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

瑜伽对头颈癌幸存者的可行性和初步疗效

基本信息

批准号：
8710107
负责人：
Sheila H Ridner
金额：
$ 19.75万
依托单位：
VANDERBILT UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8710107
关键词：
Address Adherence Adverse effects Anxiety Articular Range of Motion Attention Body Image Breathing Cancer Survivor Cancer Survivorship Chest Clinical Clinical Trials Combined Modality Therapy Communities Competence Consensus Contracture Control Groups Controlled Study Data Deglutition Development Diagnosis Epidemic Evidence based intervention Exercise Face Fatigue Fibrosis Future Goals Head and Neck Cancer Health Benefit Home environment Human Papillomavirus Impairment India Insurance Internet Intervention Jaw Late Effects Length Life Linear Models Lung Lymphedema Malignant Neoplasms Measures Meditation Mental Depression Mission Modification Monitor Muscular Atrophy Musculoskeletal Musculoskeletal Pain National Cancer Institute Nature Neck Outcome Pain Patient Self-Report Patients Persons Philosophy Physical Function Physical therapy Population Posture Quality of life Radiosurgery Randomized Controlled Trials Rehabilitation therapy Relaxation Relaxation Techniques Safety Schools Science Secondary to Services Shoulder Speech Stress Survival Rate Survivors Symptoms Syndrome Techniques Testing Time Tissues Toxic effect Treatment Efficacy United States Waiting Lists Work Yoga base body-mind cancer therapy chemotherapy cost experience functional disability head and neck cancer patient high risk improved loss of function malignant breast neoplasm multimodality cancer therapy novel pranayama programs psychologic psychological distress psychological outcomes public health relevance rehabilitation service satisfaction standard care statistics

项目摘要

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.

描述(由申请人提供)：积极的多模式治疗头颈癌(HNC)提高了生存率。这种改善与晚期毒性有关，包括功能缺陷，例如：1)言语和吞咽障碍，2)全身功能障碍(例如，虚弱和去条件化)，以及3)累及颈部、肩部和胸部的肌肉骨骼损伤(MSI)，(例如，下颌/颈部/肩部的活动范围减少和姿势改变)。MSI会导致症状(如疼痛)、功能丧失和心理问题。HPV相关性HNC的流行发生在年轻人中，结果更好，这表明越来越多的HNC幸存者和更年轻的HNC幸存者将需要管理晚期功能性治疗序列。鲜有人注意到HNC幸存者中的MSI。物理疗法(PT)对MSI的标准治疗有很大帮助，但也存在局限性，因为物理疗法存在以下局限性：1)如我们目前的研究中所述，随着时间的推移，继发于进行性纤维化和淋巴水肿的MSI变化是短期的，2)在设施中心进行，对家庭实践的重视和监测较少，3)成本高，以及4)保险报销较差。为了贯彻国家癌症研究所癌症生存办公室的使命，“提高被诊断为癌症患者的生存质量和生存时间，最大限度地减少或稳定癌症生存期间所经历的不良反应”，我们的长期目标是研究/开发补充的、低成本的、可获得的治疗方案，以解决HNC幸存者的长期MSI。瑜伽比PT更便宜，在许多社区都可以使用，而且众所周知对健康有好处。哈他瑜伽包括体式(体式)、呼吸(调息)、放松(调息)和冥想(禅定)的基本练习。通过姿势、呼吸、放松技巧和冥想，温和的哈他瑜伽练习可能会解决HNC幸存者面临的生理MSI和由此产生的心理问题。这项等待名单对照研究有两个目的：1)确定为HNC幸存者修改的Hatha瑜伽计划的可行性，特别是：a)确定和记录MSI和为安全可行的练习所需的修改，b)获取招募估计并确定招募的障碍，c)评估实施忠诚度(坚持和能力)和实施忠诚度障碍，d)建立安全性，以及e)评估满意度；2)比较以下结果：a)活动范围(颌骨、颈部和肩膀)，b)姿势，c)疼痛，d)心理困扰(焦虑、抑郁和身体形象障碍)，2)确定修改后的Hatha瑜伽计划与等待名单对照的初步疗效。HNC患者将接受为期8周的瑜伽干预，包括姿势、呼吸工作、放松和冥想。客观和自我报告测量将在干预前、第4周和第8周收集。定性分析、描述性统计和混合效应一般线性模型将用于回答我们的目标。如果我们的目标得以实现，未来我们将为HNC幸存者探索基于网络和/或社区的瑜伽干预。