Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy

Abstract

ObjectivesPatients with head and neck squamous cell carcinoma undergoing concomitant chemoradiotherapy (CCRT) frequently experience weight loss, especially loss of lean body mass (LBM), and reduced functional performance. This study investigated whether a 12‐week hospital‐based progressive resistance training (PRT) program during CCRT is feasible in the clinical setting before planning initiation of a larger randomized study which is the long‐term goal.Study designProspective pilot study.MethodsTwelve patients receiving CCRT were planned to attend a 12‐week PRT program. Primary endpoint was feasibility measured as attendance to training sessions. Secondary endpoints included changes in functional performance, muscle strength, and body composition measured by Dual‐energy X‐ray Absorptiometry (DXA) scans. Furthermore, sarcomeric protein content, pentose phosphate pathway (PPP) activity, and glycolysis were determined in muscle biopsies.ResultsTwelve patients with p16 positive oropharyngeal cancer were enrolled. The primary endpoint was met with 9 of the 12 patients completing at least 25 of 36 planned training sessions. The mean attendance rate was 77%. Functional performance was maintained during the treatment period and increased during follow‐up (p < 0.01). Strength was regained after an initial dip during treatment, paralleling responses in LBM and sarcomeric protein content. LBM began to increase immediately after treatment. The PPP was upregulated after the treatment period, whilst glycolysis remained unchanged. No adverse events were related to PRT and in questionnaires, patients emphasized the social and psychological benefits of attendance.ConclusionProgressive resistance training is feasible and safe during CCRT for head and neck cancer, and is associated with high patient satisfaction.Level of Evidence2C.

Body Composition Evaluation in Head and Neck Cancer Patients: A Review

“…A total of 41 studies were included in this review, with different methodologies: one systematic review (16), one consensus paper (17), one data descriptor (18), nine randomized trials (6, 11, 19–25), 12 cohort studies (3, 7–9, 15, 26–32), three randomized controlled trials (4, 5, 33), three cross-sectional studies (34–36), two prospective non-randomized trials (37, 38), eight retrospective studies (10, 12–14, 39–42), and one case-control study (43).…”

“…Some authors suggest that ~70% of the weight loss identified in HNC patients corresponds to lean body mass (LBM) (4–6). Loss of LBM has been presented as an important prognostic factor (4, 7) with influence in treatment toxicities (8), risk of recurrence and mortality (9), impaired muscle strength, a decline in physical activity and functional performance (6). It seems that, in HNC patients, LBM depletion may provide additional and relevant information as an outcome predictor beside weight loss alone and furthermore, high BMI, and low LBM may associate with each other (10).…”

Association between weight loss and clinical-pathologic factors in oncological patients in chemotherapy treatment: a longitudinal study

“…Head and neck tumor demonstrate a high prevalence when related to severe and not severe WL, with a discrepancy of 37 and 15 individual. Patients with head and neck cancer often present WL, especially the loss of lean mass and functional performance (Lonkvist et al, 2017). In Webster et al (2018), study, with a population composed of 666 patients diagnosed with oropharyngeal cancer during the years 2004 to 2017, the patients presented 30,3% WL during oncological treatment.…”

Toxicities Caused by Head and Neck Cancer Treatments and Their Influence on the Development of Malnutrition: Review of the Literature

“…Increase in skeletal muscle and lean body mass [41][42][43][44] Improvement in fatigue and acute QoL symptom management.…”