Yoga Intervention for Cancer Survivors
Condition: Cancer Survivors; Yoga
Study type: Observational

Summary: 
      Impaired health related quality of life (HRQOL) including fatigue, problems with sleep and
      psychosocial well being (physical, emotional, and spiritual) have been noted in adult cancer
      survivors. Physical domain is one of the most common measured indicators of HRQOL. Despite
      the tremendous implications of having an impaired QOL, few studies have staged interventions
      aimed at improving HRQOL in a heterogeneous group of cancer survivors. There is little
      literature examining whether a yoga intervention is feasible in a heterogeneous group of
      cancer survivors.

      The proposed research will utilize Vanderbilt Ingram Cancer Center (VICC), Nashville General
      Hospital (NGH) and REACH for Survivorship program for a pilot study. The investigators will
      see if a study using a broad range of diagnoses is feasible for a Yoga Intervention.
    

Detailed description: 
      The Yoga Program

      The yoga intervention will be developed by a certified yoga instructor. The yoga instructors
      teaching the classes will undergo training before teaching classes; all classes will embody
      the same positions and techniques. Based on Tantric Hatha yoga techniques, the intervention
      will incorporate physical stretches and poses, breathing exercises and meditation. All
      exercises will be done in a seated or reclined position. Yoga positions will focus on
      breathing exercises and basic stretching and will be at the easy or basic level. Yoga
      positions to be utilized in the intervention are located in the Appendix. Classes will
      include instruction on practicing the techniques taught in the classes at home.

      The yoga instructors utilized in this study are certified in yoga instruction. The classes
      will be held over a period of 60 minutes in a quiet, dimly lit conference room at Gilda's
      Club and at Nashville General Hospital. The classes will combine physical postures (asanas),
      breathing (pranayama) and deep relaxation (savsana). It will be made clear that participants
      should not practice any pose that causes or exacerbates any discomfort. Yoga poses will be
      modified based on participants needs. Individual poses will be held from 20 seconds to 5
      minutes depending on the poses. Classes will begin slowly and progress; adding poses to the
      same sequence, breath techniques and restorative poses for each class over the 10 weeks.
      Modifications and pose variations will be used to make the class appropriate for each
      individual. Chairs, yoga props, and a wall will be used to assist in poses. The class will
      consist of the following outline:

      5 Minutes: Centering, Relaxation, Body Scan

        -  Seated (Sukasana, Simple Cross Legged Pose)

        -  Reclined (Savasana, Relaxation Pose)

           10 minutes: Breathing techniques

        -  Diaphramic breathing (belly breath)

        -  Ujjayi breathing (builds heat and is an audible breath)

        -  Kapalabhati breathing (pumping breath)

        -  Nadi Sodhana breathing (alternate nostril breath)

           10 minutes: Warming spine and body

        -  Cat/Cow

        -  Twists

        -  1/2 Sun Salutations and variations

           15 minutes: Strength building and stretching poses

        -  Hamstring Opener (reclined)

        -  Downward Dog (at wall or on floor)

        -  Lunges (at wall, with chair or with no props)

        -  Bridge Pose

        -  Locust Pose (with variations)

           5 minutes: Restorative Poses

        -  Supported Bridge Pose

        -  Supported Child's Pose

        -  Supported Forward Twist

        -  Legs up Wall

        -  (rotate restorative poses throughout 10 weeks)

           5 minutes:

        -  Savasana (final relaxation)

           5 minutes:

        -  Mindfulness Meditation

      More details about the positions are located in the Appendix.

      Study Instruments

      Short Form 36 (MOS SF-36): The MOS SF-36 contains eight individual scales from which we will
      generate the Physical Component (PCS) and the Mental Component Summary (MCS) scores. The
      eight scales include physical functioning, role function-physical, bodily pain, social
      functioning, mental health, role function-emotional, vitality and general health perceptions
      [33]. The MOS SF 36 has been validated in the general population and population norms have
      been established for comparison between specific groups. Each scale is scored from 0-100,
      with 100 being the most favorable score. The SF-36 has been validated in the general
      population and population norms have been established for comparison between specific groups.
      The summary scales have been standardized to a reference normal healthy population, with a
      mean score of 50 and deviation of 10 points. Within the SF-36 is a 4 item Vitality scale
      which can be used to determine the presence or absence of fatigue.

      Brief Symptom Inventory-The BSI is a short 53 item instrument designed to measure three
      dimensions of psychological distress - somatization, depression and anxiety. Raw scores are
      converted to T scores on the basis of normative data. The T scores are then dichotomized, in
      which a T score 63 classified a respondent as having psychological distress.

      Survivor Questionnaire: A self-report questionnaire will be used to ascertain all demographic
      and historical information on race, age, income, education, current and past employment
      status, and current and past marital status. Current medical conditions will be selected by
      the participant from checklist including major medical conditions including secondary
      malignancy, cardiac, pulmonary and thyroid dysfunction. In addition, participants will be
      asked to list their current medications such as thyroid replacement, immunosuppressants, and
      anti-depressants. Lifetime smoking and alcohol habits will also be quantified, as well as
      reproductive history.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Survivors of Adult or Pediatric Cancer