Maintaining or increasing physical activity (PA) may prevent loss of muscle mass and strength after completion of head and neck cancer (HNC) treatment. However, the exercise level of HNC patients may not meet PA guidelines. We aimed to explore HNC survivors' views on PA, their report of PA, and to compare these with objectively measured PA. Combined qualitative and quantitative data of HNC survivors were explored post-treatment. Data from semi-structured interviews, questionnaires, and objective measurements of PA were collected, analyzed, and integrated. This resulted in the identification of five themes related to prioritizing, day-to-day life, intention, positive feelings, and social support, respectively, in nine HNC survivors (male: n = 5; age: 52-67 years). Objectively measured PA levels were sedentary to low. The lack of intention to increase PA may be related to HNC survivors' perception that their current activity level is sufficient, despite low levels of measured PA. While some participants feel they need no help with PA, others are insecure about possible harms. Healthcare professionals may be able to help improve PA in HNC survivors with a tailored approach that reduces fear of harm and helps to incorporate higher intensity PA in daily activities.
Abstract Background: We studied the relationship between trismus (maximum interincisor opening [MIO] ≤35 mm) and the dose to the ipsilateral masseter muscle (iMM) and ipsilateral medial pterygoid muscle (iMPM). Methods: Pretreatment and post-treatment measurement of MIO at 13 weeks revealed 17% of trismus cases in 83 patients treated with chemoradiation and intensity-modulated radiation therapy. Logistic regression models were fitted with dose parameters of the iMM and iMPM and baseline MIO (bMIO). A risk classification tree was generated to obtain optimal cut-off values and risk groups. Results: Dose levels of iMM and iMPM were highly correlated due to proximity. Both iMPM and iMM dose parameters were predictive for trismus, especially mean dose and intermediate dose volume parameters. Adding bMIO, significantly improved Normal Tissue Complication Probability (NTCP) models. Optimal cutoffs were 58 Gy (mean dose iMPM), 22 Gy (mean dose iMM) and 46 mm (bMIO). Conclusions: Both iMPM and iMM doses, as well as bMIO, are clinically relevant parameters for trismus prediction.
Purpose: Head and neck cancer (HNC) treatment often leads to physical and psychosocial impairments. Rehabilitation can overcome these limitations and improve quality of life. The aim of this study is to obtain an overview of rehabilitation care for HNC, and to investigate factors influencing rehabilitation provision, in Dutch HNC centers, and to some extent compare it to other countries. Methods: An online survey, covering five themes: organizational structure; rehabilitation interventions; financing; barriers and facilitators; satisfaction and future improvements, among HNC healthcare- and financial professionals of Dutch HNC centers. Results: Most centers (86%) applied some type of rehabilitation care, with variations in organizational structure. A speech language therapist, physiotherapist and dietitian were available in all centers, but other rehabilitation healthcare professionals in less than 60%. Facilitators for providing rehabilitation services included availability of a contact person, and positive attitude, motivation, and expertise of healthcare professionals. Barriers were lack of reimbursement, and patient related barriers including comorbidity, travel (time), low health literacy, limited financial capacity, and poor motivation. Conclusion: Although all HNC centers included offer rehabilitation services, there is substantial practice variation, both nationally and internationally. Factors influencing rehabilitation are related to the motivation and expertise of the treatment team, but also to reimbursement aspects and patient related factors. More research is needed to investigate the extent to which practice variation impacts individual patient outcomes and how to integrate HNC rehabilitation into routine clinical pathways.
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