Feasibility and Preliminary Efficacy of Tailored Yoga in Survivors of Head and Neck Cancer: A Pilot Study

Melissa Adair , Barbara Murphy, Jie Deng, Mary S. Dietrich, and Sheila H. Ridner. Integrative Cancer Therapies 1 –11, 2018

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Feasibility and Preliminary Efficacy of Tailored Yoga in Survivors of Head and Neck Cancer: A Pilot Study

Melissa Adair , Barbara Murphy, Jie Deng, Mary S. Dietrich, and Sheila H. Ridner. Integrative Cancer Therapies 1 –11, 2018

Purpose: Treatment for head and neck cancer (HNC) results in long-term toxicities and increased physical and psychosocial survivor burden. There are a limited number of treatments for these late effects. Yoga postures, breath work, relaxation, and meditation, may improve these late effects. The purpose of this study was to examine the feasibility of a tailored yoga program in HNC survivors and obtain preliminary efficacy data.

Methods: This was a randomized wait-list control study of yoga-naive HNC survivors who were >3 months post–cancer treatment. Baseline data were collected. Participants were randomized to either an 8-week hatha yoga intervention group or a wait-list group. Feasibility and efficacy data were collected. At 4 and 8 weeks, patients underwent a repeat assessment of health. Wait-list control group participants were offered the yoga program after data collection. Descriptive statistics evaluated feasibility. Mixed effects general linear models were used to generate estimates of the efficacy outcomes.

Results: Seventy-three individuals were screened and 40 were eligible. All eligible individuals consented and enrolled. Five of the intervention group discontinued early and none in the wait-list control group. Feasibility was affirmed as participants were recruited and retained in the study, there were no adverse events, fidelity to protocol was demonstrated, and satisfaction rates were high. Efficacy measures indicated potential benefit for shoulder range of motion (d = 0.57-0.86, P < .05), pain (d = 0.67-0.90, P ≤ .005), and anxiety (d = 0.59, P = .015).

Conclusion: A tailored hatha yoga program is feasible and potentially efficacious for HNC survivors. Preliminary data supports further investigation of yoga in this population is needed.

Main findings

  • N = 35 and patients randomly assigned either to an 8-week yoga intervention group or to a wait-list group that completed study visits and was then offered the same yoga practice that the intervention group received.
  • Outcome measures included:
    • Maximal interincisal opening (MIO), cervical range of motion (CROM), shoulder range of motion  (SROM): Standard devices were used to obtain these measurements.
    • Posture assessment: Spinal deviation from proper alignment by use of photography against a grid and computer analysis of the body.
    • The Vanderbilt Head and Neck Symptom Survey (VHNSS–Version 2): This self-report validated measure assessed symptom burden.
    • Brief Pain Inventory–Short Form (BPI-SF): This self reported survey captured participant’s pain experience.
    • Hospital Anxiety and Depression Scale (HADS): This self-report survey measured anxiety and depression.
    • Body Image Quality Life Instrument (BIQLI).
  • The intervention addressed all traditional hatha yoga practice components: postures, breathing, relaxation techniques, and meditation. Sixteen core poses were chosen to comprise the head and neck yoga toolbox; these poses were selected because they involved structures critical for optimizing mobility or strength in the neck and shoulders.
  • Tailored yoga appears to be safe and feasible in the posttreatment HNC population. No adverse events occurred.
  • Recruitment rates were high as was adherence with guided sessions and home practice. Participants expressed high levels of satisfaction with the yoga instruction and study related tools.
  • Preliminary data indicated that yoga may improve mood, symptom burden, and shoulder function.
  • Patients indicated that the duration of the supervised and daily home practice was burdensome. Shorter supervised and tailored home practice should be considered in future studies.
  • The yoga instructor had 500 hours of advanced training in therapeutic aspects of yoga in cancer and chronic illness and spent a year-long preceptorship in the HNC clinic prior to study initiation in order to gain insight into the issues facing this population.
  • Lack of measured change in posture may indicate the need for an alternative measurement method.
  • Patient demographics did not limit recruitment. Men and women were eager to participate due to bothersome late effects from their cancer treatment.

Preliminary efficacy data support further investigation of yoga in this and other chronically ill populations.