Feasibility and Preliminary Efficacy of Yoga in Head and Neck Cancer 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，如：1)语言和吞咽障碍，2)一般功能障碍（如无力和去适应）和3)涉及颈部、肩部和胸部的肌肉骨骼损伤（MSI）（如下颌/颈部/肩部活动范围减小和姿势改变）。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幸存者将需要处理治疗的晚期功能后遗症。很少有人关注HNC幸存者的MSI。物理治疗（PT）对MSI的标准治疗有很大的帮助，但存在局限性，因为PT是短期的，不能解决我们目前研究中指出的继发性纤维化和淋巴水肿的MSI变化，2)在基础设施中心进行，对家庭实践的重视和监测较少，3)成本高，4)保险报销少。为了与国家癌症研究所癌症幸存者办公室的使命保持一致，“提高癌症患者的生存质量和生存时间，并尽量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/开发补充性、低成本、可获得的治疗方案，以解决HNC幸存者的长期MSI。瑜伽比体育锻炼更便宜，在许多社区都有，而且对健康有好处。哈他瑜伽包括姿势（体式）、呼吸（调息）、放松（pratyahara）和冥想（禅坐）的基本练习。通过体式、呼吸练习、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。这项候补名单对照研究有两个目的：1)确定修改后的哈他瑜伽课程对HNC幸存者的可行性，特别是：a)确定并记录MSI和安全可行练习所需的修改，b)获得招募估计并确定招募障碍，c)评估实施保真度（遵守和能力）和实施保真度的障碍，d)建立安全性，e)评估满意度；以及，2)确定改良的哈他瑜伽项目的初步疗效，与候补对照相比，以下结果：a)活动范围（下颌，颈部和肩部），b)姿势，c)疼痛，d)心理困扰（焦虑，抑郁和身体形象障碍）。HNC患者将接受为期8周的瑜伽干预，包括姿势练习，呼吸练习，放松和

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.