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

描述（由申请人提供）：头颈癌（HNC）的积极多模式治疗提高了生存率。这种改善与晚期毒性相关，包括功能缺陷，例如：1）言语和吞咽受损，2）一般功能障碍（例如，虚弱和失调）和3）涉及颈部、肩部和胸部的肌肉骨骼损伤（MSI），（例如，下颌/颈部/肩部的活动范围减小和姿势改变）。MSI会引起症状（如疼痛），功能丧失和心理问题。HPV相关HNC的流行发生在年轻人中，并且具有更好的结果，这表明越来越多的年轻HNC幸存者将需要管理治疗的晚期功能性后遗症。很少有人注意到MSI在HNC幸存者。MSI的物理治疗（PT）标准治疗具有实质性帮助，但存在局限性，因为PT是：1）短期的，并且不能解决MSI随时间推移继发于进展性纤维化和水肿的变化，如我们当前研究所述，2）在基于设施的中心进行，对家庭实践的重视和监测较少，3）成本高，以及4）保险报销很少。为了与国家癌症研究所癌症存活办公室的使命保持一致，“提高诊断患有癌症的人的生存质量和生存时间，并尽量减少或稳定癌症存活期间经历的不良影响”，我们的长期目标是检查/开发互补的，成本较低的，可获得的治疗方案，以解决HNC幸存者的长期MSI。瑜伽比PT便宜，在许多社区都可以使用，并且已知对健康有益。哈他瑜伽包括基本的练习姿势（体式），呼吸（调息），放松（pratyahara）和冥想（dhyana）。通过姿势，呼吸工作，放松技巧和冥想，温和的哈他瑜伽练习可以解决HNC幸存者面临的身体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HNC幸存者修改后的哈他瑜伽计划的可行性，特别是：a）确定并记录MSI和安全可行实践所需的修改，B）获得招募估计并确定招募障碍，c）评估实施的准确性（遵守和能力）和实现保真度的障碍，d）建立安全性，以及e）评估满意度;和，2）确定修改后的哈达瑜伽计划与等待名单对照相比，对以下结果的初步疗效：a）活动范围（颌、颈和肩），B）姿势，c）疼痛，和d）心理困扰（焦虑、抑郁和体像障碍）。HNC患者将接受为期8周的瑜伽干预，包括姿势练习，呼吸工作，放松和 冥想.将在干预前、第4周和第8周收集客观和自我报告测量结果。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。如果我们的目标实现，在未来，我们将探索一个网络和/或社区为基础的瑜伽干预HNC幸存者。

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.