Feasibility and Preliminary Efficacy of Yoga in Head and Neck Cancer Survivors

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DESCRIPTION (provided by applicant): Aggressive multimodality treatments for head and neck cancer (HNC) have improved survival rates. This improvement is associated with late toxicities including functional deficits such as: 1) impaired speech and swallowing, 2) general functional impairment (e.g., weakness and deconditioning) and 3) musculoskeletal impairment (MSI) involving the neck, shoulder and chest, (e.g., decreased range of motion in jaw/neck/ shoulder and altered posture). MSI causes symptoms (such as pain), function loss, and psychological problems. The epidemic of HPV associated HNC, which occurs in younger people and has a better outcome, suggests that increased numbers and younger HNC survivors will need to manage late functional sequella of treatment. Little attention has been paid to MSI in HNC survivors. Standard treatment with physical therapy (PT) for MSI is of substantial help, however limitations exist as PT is: 1) short-term and does not address MSI changes over time secondary to progressing fibrosis and lymphedema as noted in our current study, 2) conducted at facility-based centers with less emphasis and monitoring of home practice, 3) high-cost, and 4) poorly reimbursed by insurance. In keeping with the mission of the National Cancer Institute's Office of Cancer Survivorship "to enhance the quality and length of survival of persons diagnosed with cancer and to minimize or stabilize adverse effects experienced during cancer survivorship," our long-term objective is to examine/ develop complementary, lower cost, accessible treatment options to address HNC survivor's long-term MSI. Yoga is less costly than PT, available in many communities, and has known health benefits. Hatha Yoga includes basic practices of postures (asanas), breathing (pranayama), relaxation (pratyahara), and meditation (dhyana). Through postures, breath work, relaxation techniques and meditation, gentle Hatha Yoga practices may address both physical MSI and resultant psychological issues that face HNC survivors. This wait-list control study has two aims: 1) To determine feasibility of a modified Hatha Yoga program for HNC survivors, specifically to: a) identify and document MSI and required modifications for safe and feasible practice, b) obtain recruitment estimates and determine barriers to recruitment, c) evaluate implementation fidelity (adherence and competence) and barriers to implementation fidelity, d) establish safety, and e) assess satisfaction; and, 2) To determine preliminary efficacy of a modified Hatha Yoga program as compared to a wait-list control for the following outcomes: a) range of motion (jaw, neck, and shoulder), b) posture, c) pain, and d) psychological distress (anxiety, depression and body image disturbance). HNC patients will undergo an 8 week Yoga intervention composed of practices of postures, breath work, relaxation and meditation. Objective and self- report measures will be collected pre-intervention, and weeks 4 and 8. Qualitative analysis, descriptive statistics, and Mixed Effects General Linear Models will be used to answer our aims. If our aims are achieved, in the future we will explore a web and/or community based Yoga intervention for HNC survivors.