Prehabilitation in head and neck cancer patients: a literature review

Abstract

Background Dysphagia is one consequence of head and neck cancer that has a significant impact on quality of life for head and neck cancer survivors. While survival rates continue to improve, focus has shifted to maximizing long-term function, with prevention or prehabilitation programs becoming more common. Prehabilitation programs typically include an exercise regime that specifies the exercise type, the number of repetitions to complete per set, the number of sets of each exercise to complete per day, as well as the length of the treatment block. Ideally, exercise programs are designed with principles of neuromuscular plasticity in mind. Methods Twenty-nine original research articles published between 2006 and 2020 were included in this state-of-the-art review and examined for program timing and details. Results Two definitions for prehabilitation were noted: one third of the studies defined prehabilitation as preventative exercises prior to the start of acute cancer treatment; the remaining two thirds defined prehabilitation as treatment concurrent prehabilitation. Exercises prescribed ranged from general stretching and range of motion exercises, to trismus and swallowing specific exercises. The most common swallowing specific exercise was the Mendelsohn’s maneuver, followed by the effortful swallow, Shaker, and Masako maneuver. The most common dose was 10 repetitions of an exercise, three times per day for the duration of radiation therapy. The most common measures were questionnaires, followed by g-tube dependence, mouth opening, and MBS reports. Conclusion This review of the literature has shed light on the variability of prehabilitation timing, exercise type, dose, duration of treatment, and outcomes associated with prehabilitation, making the selection of an optimal prehabilitation program difficult at this time.

The impact of dysphagia prehabilitation on swallowing outcomes post‐chemoradiation therapy in head and neck cancer: A systematic review

“…Recently published studies are further investigating the late effects of organ preservation treatment like (C)RT and IMRT on swallowing (Patterson, 2019); however, there has been no connection made yet between prehabilitation and its impact on these long‐term effects. Previous reviews on this topic (Cousins et al, 2013; Loewen et al, 2021; Perry et al, 2016), although not specifically looking at prehabilitation that is initiated prior to the beginning of (C)RT, have similar findings with regard to the heterogeneous nature of the research preventing conclusive evidence to support the implementation of a preventative exercise programme. Comparisons of the effects of prehabilitation are not viable in this study due to a number of reasons particularly factors linked to the lack of consistency in the reporting of outcome measures and the tools used, along with the reported low rates of adherence reported in studies.…”

“…Recently published studies are further investigating the late effects of organ preservation treatment like (C)RT and IMRT on swallowing (Patterson, 2019); however, there has been no connection made yet between prehabilitation and its impact on these long-term effects. Previous reviews on this topic (Cousins et al, 2013;Loewen et al, 2021;Perry et al, 2016),…”

Experiences and perceptions of social eating for patients living with and beyond head and neck cancer: a qualitative study

“…Initially, the focus was promoting physical function alone but prehabilitation has extended to incorporate psychosocial strategies [ 36 ]. However, there is no consensus on optimal timing for prehabilitation [ 37 ]. Within this study, patients differed in their opinion on the timeliness of a social eating intervention.…”

Assessing Risk of Severe Complications after Endoscopic Transnasal Transsphenoidal Surgery: A Comparison of Frailty, American Society of Anesthesiologists, and Comorbidity Scores

“…However, there is an emerging body of research regarding prehabilitation (“prehab”) as a novel way to possibly improve patient frailty prior to surgery. 42 43 Prehabilitation has been studied across various surgical specialties, 44 45 46 including otolaryngology 47 and neurosurgery, 48 and generally involves 1- 8-week-long interventions targeting exercise, education, nutrition, and mental health. While prehab has been shown to improve rate of functional capacity recovery after surgery, 49 50 its impact on postoperative outcomes remains equivocal.…”