Development and cultural-tailoring of an inpatient yoga therapy program for cancer patients undergoing hematopoietic stem cell transplantation in India, Tanzania, and the United States

University Of Tx Md Anderson Can Ctr, Houston TX

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Abstract

Abstract This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA22- 054. Cancer patients in low- and middle-income countries (LMIC) have less access to integrative oncology programs than their counterparts in high-income countries. This is especially true of countries on the African continent, such as Tanzania. This international, collaborative research program will capitalize on a newly formed partnership between Healthcare Global Enterprises (HCG), headquartered in Bengaluru, India with 24 centers across India and seven centers performing hematopoietic stem cell transplantations (HSCTs), and Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania and existing partnerships between MD Anderson, Houston, USA and Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru, India, and between HCG and S-VYASA. HCG helps to oversee HSCTs at MNH, where they are performing the only transplants in Tanzania. Yoga therapy (YT) is an evidence-based mind-body practice that can be used throughout the cancer experience from diagnosis to survivorship as well as alongside end of life care. Specifically, YT is safe and effective for relieving sleep disruption, nausea, fatigue, pain, psychosocial distress, musculoskeletal symptoms, and cognitive dysfunction, all common symptoms experience during HSCT. Although YT is starting to be incorporated alongside conventional cancer care, it has not been investigated in an inpatient setting. No studies have investigated the efficacy of YT in undergoing HSCT. YT is also not commonly provided within the hospital systems in India and Tanzania. We propose to develop an inpatient yoga program for delivery during hospitalization for HSCT tailored to patients in the US, India, and Tanzania and examine the feasibility and initial efficacy of the inpatient YT program. Once the program is developed and deemed feasible, a larger multicenter/country efficacy study will be conducted to validate the benefits of YT as an adjuvant to cancer patients undergoing HSCT in US, India, Tanzania, and possibly other countries in Africa as HCG expands their collaborative partners. The collaborative team will develop an inpatient yoga program initially designed for patients undergoing HSCT, but that can ultimately be tailored to any inpatient setting. Modifications will be made for each country and tailored for cultural sensitivity. Pilot testing will be done in each of the three countries. Subsequent multicenter trials will be conducted across multiple countries and across multiple centers within each country. The specific aims of this formative developmental research are to: 1) Develop a culturally-tailored YT program for HSCT patients. Guided by a social-ecological/contextual framework, we will conduct semi-structured interviews with patients from each center to examine cultural norms, culturally sensitive language, and specific factors relevant to yoga and psychosocial support; and 2) Optimize the HSCT YT program using an iterative process. Fifteen patients from each center (or until thematic saturation based on exit interviews) will participate in the yoga program throughout the first 30 days of the HSCT.