Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic-supported randomized controlled trial

Lauren C Capozzi, Harold Lau, Raylene A Reimer, Margaret McNeely, Janine Giese-Davis, S Nicole Culos-Reed, Lauren C Capozzi, Harold Lau, Raylene A Reimer, Margaret McNeely, Janine Giese-Davis, S Nicole Culos-Reed

Abstract

Background: Research on physical activity and nutrition interventions aimed at positively impacting symptom management, treatment-related recovery and quality of life has largely excluded head and neck (HN) cancer populations. This translates into a lack of clinical programming available for these patient populations. HN cancer patients deal with severe weight loss, with more than 70% attributed to lean muscle wasting, leading to extended recovery times, decreased quality of life (QoL), and impaired physical functioning. To date, interventions to address body composition issues have focused solely on diet, despite findings that nutritional therapy alone is insufficient to mitigate changes. A combined physical activity and nutrition intervention, that also incorporates important educational components known to positively impact behaviour change, is warranted for this population. Our pilot work suggests that there is large patient demand and clinic support from the health care professionals for a comprehensive program.

Methods/design: Therefore, the purpose of the present study is to examine the impact and timing of a 12-week PA and nutrition intervention (either during or following treatment) for HN cancer patients on body composition, recovery, serum inflammatory markers and quality of life. In addition, we will examine the impact of a 12-week maintenance program, delivered immediately following the intervention, on adherence, patient-reported outcomes (i.e., management of both physical and psychosocial treatment-related symptoms and side-effects), as well as return to work.

Discussion: This research will facilitate advancements in patient wellness, survivorship, and autonomy, and carve the path for a physical-activity and wellness-education model that can be implemented in other cancer centers.

Trial registration: Current Controlled Trials NCT01681654.

Figures

Figure 1
Figure 1
Study design protocol.

