Progressive resistance training in cachectic head and neck cancer patients undergoing radiotherapy: a randomized controlled pilot feasibility trial

Manuel Grote, Cornelius Maihöfer, Martin Weigl, Patricia Davies-Knorr, Claus Belka, Manuel Grote, Cornelius Maihöfer, Martin Weigl, Patricia Davies-Knorr, Claus Belka

Abstract

Background: Cancer cachexia is a prevalent symptom of head and neck neoplasms. The reduction in skeletal muscle mass is one of the main characteristics which can lead to poor physical functioning. The purposes of this pilot randomized controlled trial were to determine the feasibility of progressive resistance training in cachectic head and neck cancer patients during radiotherapy and to explore possible risks and benefits.

Methods: Twenty cachectic participants with head and neck cancer receiving radiation were randomized to obtain either a machine supported progressive resistance training (n = 10) or usual care (n = 10). The training took place 3 times weekly for 30 min. Intervention included 3 exercises for major muscle groups with 8-12 repetition maximum for 3 sets each. Bioelectrical impedance analysis, hand-held dynamometry, Six-Minute Walk Test and standardized questionnaires for fatigue and quality of life were used for evaluating outcomes at baseline before radiotherapy (t1), after 7 weeks of radiotherapy (t2) and 8 weeks after the end of radiotherapy (t3).

Results: All participants (n = 20) completed the trial. No serious adverse events occurred. At the initial assessment the cachectic patients had already lost 7.1 ± 5.2% of their body weight. General fatigue (score 10.7 ± 3.3) and reduced quality of life (score 71.3 ± 20.6) were prevalent in cachectic head and neck cancer patients even before radiotherapy. An average improvement of weight loading for leg press (+ 19.0%), chest press (+ 29.8%) and latissimus pull-down (+ 22.8%) was possible in the intervention group. Participants had at least 13 training sessions. The outcome measures showed nonsignificant changes at t2 and t3, but a trend for a better course of general fatigue and quality of life at t2 in the intervention group.

Conclusions: Despite advanced tumor stage and burdensome treatment the intervention adherence is excellent. Progressive resistance training in cachectic head and neck cancer patients during radiotherapy seems to be safe and feasible and may have beneficial effects of general fatigue and quality of life.

Trial registration: ClinicalTrials.gov, NCT03524755 . Registered 15 May 2018 - Retrospectively registered.

Keywords: Cachexia; Feasibility study; Head and neck cancer; Radiotherapy; Randomized controlled trial; Resistance training.

Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant flow chart
Fig. 2
Fig. 2
Weight loading progression during the first 13 training sessions for the equipment supported exercises

