Head Neck Cancer
Conditions
Brief summary
Treatment for head and neck cancer can result in marked musculo-skeletal impairment (MSI). This study will examine the effects of Hatha Yoga as a therapeutic modality to address MSI.
Detailed description
The use of aggressive treatment for head and neck cancer (HNC) particularly combined modality treatment regimens has resulted in an increase in survival. Unfortunately, this improvement has come with a marked increase in acute and late-effects. Acute HNC treatment-related toxicities have been clearly and extensively documented; however, data pertaining to adverse late-effects, those most likely to impact the survivor's long term symptom burden, functionality, and overall quality of life (QOL), are limited. This pilot study will be conducted to examine the feasibility of tailored Hatha Yoga as a therapeutic modality to address MSI in patients who have survived HNC.
Interventions
BEHAVIORALYoga Practice Plan
To enhance fidelity, a standardized Yoga intervention was chosen that includes postures, meditation, relaxation, and breath work. To ensure safety, the practice plan for each patient will be reviewed prior to initiation. All MSI limitations will be discussed, and appropriate adaptive techniques will be formulated. Qualitative techniques will be used to describe and categorize the types of impairment and modifications. By developing a catalog of impairments and suitable modifications, a safe and uniform Yoga program can be further tested and widely disseminated.
OTHERBaseline Study Measures
Participants will undergo baseline objective and self-report study measures including: 1) ROM in the jaw, neck, and shoulders; 2) posture assessment; 3) pain, and 4) psychological distress. The study measures will take 30-45 minutes to administer.
BEHAVIORALYoga Evaluation
The evaluation includes an assessment of nine traditional Yoga components: energy, symptoms, emotions, posture, breathing patterns, gait, muscle/tissue quality, joint flexibility, and muscle strength. Emphasis will be placed on the assessment of jaw/neck/shoulder MSI requiring Yoga practice modification of those poses that are unsafe or not feasible for a patient to perform. Information from the evaluation will be used to establish the tailored Yoga program
BEHAVIORALYoga Program
The Yoga program has 5 components: 1) Awareness Practice to enhance self-awareness, 2)Poses - 16 core poses will be modified for each patient's specific needs, 3)Breath Work - breath awareness and proper breathing for maximum benefit, 4)Relaxation - alternating between methods of relaxation, 5)Mediation - awareness and practice of inner silence
OTHERStudy Assessments
Data collection methods used to assess efficacy include physical measurement/examination, jaw range of motion (device) - scales to measure opening, cervical range of motion(Device), Shoulder Range of Motion - Goniometer, Posture - Wall Zone Grid, self-reported surveys for physical symptoms, pain, psychological symptoms, anxiety, depression and quality of life
Sponsors
National Institutes of Health (NIH)
National Cancer Institute (NCI)
Vanderbilt-Ingram Cancer Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* \>/= 18 years of age * \>3 months post-treatment of HNC * no active cancer * ability to understand English in order to complete questionnaires * willing to participate in the guided and home Yoga practice * willing to drive to the study site * willing and able to provide informed consent * completed medically indicated physical therapy * medical clearance by study medical oncologist
Exclusion criteria
* a prior cancer diagnosis within the past three years (except basal cell, surgically treated squamous cell skin cancer, early prostate cancer under observation) * have received radiation therapy or chemotherapy for any condition other than primary HNC * medical conditions that would prohibit the safe implementation of a Yoga practice (e.g., vertigo, dementia) * active Yoga practice within the past 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients who complete a modified Yoga program for HNC survivors | at 8 weeks | Number of patients that complete an 8-week course of guided yoga sessions and that complete a Participant Practice Log to document their non-guided home yoga sessions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in cervical ROM | at 8 weeks | Change from baseline in cervical ROM, measured in degrees of neck movement |
| Change in head and neck-related treatment systems | at 8 weeks | Change from baseline in the Vanderbilt Head and Neck Symptom Survey: 9 questions on treatment-related symptoms with 0 = least amount of problems to 10 = most amount of problems. Higher scores indicate increased treatment-related distress |
| Change in range of motion (ROM) jaw maximal inter-incisoral opening | at 8 weeks | Change in ROM from baseline in the jaw maximal inter-incisoral opening, measured in millimeters (mm) |
| Change in Body Image Quality of Life Inventory | at 8 weeks | Change from baseline in scores in the Change in Body Image Quality of Life Inventory. 18 questions with minus 3 = very negative effect to plus 3 = very positive effect. sum of scores with higher scores indicating a more positive body image |
| Change in Anxiety and Depression Scale | 8 weeks | Change from baseline in scores on the Hospital Anxiety and Depression Inventory with a score of \>/= 8 as possible cause for mental health referral |
| Change in Brief Pain Inventory | at 8 weeks | Change from baseline in scores for the Brief Pain Inventory: 9 items with 0 = no pain to 10 = pain as bad as you can imagine. Higher sum of scores indicate greater pain burden |
Countries
United States
Outcome results
None listed