Factors influencing physical activity in individuals with head and neck cancer: a scoping review.

OBJECTIVES: Higher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types have a sedentary or low-activity lifestyle. Limited knowledge exists regarding the factors that influence PA in this group. Therefore, we reviewed and mapped the available literature on factors that may influence PA in people with HNC. DESIGN: We conducted a scoping review based on the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for scoping reviews. DATA SOURCES: CINHAL, the Cochrane Library, EMBASE, PsycINFO, MEDLINE and Scopus were searched from inception to July 2023. ELIGIBILITY CRITERIA: We included qualitative and quantitative studies that stated factors such as barriers, facilitators, beliefs, perceptions and views influencing PA in individuals with HNC. Furthermore, views and recommendations of healthcare professionals involved in the care of people affected by HNC and researchers in this domain were eligible for data extraction. DATA EXTRACTION AND SYNTHESIS: Data were extracted and synthesised by one reviewer according to the predefined items including characteristics, barriers, facilitators, beliefs, perceptions and views of people being affected and views and recommendations of experts. Quantitative data were charted descriptively, and qualitative data were analysed and summarised using a basic content analysis approach. RESULTS: Of the 1351 publications, we included 19 in our review. Publications mainly focused on barriers to PA, with some studies reporting facilitators and collecting data on patients' and healthcare professionals' views on PA. Most research teams made recommendations for promoting PA in people with HNC.Characteristics associated with activity levels included age, cancer type and stage, morbidity level and attitude towards being active. Prevalent barriers consisted of health-related factors, including fatigue, pain and nutritional issues, alongside personal and environmental impediments such as time constraints, lack of interest or motivation. Facilitating factors for PA included perceived or experienced mental and health-related benefits. Consensus among patients, healthcare professionals and researchers highlighted the necessity for enhanced information and education, emphasising individualised approaches to promote PA throughout the cancer continuum. CONCLUSIONS: Numerous factors affect PA in individuals with HNC. Future research should concentrate on screening and addressing risk factors for sedentary behaviour and activity barriers and on optimal design and delivery of interventions to incorporate PA promotion into the care pathway.

Effect of combined therapies including nutrition and physical exercise in advanced cancer patients: A pooled analysis.

Background and aims: Although many cancer patients suffer from malnutrition or cancer cachexia, there is no standard of care so far due to limited intervention trials. Pooled data from two combined trials were analyzed regarding nutritional status and survival time. Materials and methods: Data from two trials with advanced cancer patients were included. In both trials, patients in the intervention group received at least three times nutritional counseling and supervised training sessions. Patients in the control group continued being treated according to usual care. Nutritional status was measured using BMI, body composition and handgrip strength. Survival time was analyzed using the Cox proportional hazard model with the period between the beginning of the trial and death as underlying time scale. Results: 68 men (61.8%) and 42 women (38.2%) were randomized either to the intervention (n = 56) or the control (n = 54) group. The inter-group difference for changes in BMI and body composition was not statistically significant after 3 months. Handgrip strength improved significantly from 34.4 ± 10.2 kg to 36.3 ± 9.9 kg at 3 months in the intervention compared to 33.9 ± 9.2 kg to 34.9 ± 9.1 kg in the control group (p = 0.006). The analysis of survival time showed no inter-group difference for all patients. A detailed analysis for different diagnoses showed that in patients with lung cancer, the covariates "CRP value," "days from first diagnosis to randomization" as well as "gender" were significantly associated with survival time. Patients with higher CRP value had a shorter survival time and female patients had a shorter survival time than male patients in our analysis. In addition, patients with pancreatic cancer randomized to the control group had a 20% shorter survival time than those in the intervention group (p = 0.048). Conclusion: The pooled analysis showed a significant improvement of handgrip strength in advanced cancer patients through the implementation of a combined therapy. Handgrip strength is of prognostic significance in hospitalized patients due to its association with mortality and morbidity. However, no improvements in further tests were detected. There is great need for further investigations examining the effect of nutritional and exercise therapy on survival time with focus on different cancer diagnoses.

Effect of a leucine-rich supplement in combination with nutrition and physical exercise in advanced cancer patients: A randomized controlled intervention trial.

BACKGROUND & AIMS: Branched-chain amino acids and specifically leucine stimulate protein synthesis and may overcome an anabolic resistance in malnourished and cachectic cancer patients. Therefore, we hypothesized that the addition of a leucine-rich supplement to a multimodal therapy improves physical function in advanced cancer patients. METHODS: This single center, randomized trial examined a multimodal therapy over 12 weeks in patients with advanced cancer. The intervention group received a leucine-rich supplement in combination with a nutrition and physical exercise program. Patients in the control group received standard care. Primary endpoint was physical function measured with the short physical performance battery (SPPB). Secondary endpoints were further physical performance tests, nutritional status, dietary intake, fatigue, quality of life (QoL) and clinical course. All parameters were evaluated at baseline, after three and at six months. RESULTS: 23 women and 29 men with an average age of 63.1 ± 10.3 (range 30-81) years and BMI of 25.4 ± 4.7 kg/m2 were randomized either to the intervention (n = 27) or control (n = 25) group. Patients in the intervention group joined a mean of 28.4 ± 7.4 training sessions (78.8%), 3.2 ± 0.6 nutritional counselling sessions (106.7%) and consumed on average 85.4 ± 33.2 supplements (71.2%). Inter-group comparison showed no significant difference in the primary endpoint SPPB after three (p = 0.184, 95% CI: -1.43, 0.29) and six months (p = 0.986, 95% CI: -0.87, 0.89). However, the secondary endpoint handgrip strength improved significantly from 35.8 ± 9.8 kg at baseline to 37.6 ± 10.0 kg at three months in the intervention group compared to 35.7 ± 8.8 kg at baseline to 34.0 ± 10.1 kg at three months in the control group (p < 0.001, 95% CI: -6.03, -1.97). The inter-group difference for changes in the further secondary endpoints nutritional status, dietary intake, fatigue, QoL and clinical course showed a trend towards an improvement in the intervention group, however, the differences were not significant after three and six months. CONCLUSIONS: The present trial demonstrated a good adherence to the multimodal therapy as well as a significant improvement of handgrip strength in patients with advanced cancer. In addition, the clinical course data underlined the safety of the program. However, we failed to show significant improvements in further physical performance tests, especially our primary outcome factor SPPB as well as nutritional status, fatigue or QoL.