Advertisement
Editorial| Volume 58, ISSUE 7, P738-743, September 2020

Should survivors of head and neck cancer be considered a distinct special population within the context of exercise prescription?

      Exercise is now widely accepted as a safe, cost-efficient, and effective intervention for survivors of cancer.
      • Mewes J.C.
      • Steuten L.M.
      • Ijzerman M.J.
      • et al.
      Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review.
      • Pedersen B.K.
      • Saltin B.
      Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases.
      • Gerritsen J.K.
      • Vincent A.J.
      Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials.
      Considerable scientific evidence supports its efficacy in improving the quality of life of survivors,
      • Gerritsen J.K.
      • Vincent A.J.
      Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials.
      as it helps to prevent and manage comorbidities,
      • Pedersen B.K.
      • Saltin B.
      Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases.
      and reduces cancer-specific and all-cause mortality.
      • McTiernan A.
      • Friedenreich C.M.
      • Katzmarzyk P.T.
      • et al.
      Physical activity in cancer prevention and survival: a systematic review.
      Evidence-based guidelines have been published to inform medical and allied health professionals about how best to prescribe it,
      • Kushi L.H.
      • Doyle C.
      • McCullough M.
      • et al.
      American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.
      • Cormie P.
      • Atkinson M.
      • Bucci L.
      • et al.
      Clinical Oncology Society of Australia position statement on exercise in cancer care.
      • Hayes S.C.
      • Newton R.U.
      • Spence R.R.
      • et al.
      The Exercise and Sports Science Australia position statement: exercise medicine in cancer management.
      • Campbell K.L.
      • Winters-Stone K.M.
      • Wiskemann J.
      • et al.
      Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable.
      • Schmitz K.H.
      • Campbell A.M.
      • Stuiver M.M.
      • et al.
      Exercise is medicine in oncology: engaging clinicians to help patients move through cancer.
      but an important issue is the current lack of specific guidelines for different cancers, despite apparent differences in the physical manifestations of the disease and its treatment. One group of cancers for which this seems particularly relevant is head and neck cancer (HNC), which includes malignancies of the lips, mouth, oropharynx, nasopharynx, larynx, salivary glands, and paranasal sinuses.
      • Devins G.M.
      • Otto K.J.
      • Irish J.C.
      • et al.
      Psychological issues related to site of cancer: head and neck cancer.
      Survivors of HNC share many of the same issues as those treated for other cancers (intrusive treatments, dependency, the threat of recurrence, and early mortality),
      • Devins G.M.
      • Otto K.J.
      • Irish J.C.
      • et al.
      Psychological issues related to site of cancer: head and neck cancer.
      but the notable biopsychosocial issues they experience are either unique to the disease or are more severe.
      • De Boer M.F.
      • McCormick L.K.
      • Pruyn J.F.
      • et al.
      Physical and psychosocial correlates of head and neck cancer: a review of the literature.
      • Sammut L.
      • Ward M.
      • Patel N.
      Physical activity and quality of life in head and neck cancer survivors: a literature review.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mewes J.C.
        • Steuten L.M.
        • Ijzerman M.J.
        • et al.
        Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review.
        Oncologist. 2012; 17: 1581-1593
        • Pedersen B.K.
        • Saltin B.
        Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases.
        Scand J Med Sci Sports. 2015; 25 Suppl 3: 1-72
        • Gerritsen J.K.
        • Vincent A.J.
        Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials.
        Br J Sports Med. 2016; 50: 796-803
        • McTiernan A.
        • Friedenreich C.M.
        • Katzmarzyk P.T.
        • et al.
        Physical activity in cancer prevention and survival: a systematic review.
        Med Sci Sports Exerc. 2019; 51: 1252-1261
        • Kushi L.H.
        • Doyle C.
        • McCullough M.
        • et al.
        American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.
        CA Cancer J Clin. 2012; 62: 30-67
        • Cormie P.
        • Atkinson M.
        • Bucci L.
        • et al.
        Clinical Oncology Society of Australia position statement on exercise in cancer care.
