Evaluating a 12-Week Yoga Intervention for Gynecologic Cancer Survivors Using Hierarchical Linear Modeling

Abstract

Objective: Yoga benefits individuals following cancer treatment; however, researchers have primarily focused on breast cancer populations and used study designs that preclude examination of trends over time. We aimed to evaluate the effects of a co-created Hatha yoga program on repeated measures of patient-reported outcomes among gynecologic cancer survivors. Methods: A multiple baseline series N-of-1 A₁BA₂ trial design was used. Participants completed a 12-week bi-modal Hatha yoga program with optional group discussions, journals, and pre-recorded videos for at-home practice. Outcomes were assessed via online questionnaires prior to (A₁; 3-5 timepoints), during (B; 3 timepoints), and after the program (A₂; 3 timepoints). Data from 20 participants (M_age=62.4 years) were analyzed using hierarchical linear modeling following a stepwise model-building approach. Results: Piecewise models including fixed (i.e., an intercept and slopes for A₁, B, and A₂) and random (i.e., an intercept) effects fit the data best. Significant (p<.05) improvements were observed in quality of life (A₁: b=0.96, SE=0.44; B: b=0.44, SE=0.11), cognitive function (B: b=0.12, SE=0.05), sexual distress (A₁: b=-0.93, SE=-0.93; B: b=-0.25, SE=-0.25), negative body image (B: b=-0.22, SE=0.10), and perceived stress (B: b=-0.24, SE=0.06). Fatigue (A₂: b=-0.12, SE=0.06) and perceived stress (A₂: b=0.10, SE=0.04) worsened after the program. Conclusions: Results offer preliminary evidence that a co-created yoga program may improve and maintain (up to 8 weeks) patient-reported outcomes for gynecologic cancer survivors. These findings lay important groundwork for a future hybrid implementation-effectiveness trial to evaluate the program’s real-world impact and scalability.