References

    1. Stewart BWW, Christopher P. World Cancer Report 2014: Lyon: International Agency for Research on Cancer/world health organization; 2014. 10.1603/EC14197, .
    1. Kaatsch, P., et al., Krebs in Deutschland 2009/2010–9. Ausgabe, 2013. 2013, Robert Koch-Institut.
    1. Radoi L, Luce D. A review of risk factors for oral cavity cancer: the importance of a standardized case definition. Community Dent Oral Epidemiol. 2013;41(2):97–109. doi: 10.1111/j.1600-0528.2012.00710.x.
    1. Turati F, et al. A meta-analysis of alcohol drinking and oral and pharyngeal cancers: results from subgroup analyses. Alcohol Alcohol. 2013;48(1):107–118. doi: 10.1093/alcalc/ags100.
    1. Chaturvedi AK, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol. 2013;31(36):4550–4559. doi: 10.1200/JCO.2013.50.3870.
    1. Jereczek-Fossa BA, et al. Fatigue during head-and-neck radiotherapy: prospective study on 117 consecutive patients. Int J Radiat Oncol Biol Phys. 2007;68(2):403–415. doi: 10.1016/j.ijrobp.2007.01.024.
    1. Fingeret MC, et al. The nature and extent of body image concerns among surgically treated patients with head and neck cancer. Psycho-Oncology. 2012;21(8):836–844. doi: 10.1002/pon.1990.
    1. Nugent B, Lewis S, O'Sullivan Joe M. Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev. 2013. 10.1002/14651858.CD007904.pub3.
    1. Semple C, et al. Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev. 2013. 10.1002/14651858.CD009441.pub2.
    1. Carvalho Alan PV, Vital Flávia MR, Soares Bernardo GO. Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer. Cochrane Database Syst Rev. 2012. 10.1002/14651858.CD008693.pub2.
    1. Bensadoun RJ, et al. A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer. 2010;18(8):1033–1038. doi: 10.1007/s00520-010-0847-4.
    1. Platteaux N, et al. Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia. 2010;25(2):139–152. doi: 10.1007/s00455-009-9247-7.
    1. Vissink A, et al. Clinical management of salivary gland hypofunction and xerostomia in head-and-neck cancer patients: successes and barriers. Int J Radiat Oncol Biol Phys. 2010;78(4):983–991. doi: 10.1016/j.ijrobp.2010.06.052.
    1. Rodriguez-Caballero A, et al. Cancer treatment-induced oral mucositis: a critical review. Int J Oral Maxillofac Surg. 2012;41(2):225–238. doi: 10.1016/j.ijom.2011.10.011.
    1. Couch M, et al. 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. George J, et al. Cancer cachexia syndrome in head and neck cancer patients: part II. Pathophysiology Head Neck. 2007;29(5):497–507. doi: 10.1002/hed.20630.
    1. Chandu A, Smith AC, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg. 2006;64(3):495–502. doi: 10.1016/j.joms.2005.11.028.
    1. Fregnani ER, et al. IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients. Radiat Oncol. 2016;11(1):116. doi: 10.1186/s13014-016-0694-7.
    1. Askoxylakis V, et al. Intensity modulated radiation therapy (IMRT) for sinonasal tumors: a single center long-term clinical analysis. Radiat Oncol. 2016;11:17. doi: 10.1186/s13014-016-0595-9.
    1. Straube C, et al. Reduced volume SIB-IMRT/IGRT to head and neck cancer in elderly and frail patients: outcome and toxicity. Radiat Oncol. 2016;11(1):133. doi: 10.1186/s13014-016-0711-x.
    1. Kiang A, et al. Long-term disease-specific and cognitive quality of life after intensity-modulated radiation therapy: a cross-sectional survey of nasopharyngeal carcinoma survivors. Radiat Oncol. 2016;11(1):127. doi: 10.1186/s13014-016-0704-9.
    1. Orth M, et al. Current concepts in clinical radiation oncology. Radiat Environ Biophys. 2014;53(1):1–29. doi: 10.1007/s00411-013-0497-2.
    1. Speck RM, et al. 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. Pekmezi DW, Demark-Wahnefried W. Updated evidence in support of diet and exercise interventions in cancer survivors. Acta Oncol. 2011;50(2):167–178. doi: 10.3109/0284186X.2010.529822.
    1. Grabenbauer A, et al. Feasibility of a 12-month-exercise intervention during and after radiation and chemotherapy in cancer patients: impact on quality of life, peak oxygen consumption, and body composition. Radiat Oncol. 2016;11:42. doi: 10.1186/s13014-016-0619-5.
    1. Jager-Wittenaar H, et al. Critical weight loss in head and neck cancer--prevalence and risk factors at diagnosis: an explorative study. Support Care Cancer. 2007;15(9):1045–1050. doi: 10.1007/s00520-006-0212-9.
    1. Bozzetti F. Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer. 2009;17(3):279–284. doi: 10.1007/s00520-008-0476-3.