        Med J Aust. 2018; 209: 184-187
        • Hayes S.C.
        • Newton R.U.
        • Spence R.R.
        • et al.
        The Exercise and Sports Science Australia position statement: exercise medicine in cancer management.
        J Sci Med Sport. 2019; 22: 1175-1199
        • Campbell K.L.
        • Winters-Stone K.M.
        • Wiskemann J.
        • et al.
        Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable.
        Med Sci Sports Exerc. 2019; 51: 2375-2390
        • Schmitz K.H.
        • Campbell A.M.
        • Stuiver M.M.
        • et al.
        Exercise is medicine in oncology: engaging clinicians to help patients move through cancer.
        CA Cancer J Clin. 2019; 69: 468-484
        • Devins G.M.
        • Otto K.J.
        • Irish J.C.
        • et al.
        Psychological issues related to site of cancer: head and neck cancer.
        in: Holland J.C. Breitbart W.S. Butow P.N. Psycho-oncology. 3rd ed. Oxford University Press, 2015: 92-97
        • De Boer M.F.
        • McCormick L.K.
        • Pruyn J.F.
        • et al.
        Physical and psychosocial correlates of head and neck cancer: a review of the literature.
        Otolaryngol Head Neck Surg. 1999; 120: 427-436
        • Sammut L.
        • Ward M.
        • Patel N.
        Physical activity and quality of life in head and neck cancer survivors: a literature review.
        Int J Sports Med. 2014; 35: 794-799
        • Taib B.G.
        • Oakley J.
        • Dailey Y.
        • et al.
        Socioeconomic deprivation and the burden of head and neck cancer – regional variations of incidence and mortality in Merseyside and Cheshire, North West, England.
        Clin Otolaryngol. 2018; 43: 846-853
        • Lokker M.E.
        • Offerman M.P.
        • van der Velden L.A.
        • et al.
        Symptoms of patients with incurable head and neck cancer: prevalence and impact on daily functioning.
        Head Neck. 2013; 35: 868-876
        • Conway D.I.
        • Brenner D.R.
        • McMahon A.D.
        • et al.
        Estimating and explaining the effect of education and income on head and neck cancer risk: INHANCE consortium pooled analysis of 31 case-control studies from 27 countries.
        Int J Cancer. 2015; 136: 1125-1139
        • Hashibe M.
        • Hunt J.
        • Wei M.
        • et al.
        Tobacco, alcohol, body mass index, physical activity, and the risk of head and neck cancer in the prostrate, lung, colorectal, and ovarian (PLCO) cohort.
        Head Neck. 2013; 35: 914-922
        • Douma J.A.
        • Verdonck-de Leeuw I.M.
        • Leemans C.R.
        • et al.
        Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer.
        Acta Oncol. 2020; 159: 342-350
        • Rogers L.Q.
        • Courneya K.S.
        • Robbins K.T.
        • et al.
        Physical activity and quality of life in head and neck cancer survivors.
        Support Care Cancer. 2006; 14: 1012-1019
        • Gannon J.A.
        • Guinan E.M.
        • Doyle S.L.
        • et al.
        Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study.
        Dis Esophagus. 2017; 30: 1-7
        • Eytan D.F.
        • Blackford A.L.
        • Eisele D.W.
        • et al.
        Prevalence of comorbidities and effect on survival in survivors of human papillomavirus-related and human papillomavirus-unrelated head and neck cancer in the United States.
        Cancer. 2019; 125: 249-260
        • Bras L.
        • Driessen D.A.
        • de Vries J.
        • et al.
        Patients with head and neck cancer: are they frailer than patients with other solid malignancies?.
        Eur J Cancer Care (Engl). 2020; 29e13170
        • Inoue H.
        • Nibu K.
        • Saito M.
        • et al.
        Quality of life after neck dissection.
        Arch Otolaryngol Head Neck Surg. 2006; 132: 662-666
        • Gane E.M.
        • Michaleff Z.A.
        • Cottrell M.A.
        • et al.
        Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review.
        Eur J Surg Oncol. 2017; 43: 1199-1218
        • McNeely M.L.
