ReviewEffectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: A systematic review
Introduction
Although head and neck cancer (HNC) survivorship care guidelines recommend survivors engage in regular physical activity, the benefits of physical activity in this population are largely unknown. In the United States, mucosal head and neck squamous cell carcinoma (HNSCC) is the 9th most common cancer and there are approximately 436,000 HNSCC survivors [1]. Several oncologic societies have recently updated or issued new HNC survivorship guidelines, all of which include formal promotion of physical activity [2], [3], [4]. The American Cancer Society (ACS), American Society of Clinical Oncology and National Comprehensive Cancer Network recommend HNC patients to incorporate two days of strength training and a minimum of 150 min of moderate or 75 min of vigorous aerobic physical activity per week [2], [3], [4].
However, the ACS guideline specifically acknowledges that “primary care clinicians are encouraged to rely upon research with survivors of other cancers when counseling patients with HNC about physical activity…in lieu of an acceptable level of HNC-specific studies.” Previous literature has demonstrated the safety and feasibility of physical activity interventions in HNC survivors [5]. While some studies have assessed associations between physical activity interventions and outcomes in HNC survivors, these have been largely underpowered and employed diverse interventions in heterogeneous populations. Thus, the importance and efficacy of physical activity interventions in HNC survivors is inadequately understood. The objective of this review is to evaluate the effectiveness of physical activity interventions in improving patient-reported and objective outcomes in HNC survivors.
Section snippets
Methods
Using search concepts including “physical activity”, “exercise”, “head and neck cancer”, “outcomes”, “survival”, “recurrence”, and “quality of life”, formal comprehensive search strategies were developed with the assistance of a medical librarian (HM). MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library were searched from their inception through December 19, 2018 using the search terms documented in the Appendix. 2,392 articles were identified and exported to EndNote8. 927
Overview
Demographic and study characteristics of the 20 included studies are reported in Table 1 [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31]. Study designs included randomized controlled trials (RCT; n = 11), pretest–posttest single group design (SGD; n = 5), non-randomized controlled trials (NRCT; n = 3), and a case-control study (CC; n = 1). Study cohort sizes ranged from 8 to 114 individuals and collectively totaled 749
Physical activity interventions provide some benefit to HNC survivors without adverse harms
This review demonstrated that physical activity in HNC survivors sometimes resulted in improved quality of life, sleep, depressive symptoms, pain, aerobic capacity, lean body mass and muscle strength along with physical-, emotional-, and cognitive functioning. These improvements mirror the improved outcomes from physical activity interventions in cancer-free adults and survivors of other cancers (e.g. breast cancer, colorectal cancer, and lymphoma) [35], [36], [37], [38], [39], [40], [41]. In
Conclusion
This review addresses the gap in evidence acknowledged by the ACS Head and Neck Cancer Survivorship Care guideline. In summary, physical activity interventions are often associated with some objective and patient-reported benefits without clear evidence of harmful effects. The impact of physical activity on survival and recurrence in HNC is unknown. Both traditional and alternative (yoga, Tai Chi) forms of physical activity improve outcomes in HNC. Although alternative physical activity
Financial disclosure
Nothing to disclose.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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2022, Oral OncologyCitation Excerpt :There is limited controlled evidence regarding the management of lymphoedema in HNC survivors; however, a systematic review found that manual lymphatic drainage and complete decongestion therapy have the best evidence of benefit and are likely useful first-line treatments [22]. A systematic review in patients who had survived HNC found that physical activity can reduce fatigue in survivors; this applies to both traditional aerobics and strength-based activities and those such as yoga and tai chi [23]. Reducing fatigue in HNC survivors can also help to improve overall QoL, and patients should receive patient education and counselling to help manage both the symptoms and to also address any underlying psychological issues (especially depression) that could be contributing to fatigue [24].
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