The effectiveness of a comprehensive supervised exercise program (CSEP) during radiotherapy in head and neck cancer patients on health-related quality of life
In February 2022, a new research project started at the University Hospitals of Leuven and the Department of Oncology and Rehabilitation Sciences of KU Leuven. The study is performed with the support of a scientific grant obtained by Kom op tegen Kanker.
With over 500 000 annually reported cases worldwide head and neck cancer (HNC) is the seventh most common type of cancer worldwide (1, 2). Besides the physical and psychosocial consequences of the cancer treatment, HNC patients typically start their cancer treatment already with poor physical and psychosocial health, possibly reducing quality of life even more (3, 4). In order to prevent worsening of functioning and limit the physical impact of the HNC treatment, a comprehensive supervised exercise program (CSEP) may be beneficial early during treatment.
Therefore, this randomized controlled trial investigates the effectiveness of an exercise program during HNC treatment on health-related quality of life. Overall, this project explores whether an exercise program during HNC treatment has added value compared to standard care alone. Up to now, it is not yet investigated properly whether the general guidelines for exercise programs are translatable to the HNC population. Given the specific physical and psychosocial needs in the HNC population, this should be investigated properly (3-6).
The recruitment of the clinical trial started in January 2022. Potentially eligible participants are approached and recruited during the consultation at the department of Radiation Oncology of the University Hospital of Leuven. The recruitment is ongoing with up to now 39 out of the 150 participants included. After obtaining informed consent, patients will randomly be assigned to receive either the usual care + CSEP (intervention group) or usual care only (control group). Both groups will receive the current standard of supportive care including guidance by a dietician on oral food intake, smoking cessation counseling, speech and language therapist guidance concerning swallowing exercises, follow up by our social workers and psychologists, follow up by nurse care team. The intervention group will receive the CSEP, additional to usual supportive care. The CSEP consists of a one-hour individualized exercise program three times a week, starting within 1 week after the start of the radiotherapy, taking into account motivation, personal goals and pre-diagnostic activity level. The supervised exercise sessions take place in the exercise room of the department of Physical Medicine and Rehabilitation of the University Hospitals of Leuven. The exercise sessions consist of a combination of 30 minutes aerobic training at moderate intensity (walking, cycling) and 30 minutes strength training and stretching (exercises for all major muscle groups and in particular the upper limb, head and neck region). The sessions are held in the hospital twice a week in week 1 to 6 and once a week in week 7 to 12, while the remaining one or two sessions are performed independently at home. During the maintenance program (from week 13), patients exercise at home with a monthly tele-consultation. Patients have online access to videos of exercises to be performed at home. Kaat Van Aperen, the PhD student working on this project, supervises the exercise sessions at the hospital, the tele-consultations during the maintenance program and coordinates the project.
In the near future, a feasibility study on a CSEP during radiotherapy in head and neck cancer patients will be conducted in a small group of the participants of the effectiveness study. The barriers and facilitators for participating in a CSEP starting from diagnosis should be properly investigated. The findings can be used by professionals to encourage engagement with and adherence to exercise programs during HNC treatment.
Kaat Van Aperen
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