        • Parliament M.B.
        • Seikaly H.
        • et al.
        Sustainability of outcomes after a randomized crossover trial of resistance exercise for shoulder dysfunction in survivors of head and neck cancer.
        Physiother Can. 2015; 67: 85-93
        • Baggi F.
        • Santoro L.
        • Grosso E.
        • et al.
        Motor and functional recovery after neck dissection: comparison of two early physical rehabilitation programmes.
        Acta Otorhinolaryngol Ital. 2014; 34: 230-240
        • Clark M.A.
        An evidence-based approach to understanding human movement impairments.
        in: Clark M.A. Lucett S.C. Sutton B.G. NASM essentials of corrective exercise training. Jones & Bartlett Learning, 2014
        • Deng J.
        • Ridner S.H.
        • Murphy B.A.
        Lymphedema in patients with head and neck cancer.
        Oncol Nurs Forum. 2011; 38: E1-10
        • Sember A.
        • Pranskevich C.
        • Scott S.T.
        • et al.
        Prehabilitation for lymphedema in head and neck cancer patients at a community cancer center.
        J Community Support Oncol. 2017; 15: e127-34
        • Singh B.
        • Disipio T.
        • Peake J.
        • et al.
        Systematic review and meta-analysis of the effects of exercise for those with cancer-related lymphedema.
        Arch Phys Med Rehabil. 2016; 97: 302-315
        • Dirix P.
        • Nuyts S.
        • Vander Poorten V.
        • et al.
        The influence of xerostomia after radiotherapy on quality of life: results of a questionnaire in head and neck cancer.
        Support Care Cancer. 2008; 16: 171-179
        • Weber C.
        • Dommerich S.
        • Pau H.W.
        • et al.
        Limited mouth opening after primary therapy of head and neck cancer.
        Oral Maxillofac Surg. 2010; 14: 169-173
        • Rogers L.Q.
        • Courneya K.S.
        • Robbins K.T.
        • et al.
        Physical activity correlates and barriers in head and neck cancer patients.
        Support Care Cancer. 2008; 16: 19-27
        • Midgley A.W.
        • Lowe D.
        • Levy A.R.
        • et al.
        Exercise program design considerations for head and neck cancer survivors.
        Eur Arch Otorhinolaryngol. 2018; 275: 169-179
        • AAOM
        AAOM clinical practice statement: subject: clinical management of cancer therapy-induced salivary gland hypofunction and xerostomia.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 122: 310-312
        • Ligtenberg A.J.
        • Liem E.H.
        • Brand H.S.
        • et al.
        The effect of exercise on salivary viscosity.
        Diagnostics (Basel). 2016; 6 (pii:E40)
        • Nund R.L.
        • Ward E.C.
        • Scarinci N.A.
        • et al.
        The lived experience of dysphagia following non-surgical treatment for head and neck cancer.
        Int J Speech Lang Pathol. 2014; 16: 282-289
        • Lim C.L.
        • Byrne C.
        • Lee J.K.
        Human thermoregulation and measurement of body temperature in exercise and clinical settings.
        Ann Acad Med Singap. 2008; 37: 347-353
        • Wendt D.
        • van Loon L.J.
        • Lichtenbelt W.D.
        Thermoregulation during exercise in the heat: strategies for maintaining health and performance.
        Sports Med. 2007; 37: 669-682
        • Hutcheson K.A.
        • Alvarez C.P.
        • Barringer D.A.
        • et al.
        Outcomes of elective total laryngectomy for laryngopharyngeal dysfunction in disease-free head and neck cancer survivors.
        Otolaryngol Head Neck Surg. 2012; 146: 585-590
        • Hess M.M.
        • Schwenk R.A.
        • Frank W.
        • et al.
        Pulmonary function after total laryngectomy.
        Laryngoscope. 1999; 109: 988-994
        • Kapila M.
        • Deore N.
        • Palav R.S.
        • et al.
        A brief review of voice restoration following total laryngectomy.
        Indian J Cancer. 2011; 48: 99-104
        • Tanaka H.