References

    1. Piccirillo J, Costas I, Reichman M, In: SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Volume 2012. Howlader N, Noone AM, Krapcho M, editor. 2011. Chapter 2: Cancers of the Head and Neck. Suervaeylance Epidemiology and End Result Survival Monograph. National Cancer Institute.
    1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137–2150. doi: 10.1200/JCO.2005.05.2308.
    1. Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics 2012. Toronto, ON: Canadian Cancer Society; 2012. pp. 0835–2976.
    1. Andersen C, Adamsen L, Moeller T, Midtgaard J, Quist M, Tveteraas A, Rorth M. The effect of a multidimensional exercise programme on symptoms and side-effects in cancer patients undergoing chemotherapy–the use of semi-structured diaries. Eur J Oncol Nurs. 2006;10(4):247–262. doi: 10.1016/j.ejon.2005.12.007.
    1. Yabroff KR, Lawrence WF, Clauser S, Davis WW, Brown ML. Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst. 2004;96(17):1322–1330. doi: 10.1093/jnci/djh255.
    1. Thomas R, Davies N. Lifestyle during and after cancer treatment. Clin Oncol (R Coll Radiol) 2007;19(8):616–627. doi: 10.1016/j.clon.2007.06.002.
    1. McNeely M, Peddle C, Parliament M, Courneya K. <br />cancer rehabilitation: recommendations for integrating exercise programming in the clinical practice setting. Current Cancer Therapy Reviews. 2006;2(4):35.
    1. Courneya KS, Friedenreich CM. Physical activity and cancer control. Semin Oncol Nurs. 2007;23(4):242–252. doi: 10.1016/j.soncn.2007.08.002.
    1. Mock V, Pickett M, Ropka ME, Muscari Lin E, Stewart KJ, Rhodes VA, McDaniel R, Grimm PM, Krumm S, McCorkle R. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract. 2001;9(3):119–127. doi: 10.1046/j.1523-5394.2001.009003119.x.
    1. van Weert E, Hoekstra-Weebers J, Otter R, Postema K, Sanderman R, van der Schans C. Cancer-related fatigue: predictors and effects of rehabilitation. Oncologist. 2006;11(2):184–196. doi: 10.1634/theoncologist.11-2-184.
    1. Winningham ML, MacVicar MG. The effect of aerobic exercise on patient reports of nausea. Oncol Nurs Forum. 1988;15(4):447–450.
    1. Ravasco P, Monteiro-Grillo I, Camilo ME. Does nutrition influence quality of life in cancer patients undergoing radiotherapy? Radiother Oncol. 2003;67(2):213–220. doi: 10.1016/S0167-8140(03)00040-9.
    1. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol) 2003;15(8):443–450. doi: 10.1016/S0936-6555(03)00155-9.
    1. Cheema BS, Gaul CA. Full-body exercise training improves fitness and quality of life in survivors of breast cancer. J Strength Cond Res. 2006;20(1):14–21.
    1. Kendall AR, Mahue-Giangreco M, Carpenter CL, Ganz PA, Bernstein L. Influence of exercise activity on quality of life in long-term breast cancer survivors. Qual Life Res. 2005;14(2):361–371. doi: 10.1007/s11136-004-1468-5.
    1. Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4(2):87–100. doi: 10.1007/s11764-009-0110-5.
    1. Rogers LQ, Courneya KS, Robbins KT, Malone J, Seiz A, Koch L, Rao K, Nagarkar M. Physical activity and quality of life in head and neck cancer survivors. Support Care Cancer. 2006;14(10):1012–1019. doi: 10.1007/s00520-006-0044-7.
    1. O'Neill M, Heron DE, Flickinger JC, Smith R, Ferris RL, Gibson M. Posttreatment quality-of-life assessment in patients with head and neck cancer treated with intensity-modulated radiation therapy. Am J Clin Oncol. 2011;34(5):478–482.
    1. Lenk K, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle. 2010;1(1):9–21. doi: 10.1007/s13539-010-0007-1.
    1. Gustafsson M, Edvardsson T, Ahlstrom G. The relationship between function, quality of life and coping in patients with low-grade gliomas. Support Care Cancer. 2006;14(12):1205–1212. doi: 10.1007/s00520-006-0080-3.
    1. Taylor JC, Terrell JE, Ronis DL, Fowler KE, Bishop C, Lambert MT, Myers LL, Duffy SA, Bradford CR, Chepeha DB, Hogikyan ND, Prince ME, Teknos TN, Wolf GT. University of Michigan Head and Neck Cancer Team. Disability in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2004;130(6):764–769. doi: 10.1001/archotol.130.6.764.
    1. Silver HJ, Dietrich MS, Murphy BA. 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(10):893–900. doi: 10.1002/hed.20607.
    1. Richey LM, George JR, Couch ME, Kanapkey BK, Yin X, Cannon T, Stewart PW, Weissler MC, Shores CG. Defining cancer cachexia in head and neck squamous cell carcinoma. Clin Cancer Res. 2007;13(22 Pt 1):6561–6567.
    1. Couch M, Lai V, Cannon T, Guttridge D, Zanation A, George J, Hayes DN, Zeisel S, Shores C. Cancer cachexia syndrome in head and neck cancer patients: part I. Diagnosis, impact on quality of life and survival, and treatment. Head Neck. 2007;29(4):401–411. doi: 10.1002/hed.20447.
