Optimising physical fitness in patients receiving chemoradiotherapy for head and neck cancer: a feasibility study

Treatment of advanced Head and Neck Cancer (HNC) with Chemoradiotherapy (CRT)
has a negative impact on physical functioning, body composition, fatigue and
health related quality of life (HRQoL). Unintentional weight loss, of which a
large percentage is lean body mass, often occurs despite intensive nutritional
support. Besides dietary interventions, physical exercise is a prerequisite for
maintaining and rebuilding muscle mass. Current evidence, mainly from research
with breast cancer patients, shows that exercise interventions offered during
chemotherapy treatment have positive effect on physical functioning, fatigue
and HRQoL. HNC patients may also benefit from exercise during CRT, although
studies in this population are scarce. Based on our clinical experience and
(limited) available evidence, we developed an exercise program tailored to
preferences and abilities of HNC patients during CRT.

This study will evaluate feasibility in terms of adherence and compliance to,
patient satisfaction with, and recruitment and retention of, an exercise
intervention during CRT in advanced HNC patients. Secondary objectives are to
obtain preliminary outcome data for (change in) HRQoL, physical performance,
muscle strength,body composition, nutritional status and energy expenditure for
future power calculations.

Two-centre feasibility study using a mixed methods design, including
quantitative measures to obtain data on feasibility, physical performance,
muscle strength and mass, HRQoL outcomes, and qualitative methods
(semi-structured interviews) to gain insight into the participants*
perspectives on feasibility and satisfaction.

The 10-week exercise intervention combines endurance and resistance training,
and starts between one week prior to and two week after the start of 7 weeks of
CRT and continues for 2-4 weeks after completion of CRT. Related to
high-frequent hospital visits and the willingness to do exercises in daily
life, a combined supervised and home-based, moderate-intensity exercise
programme is planned.

Visits scheduled for physical assessment and exercise intervention will be
combined with treatment-related visits if possible.
The patient will be asked threetimes to spend, at most, 30 minutes completing
questionnaires, to perform physical tests and to undergo measurements of body
composition and resting energy expenditure. Furthermore, the patient is asked
to wear an activity tracker, to keep an activity diary and (for two times three
days) a food diary. The patient is also asked to participate in semi-structured
interviews (45 minutes). As in any exercise situation, injuries due to exercise
can occur; to minimize the risk the intensity of the exercise program will be
gradually increased during the study and the program will be supervised by a
physiotherapist. The estimated extra risk for the patient while participating
in this study is low.
Benefits: Possible benefits for participants are a reduction in fatigue and an
increase of physical fitness possibly leading to prosperous recovery and better
HRQoL.