Patient‐reported outcomes, body composition, and nutrition status in patients with head and neck cancer: Results from an exploratory randomized controlled exercise trial

Abstract

BACKGROUND:Patients with head and neck cancer experience loss of weight and muscle mass, decreased functioning, malnutrition, depression, and declines in quality of life during and after treatment. The purpose of this exploratory randomized study was to determine the optimal timing for the initiation of a lifestyle and progressive resistance exercise training intervention (during or after radiation therapy), as determined by intervention adherence and by comparing between-group outcomes across 24 weeks. METHODS: Sixty patients with head and neck cancer were randomized to engage in a 12-week lifestyle intervention and progressive resistancetraining program either during radiation treatment or immediately after completion. The primary outcome of body compositionspecifically, lean body mass, body mass index, and body fat-as well as secondary outcomes of fitness, quality of life, depression, and nutrition status were evaluated. RESULTS: The progressive resistance-training intervention carried out during treatment did not significantly influence the primary outcome of body composition, despite a significant increase in weekly physical activity reported by the intervention group. A small-to-medium intervention effect was noted for some secondary outcomes, including fitness, quality of life, and nutrition status. Regardless of whether patients received the immediate or delayed progressive resistance-training intervention, the analysis revealed a main effect of time on body composition, fitness, quality of life, depression, and nutritional scores. CONCLUSIONS: Although the intervention during treatment did not reduce the loss of lean body mass, delaying the exercise program until after treatment completion was associated with improved intervention adherence, a finding with important clinical implications. Cancer 2016;122:1185

Feasibility and preliminary effects of resistance training and nutritional supplements during versus after radiotherapy in patients with head and neck cancer: A pilot randomized trial

“…The recruitment rate of 82% in the current study is high compared with what to our knowledge are the few exercise trials among patients with HNC conducted during treatment. Two previous randomized trials that evaluated the feasibility and efficacy of resistance training during RT both reported a recruitment rate of 55% . The main reasons for declining participation in these 2 studies were “too time‐consuming” and “feeling overwhelmed or emotional distress.” Also in the current study, we noted that although many patients appeared to be overwhelmed by the medical situation at the point of study request, few declined to participate in the study.…”

Gastric cancer, nutritional status, and outcome

“…Accumulating evidence has indicated that cancer and nutritional status are closely linked 23,24. However, the underlying reasons why preoperative malnutrition causes a poor outcome remain unclear.…”

A turning point: Head and neck cancer patients’ exercise preferences and barriers before and after participation in an exercise intervention

“…This trial involved twice weekly group circuit classes taught by a certified exercise physiologist in urban hospital and community cancer centres, and home-based programmes that participants were instructed to complete at least two additional times per week (Capozzi et al, 2012). This group was an ideal sample from which to examine the changes in exercise preferences and barriers among HNC survivors since across the intervention period, participants significantly increased their average recommended physical activity minutes from below to above recommended weekly recommended minutes (Capozzi et al, 2016). Given the weight loss associated with HNC and its treatments, aerobic activity was limited to a brief warm-up before each strength workout, although participants were encouraged to progressively increase this to meet exercise guidelines as their weight stabilised.…”

“…This three-item questionnaire is widely used and has been successfully employed in previous HNC literature (Capozzi et al, 2016). This three-item questionnaire is widely used and has been successfully employed in previous HNC literature (Capozzi et al, 2016).…”