    1. MacDonald N, Easson AM, Mazurak VC, Dunn GP, Baracos VE. Understanding and managing cancer cachexia. J Am Coll Surg. 2003;197(1):143–161. doi: 10.1016/S1072-7515(03)00382-X.
    1. Al-Majid S, Waters H. The biological mechanisms of cancer-related skeletal muscle wasting: the role of progressive resistance exercise. Biol Res Nurs. 2008;10(1):7–20. doi: 10.1177/1099800408317345.
    1. Schmitz KH, Ahmed RL, Hannan PJ, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomarkers Prev. 2005;14(7):1672–1680. doi: 10.1158/1055-9965.EPI-04-0736.
    1. Brown JK. A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. Oncol Nurs Forum. 2002;29(3):517–532. doi: 10.1188/02.ONF.517-532.
    1. Ledeboer QC, Velden LA, Boer MF, Feenstra L, Pruyn JF. Physical and psychosocial correlates of head and neck cancer: an update of the literature and challenges for the future (1996-2003) Clin Otolaryngol. 2005;30(4):303–319. doi: 10.1111/j.1365-2273.2005.01035.x.
    1. Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, Baggio V, Lamon S, Babare R, Rosti G, Giometto M, Boscolo-Rizzo P, Kiwanuka E, Tessarin M, Caregaro L, Marchiori C. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer. 2010;18(7):837–845. doi: 10.1007/s00520-009-0717-0.
    1. McMahon K, Brown JK. Nutritional screening and assessment. Semin Oncol Nurs. 2000;16(2):106–112. doi: 10.1053/on.2000.5549.
    1. Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, McTiernan A, Rock CL, Thompson C, Gansler T, Andrews KS. 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee, American Cancer Society. Nutrition and physical activity during and after cancer treatment: an American cancer society guide for informed choices. CA Cancer J Clin. 2006;56(6):323–353. doi: 10.3322/canjclin.56.6.323.
    1. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10(3):141–146.
    1. Courneya KS, Friedenreich CM. Determinants of exercise during colorectal cancer treatment: an application of the theory of planned behavior. Oncol Nurs Forum. 1997;24(10):1715–1723.
    1. Courneya KS, Friedenreich CM. Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med. 1997;3(3):215–226. doi: 10.1089/acm.1997.3.215.
    1. Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993;25(1):81–91. doi: 10.1249/00005768-199301000-00012.
    1. Radloff L. <br />The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385. doi: 10.1177/014662167700100306.
    1. Hopko DR, Bell JL, Armento ME, Robertson SM, Hunt MK, Wolf NJ, Mullane C. The phenomenology and screening of clinical depression in cancer patients. J Psychosoc Oncol. 2008;26(1):31–51.
    1. Chang VT, Hwang SS, Feuerman M. Validation of the Edmonton symptom assessment scale. Cancer. 2000;88(9):2164–2171. doi: 10.1002/(SICI)1097-0142(20000501)88:9<2164::AID-CNCR24>;2-5.
    1. Tremblay A, Sevigny J, Leblanc C, Bouchard C. The reproducibility of a three-day dietary record. Nutr Res. 1983;3(6):819–830. doi: 10.1016/S0271-5317(83)80035-9.
    1. Chicago Dietetic Association, South Suburban Dietetic Association (Ill.) Dietitian's of Canada. 6. Chicago, Ill: American Dietetic Association; 2000. (Manual of clinical dietetics).
    1. Lau DC. Obesity Canada Clinical Practice Guidelines Steering Committee and Expert Panel. Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ. 2007;176(8):1103–1106. doi: 10.1503/cmaj.070306.
    1. Canadian Society for Exercise Physiology. The Canadian physical activity, fitness & lifestyle approach (CPAFLA): CSEP- health and fitness program's health-related appriasal and counselling strategy. 3. Ottawa, Ontario: Canadian Society for Exercise Physiology; 2003.
    1. Rikli R, Jones J. Senior fitness test manual. Champaign Il: Human Kinetics; 2001.
    1. Fleishman E. The structure and measurement of physical fitness. Oxford, England: Prentice-Hall; 1964.
    1. Brasel KJ. Quality-of-life assessment in palliative care. Am J Hosp Palliat Care. 2007;24(3):231–235. doi: 10.1177/1049909107301778.
    1. Seruga B, Zhang H, Bernstein LJ, Tannock IF. Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer. 2008;8(11):887–899. doi: 10.1038/nrc2507.
    1. Baldwin C. Nutritional support for malnourished patients with cancer. Curr Opin Support Palliat Care. 2011;5(1):29–36. doi: 10.1097/SPC.0b013e328343a05d.
    1. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191. doi: 10.3758/BF03193146.
    1. Buchner A, Erdfelder E, Faul F. Handbuch quantitative methoden. Weinheim: Psychologie Verlags Union; 1996.

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