        Swimming exercise: impact of aquatic exercise on cardiovascular health.
        Sports Med. 2009; 39: 377-387
        • Crevenna R.
        • Schneider B.
        • Mittermaier C.
        • et al.
        Implementation of the Vienna Hydrotherapy Group for Laryngectomees - a pilot study.
        Support Care Cancer. 2003; 11: 735-738
        • Langius J.A.
        • Bakker S.
        • Rietveld D.H.
        • et al.
        Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy.
        Br J Cancer. 2013; 109: 1093-1099
        • Jager-Wittenaar H.
        • Dijkstra P.U.
        • Vissink A.
        • et al.
        Critical weight loss in head and neck cancer – prevalence and risk factors at diagnosis: an explorative study.
        Support Care Cancer. 2007; 15: 1045-1050
        • Silver H.J.
        • Dietrich M.S.
        • Murphy B.A.
        Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy.
        Head Neck. 2007; 29: 893-900
        • Talwar B.
        • Donnelly R.
        • Skelly R.
        • et al.
        Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.
        J Laryngol Otol. 2016; 130: S32-40
        • Buffart L.M.
        • Galvão D.A.
        • Brug J.
        • et al.
        Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions.
        Cancer Treat Rev. 2014; 40: 327-340
        • Lydiatt W.M.
        • Moran J.
        • Burke W.J.
        A review of depression in the head and neck cancer patient.
        Clin Adv Hematol Oncol. 2009; 7: 397-403
        • de Leeuw J.R.
        • de Graeff A.
        • Ros W.J.
        • et al.
        Prediction of depressive symptomatology after treatment of head and neck cancer: the influence of pre-treatment physical and depressive symptoms, coping, and social support.
        Head Neck. 2000; 22: 799-807
        • Morres I.D.
        • Hatzigeorgiadis A.
        • Stathi A.
        • et al.
        Aerobic exercise for adult patients with major depressive disorder in mental health services: a systematic review and meta-analysis.
        Depress Anxiety. 2019; 36: 39-53
        • Stubbs B.
        • Vancampfort D.
        • Rosenbaum S.
        • et al.
        Dropout from exercise randomized controlled trials among people with depression: a meta-analysis and meta regression.
        J Affect Disord. 2016; 190: 457-466
        • Perna F.M.
        • Craft L.
        • Freund K.M.
        • et al.
        The effect of a cognitive behavioral exercise intervention on clinical depression in a multiethnic sample of women with breast cancer: a randomized controlled trial.
        Int J Sport Exerc Psychol. 2010; 8: 36-47
        • Bossi P.
        • Di Pede P.
        • Guglielmo M.
        • et al.
        Prevalence of fatigue in head and neck cancer survivors.
        Ann Otol Rhinol Laryngol. 2019; 128: 413-419
        • Rogers S.N.
        • Thomson F.
        • Lowe D.
        The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.
        Ann R Coll Surg Engl. 2018; 100: 209-215
        • van den Beuken-van Everdingen M.H.
        • de Rijke J.M.
        • Kessels A.G.
        • et al.
        Prevalence of pain in patients with cancer: a systematic review of the past 40 years.
        Ann Oncol. 2007; 18: 1437-1449
        • Lundberg T.R.
        • Howatson G.
        Analgesic and anti-inflammatory drugs in sports: implications for exercise performance and training adaptations.
        Scand J Med Sci Sports. 2018; 28: 2252-2262
      1. Riebe D. Ehrman J.K. Liguori G. ACSM’s guidelines for exercise testing and prescription. 10th ed. Wolters Kluwer Health, 2018
        • Esh C.J.
        • Mauger A.R.
        • Palfreeman R.A.
        • et al.
        Acetaminophen (paracetamol): use beyond pain management and dose variability.
        Front Physiol. 2017; 8: 1092
        • Katz M.R.
        • Irish J.C.
        • Devins G.M.
        • et al.
        Reliability and validity of an observer-rated disfigurement scale for head and neck cancer patients.
        Head Neck. 2000; 22: 132-141
        • Rumsey N.
        • Clarke A.
        • White P.
