Jennifer Brunet

The impact of a co-created yoga program for women diagnosed with gynecologic cancer on patient-reported outcomes: a series N-of-1 trial

Psychosocial oncology supportive care research has focused on adults diagnosed with breast cancer and used conventional group-based analyses that can mask meaningful individual differences. This study aimed to evaluate the effects of a co-created 12-week Hatha yoga program on patient-reported outcomes among women diagnosed with gynecologic cancer, using group- and individual-level analyses to emphasize person-centered processes. A multiple baseline series N-of-1 trial design was used. Participants self-selected to enroll in a morning or evening program, attending bi-modal 60-min classes twice weekly, complemented by optional group discussions, journaling, and pre-recorded videos for at-home practice. Self-report data were collected online at 9-11 timepoints, spanning baseline (3-5 weeks), program (12 weeks), and follow-up (8 weeks) phases. Data from 20 participants (M Visual analysis of individual profiles and piecewise models that represent the average rate of change for the sample demonstrated similar results across most outcomes. Collectively, the analyses showed that during the program, quality of life, perceived cognitive abilities, sexual distress, and perceived stress improved (ps < .05), while follow-up fatigue and perceived stress worsened (ps < .05). However, the results of the analyses diverged for negative body image. The overall slope (fixed effect) showed improvement during the program (p < .05); yet, visual analysis of individual profiles suggested variability across participants. Individual-level analyses also revealed divergent responses for 3 participants across outcomes. This study demonstrates the potential of a co-created Hatha yoga program to improve psychosocial outcomes for women with gynecologic cancer, an often underrepresented population in the literature. Findings also highlight the added value of using individual-level analytic approaches, supporting the need for personalized approaches in supportive care. The co-created program represents a promising line of inquiry to meet a pressing need for programs that address the sequelae of gynecologic cancer. ClinicalTrials.gov, no.: NCT05610982; November 3, 2022.

Evaluating the Feasibility and Acceptability of a Community-Based, Co-Created Yoga Program for Women with Gynecologic Cancer: A Series N-of-1 Feasibility Study

Purpose: Current yoga programs for cancer survivors do not meet participants’ needs and are rarely implemented in community-based settings, despite reported benefits. The aim of the current study was to implement a co-created 12-week bi-modal Hatha-based yoga program for adults diagnosed with gynecologic cancer in the community and assess the feasibility and acceptability of the program and study methods. Methods: Using a mixed methods series N-of-1 A1BA2 research design, participants were recruited from The Ottawa Hospital. Participants self-selected a morning or evening program, completed surveys 9 to 11 times and were interviewed post-program. The yoga instructor was interviewed post-program about her experience delivering the program. Quantitative feasibility outcomes were tracked throughout the study. Qualitative acceptability outcomes were explored during post-program semi-structured interviews. Audio and video recordings of the yoga classes and data from the instructor interview were used to assess fidelity outcomes to determine whether the protocol could be adhered to consistently. Results: Forty-one individuals were screened for eligibility and 20 consented (48.7%). Seventeen participants (85.0%) completed the final survey. Participants attended 83.1% (19.9/24) of classes with varied engagement with optional features. The instructor was 61.3% adherent to the prescribed protocol, using recommended behaviors 44.6% of the time. Participants shared barriers and facilitators that influenced the success of the trial methods and program. Conclusions: The program was well-received and trial methods were moderately successful, but refinements are warranted before a large-scale trial. Community-based yoga programs could be feasible and acceptable for women with gynecologic cancer.