    1. Carson JA, Baltgalvis KA. Interleukin 6 as a key regulator of muscle mass during cachexia. Exerc Sport Sci Rev. 2010;38(4):168–176. doi: 10.1097/JES.0b013e3181f44f11.
    1. Douglas E, McMillan DC. Towards a simple objective framework for the investigation and treatment of cancer cachexia: the Glasgow prognostic score. Cancer Treat Rev. 2014;40(6):685–691. doi: 10.1016/j.ctrv.2013.11.007.
    1. Parmar MP, Swanson T, Jagoe RT. Weight changes correlate with alterations in subjective physical function in advanced cancer patients referred to a specialized nutrition and rehabilitation team. Support Care Cancer. 2013;21(7):2049–2057. doi: 10.1007/s00520-013-1762-2.
    1. Smets EM, et al. Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer. 1996;73(2):241–245. doi: 10.1038/bjc.1996.42.
    1. Chang VT, Xia Q, Kasimis B. The functional assessment of anorexia/Cachexia therapy (FAACT) appetite scale in veteran cancer patients. J Support Oncol. 2005;3(5):377–382.
    1. Ribaudo JM, et al. Re-validation and shortening of the functional assessment of anorexia/Cachexia therapy (FAACT) questionnaire. Qual Life Res. 2000;9(10):1137–1146. doi: 10.1023/A:1016670403148.
    1. Schmidt K, et al. Validity of the six-minute walk test in cancer patients. Int J Sports Med. 2013;34(7):631–636. doi: 10.1055/s-0032-1323746.
    1. Knols RH, et al. Hand-held dynamometry in patients with haematological malignancies: measurement error in the clinical assessment of knee extension strength. BMC Musculoskelet Disord. 2009;10:31. doi: 10.1186/1471-2474-10-31.
    1. Kyle UG, et al. Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr. 2004;23(5):1226–1243. doi: 10.1016/j.clnu.2004.06.004.
    1. Conn VS, et al. A meta-analysis of exercise interventions among people treated for cancer. Support Care Cancer. 2006;14(7):699–712. doi: 10.1007/s00520-005-0905-5.
    1. Knols RH, et al. Isometric strength measurement for muscle weakness in cancer patients: reproducibility of isometric muscle strength measurements with a hand-held pull-gauge dynamometer in cancer patients. Support Care Cancer. 2002;10(5):430–438. doi: 10.1007/s00520-002-0343-6.
    1. Stone CA, et al. Hand-held dynamometry: tester strength is paramount, even in frail populations. J Rehabil Med. 2011;43(9):808–811. doi: 10.2340/16501977-0860.
    1. Mänttäri Ari, Suni Jaana, Sievänen Harri, Husu Pauliina, Vähä-Ypyä Henri, Valkeinen Heli, Tokola Kari, Vasankari Tommi. Six-minute walk test: a tool for predicting maximal aerobic power (VO2 max) in healthy adults. Clinical Physiology and Functional Imaging. 2018;38(6):1038–1045. doi: 10.1111/cpf.12525.
    1. LeBlanc TW, et al. Validation and real-world assessment of the functional assessment of anorexia-Cachexia therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS) Support Care Cancer. 2015;23(8):2341–2347. doi: 10.1007/s00520-015-2606-z.
    1. Sun G, et al. Comparison of multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of percentage body fat in a large, healthy population. Am J Clin Nutr. 2005;81(1):74–78. doi: 10.1093/ajcn/81.1.74.
    1. Isenring E, et al. The impact of nutrition support on body composition in cancer outpatients receiving radiotherapy. Acta Diabetol. 2003;40(Suppl 1):S162–S164. doi: 10.1007/s00592-003-0054-6.
    1. Ida S, et al. Changes in body composition secondary to neoadjuvant chemotherapy for advanced esophageal cancer are related to the occurrence of postoperative complications after esophagectomy. Ann Surg Oncol. 2014;21(11):3675–3679. doi: 10.1245/s10434-014-3737-z.
    1. Takekiyo T, et al. Effect of exercise therapy on muscle mass and physical functioning in patients undergoing allogeneic hematopoietic stem cell transplantation. Support Care Cancer. 2015;23(4):985–992. doi: 10.1007/s00520-014-2425-7.
    1. Johns N, Stephens NA, Fearon KC. Muscle wasting in cancer. Int J Biochem Cell Biol. 2013;45(10):2215–2229. doi: 10.1016/j.biocel.2013.05.032.
    1. Cramp, F. and J. Byron-Daniel, Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev, 2012. 11: p. Cd006145.
    1. Mishra SI, et al. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012;(8):Cd008465. 10.1002/14651858.CD008465.pub2.
    1. Locher JL, et al. Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: a comprehensive review and call for evidence-based medicine. JPEN J Parenter Enteral Nutr. 2011;35(3):365–374. doi: 10.1177/0148607110377097.

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