        • et al.
        Altered body image: appearance-related concerns of people with visible disfigurement.
        J Adv Nurs. 2004; 48: 443-453
        • Carlson R.H.
        Head & neck cancer patients face social isolation, financial burdens.
        Oncol Times. 2016; 38: 25
        • Doherty P.
        • Petre C.
        • Onion N.
        • et al.
        The national audit of cardiac rehabilitation: quality and outcomes report.
        British Heart Foundation, 2018 (Available from URL: https://www.bhf.org.uk/informationsupport/publications/statistics/national-audit-of-cardiac-rehabilitation-quality-and-outcomes-report-2018. [Last accessed 24 March 2020])
        • Nicolotti N.
        • Chuang S.C.
        • Cadoni G.
        • et al.
        Recreational physical activity and risk of head and neck cancer: a pooled analysis within the international head and neck cancer epidemiology (INHANCE) consortium.
        Eur J Epidemiol. 2011; 26 (Erratum in: Eur J Epidemiol 2011; 26:827): 619-628
        • Leitzmann M.F.
        • Koebnick C.
        • Freedman N.D.
        • et al.
        Physical activity and head and neck cancer risk.
        Cancer Causes Control. 2008; 19: 1391-1399
        • Lin C.L.
        • Lee W.T.
        • Ou C.Y.
        • et al.
        Regular recreational physical activity and risk of head and neck cancer.
        BMC Cancer. 2017; 17: 286
        • Capozzi L.C.
        • Nishimura K.C.
        • McNeely M.L.
        • et al.
        The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review.
        Br J Sports Med. 2016; 50: 325-338
        • Kirkham A.A.
        • Bonsignore A.
        • Bland K.A.
        • et al.
        Exercise prescription and adherence for breast cancer: one size does not FITT all.
        Med Sci Sports Exerc. 2018; 50: 177-186
        • Brown J.
        • Shackelford D.Y.
        • Hipp M.L.
        • et al.
        Evaluation of an exercise-based phase program as part of a standard care model for cancer survivors.
        Trans J ACSM. 2019; 4: 45-54
        • Legh-Jones H.
        • Moore S.
        Network social capital, social participation, and physical inactivity in an urban adult population.
        Soc Sci Med. 2012; 74: 1362-1367
        • Forechi L.
        • Mill J.G.
        • Griep R.H.
        • et al.
        Adherence to physical activity in adults with chronic diseases: ELSA-Brasil.
        Rev Saude Publica. 2018; 52: 31
        • Macintyre S.
        Inequalities in health in Scotland: what are they and what can we do about them? Occasional paper No. 17.
        MRC Social & Public Health Sciences Unit, Glasgow2007 (Available from URL: file:///C:/Users/User/Downloads/OP017%20(1).pdf. [Last accessed 25 March 2020])
        • Demark-Wahnefried W.
        • Rogers L.Q.
        • Alfano C.M.
        • et al.
        Practical clinical interventions for diet, physical activity, and weight control in cancer survivors.
        CA Cancer J Clin. 2015; 65: 167-189
      2. UK chief medical officers’ physical activity guidelines.
        2019 (Available from URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf. [Last accessed 25 March 2020])
        • Macmillan Cancer Support
        Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer.
        2019 (Available from URL: https://www.macmillan.org.uk/assets/prehabilitation-guidance-for-people-with-cancer.pdf. [Last accessed 25 March 2020])
        • Rundell K.W.
        • Smoliga J.M.
        • Weiss P.
        Pulmonary disorders and conditions.
        in: Jacobs P.L. NSCA’s essentials of training special populations. Human Kinetics, 2018: 145-179
        • Swank A.M.
        • Sharp C.
        Cardiovascular conditions and disorders.
        in: Jacobs P.L. NSCA’s essentials of training special populations. Human Kinetics, 2018: 181-213
        • Sasso J.P.
        • Eves N.D.
        • Christensen J.F.
        • et al.
        A framework for exercise prescription in exercise-oncology research.
        J Cachexia Sarcopenia Muscle. 2015; 6: 115-124