Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: A systematic review

Highlights

• Physical activity interventions in HNC survivors often confer some benefit.

• The impact of physical activity interventions on HNC survival is unknown.

• Both conventional and alternative physical activity interventions improve outcomes.

• Yoga and Tai Chi physical activity interventions frequently benefitted HNC survivors.

Abstract

Objective

To assess the effectiveness of physical activity interventions in improving objective and patient-reported outcomes in HNC survivors.

Introduction

Multiple guidelines recommend that head and neck cancer (HNC) survivors participate in regular physical activity. Physical activity is associated with improved outcomes and mortality in healthy individuals as well as in certain cancer populations. However, the effectiveness of physical activity interventions in HNC survivors is inadequately understood.

Methods and results

Our literature search through December 2018 identified 2,392 articles. After de-duplication, title and abstract review, full-text review and bibliographic search, 20 studies met all inclusion criteria. Inclusion criteria included any full-body physical activity intervention in HNC survivors that did not target discrete organ sites or functions (e.g. swallowing). Study cohorts included 749 predominantly male participants with a mean age range of 48–63 years. At their conclusion, physical activity interventions were associated with at least one significant improvement in an objective or patient-reported outcome in 75% of studies. Aerobic capacity and fatigue were the most commonly improved outcomes. None of the included studies evaluated associations with survival or recurrence. Although traditional aerobic and resistance interventions were more common, a greater proportion of alternative physical activity (yoga and Tai Chi) interventions demonstrated improved objective and patient-reported outcomes.

Conclusion

Physical activity interventions in HNC survivors often conferred some improvement in objective and patient-reported outcomes. Additional highly-powered, randomized controlled studies are needed to establish the optimal type, intensity, and timing of physical activity interventions as well as their impact on oncologic outcomes.

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.