answer to the modern-day health care reform dilemma.

There are house-calls programs here and there. San Diego. Boston. The Veterans Health Administration cares for thousands in their own homes, saving money by reducing unnecessary hospitalizations and emergency room visits.

But Boling wants to bring house calls to the masses — up to 3 million of the most high-risk, high-cost Medicare patients in the country. The idea is not just cost savings, but to provide a financial incentive to persuade more doctors to return to this kind of work. It’s also about improving access and providing patients the independence they so desire.

Mostly, it’s about people like Alberta Scott and the questions that first came to Boling’s mind when he heard she’d been admitted to an institution for treatment of a blood infection.

In a few weeks, if all goes well, can she go home? If so, who will take care of her?

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At 55, Boling has a vague memory of his own pediatrician standing in the kitchen of his childhood home. It’s not an image many of us can conjure in an era of overcrowded ERs and specialty clinics and the type of “managed care” that often means a long wait in a sterile reception room followed by a hasty examination.

The visiting doc went out not long after the horse and buggy, as technology advanced and institutionalized health care became the norm. In 1930, house calls accounted for 40 percent of doctor-patient encounters. By 1980, that had dropped to less than 1 percent. Today, about 4,000 of the nation’s 800,000-plus doctors make house calls a substantial part of their practices, although nurses and physician assistants have picked up some of the slack, the American Academy of Home Care Physicians reports.

Boling was just a young doc himself, finishing up his residency, when a mentor persuaded him to spend half his time doing clinic work, and the other half developing a house-calls program. Like most medical students today, Boling had never thought about making house calls a part of his practice. He nevertheless hung a giant map of Richmond on his office wall and began identifying patients who lived within a 15-mile radius of the downtown VCU medical center.

Each home was marked on the map with colored pins, and visits were scheduled by geography — north, south, east, west — to maximize Boling’s time. It took only a few stops, and some memorable patients, for Boling to recognize that home care made sense.