Yoga-based supportive care may help alleviate the negative side effects of radiation treatment, decrease the use of feeding tube placements, and reduce emergency department visits in patients with head and neck cancer, especially when family caregivers participate, according to new findings presented by Milbury et al at the 2023 ASCO Quality Care Symposium (Abstract 292).
Background
Patients undergoing radiation treatment may experience side effects—including mucositis, swelling inside the mouth and throat that can lead to painful mouth sores, and difficulty swallowing—that can lead to declines in physical functioning and increase health-care utilization.
“This study is one of the first to compare a patient-oriented behavioral intervention delivery to one that includes patients and their caregivers,” explained lead study author Kathrin Milbury, PhD, Associate Professor in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center.
Study Methods and Results
In the new study, researchers enrolled 100 patients with head and neck cancer—who planned to receive ≥ 25 fractions of radiotherapy—and their caregivers. The researchers noted that 67% of the patients had early-stage cancer and 54% of them were receiving radiotherapy delivered concurrently with chemotherapy. The mean age of patients was 60.3 years and the median age of the caregivers was 54.9 years. Further, 85% of the patients were male and 15% of them were female, whereas 83% of the caregivers were female and 17% of them were male. Regarding race, 79%, 16%, 2%, 2%, and 1% of the patients identified as non-Hispanic White, White Hispanic, Black, Asian, and biracial, respectively; and a 73%, 15%, 7%, 3%, and 2% of the caregivers identified as non-Hispanic White, White Hispanic, Asian, biracial, and Black, respectively.
The patients were randomly assigned to receive either yoga-based supportive care with their caregivers (n = 34), patient-only yoga (n = 33), or usual care (n = 33). Both yoga programs consisted of 15 sessions, either in-person or via videoconference, with sessions happening in parallel with the patient’s radiotherapy schedule. The programs were designed to include poses—such as stretching and strengthening the neck and facial muscles, whole-body postures to prevent muscle loss, and breathing and meditation exercises to create a relaxed state and sense of well-being—that focused on preventing and reducing the common side effects of head and neck cancer treatment. The researchers emphasized that because patients frequently experience anxiety during radiation treatment, some of them used the relaxation exercises during treatments in lieu of benzodiazepines.
The researchers extracted Information on feeding tube placement, emergency department visits, and hospital admissions from the patients' electronic medical records. In addition, the patients were asked to complete the self-report portion of the Scored Patient-Generated Subjective Global Assessment on a weekly basis during the radiotherapy period to indicate their current food intake compared with their normal food intake.
The researchers found that the yoga session attendance was high in both groups, with 88% of patients involved in the study attending at least 10 sessions (13.1 sessions in the patient-caregiver group and 13.3 sessions in the patient-only group).
They observed a significant effect favoring the patient-caregiver group compared with the usual care group for patient-reported physical function and nutrition intake. Additionally, the patients in both yoga groups had significantly fewer feeding tube placements compared with those in the usual care group.
The researchers found that the effect for emergency department visits was marginally significant and the effect for hospital admissions was not statistically significant.
Next Steps
“I believe the lack of significant group differences between the patient-only yoga and patient-caregiver yoga groups is related to the high session attendance in both yoga groups. One of benefits of yoga is … immediate stress relief, and as such, our participants experienced the benefit early on in the program," highlighted Dr. Milbury.
The researchers are currently studying the dyadic yoga intervention in patients with head and neck cancer undergoing concurrent chemoradiation. They also plan to test the acceptability of this intervention among minoritized and underserved groups.
“These results demonstrate that a focused yoga intervention can be successfully delivered in person or online not only to patients with cancer undergoing radiation therapy but also to their caregivers. Such an intervention can be beneficial for physical functioning, recovery, and nutrition intake,” concluded Charu Aggarwal, MD, MPH, FASCO, of ASCO, who was not involved in the study.
Disclosure: The research in this study was funded by the American Cancer Society. For full disclosures of the study authors, visit meetings.asco.org.
