Head Matters: a self help program for head and neck cancer
Most head and neck cancer patients undergo 6 weeks of intensive (chemo) radiation therapy (C)RT pre- or post-surgery, leading to overall survival, but also severe side effects like oral mucositis, pain, swallowing problems (55% of patients), trismus, fibrosis in the orofacial region and stiffness and pain in neck and shoulders.
Short term physiological changes, if not managed and prevented correctly, can lead to long term problems with swallowing and other complications like orofacial muscular atrophy, loss of TMJ mobility, shoulder and postural problems. Often poorly recognised by patients and health care professionals alike, resulting in severe functional problems, sometimes presenting years after initial treatment.
A prophylactic exercise program was designed to perform at home with weekly coaching by phone.
Adherence was 64%, and feasibility was good, with 58% of participants performing exercises in all categories at least once a day. Further studies will explore the effectiveness in the long run.
Head and neck cancers (HNC) in the oral cavity, nasopharynx, oropharynx, hypopharynx, and the larynx represent 5% of all cancers (note LR: with different prevalences per continent).
Head Matters was developed in the Netherlands by a multidisciplinary team, consisting of 15 minutes per day of prophylactic exercises to optimize and maintain:
- mobility of head, neck and shoulders
- swallowing function
- vocal health and vocal function, and
- speech function and functional communication.
Information was available in booklet format, DVD and online; weekly coaching was provided to assist and motivate patients.
Overall participation (80%) and adherence (64%) was good, with the majority (58%) of patients exercising daily. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies.
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Head Matters: A promising intervention? What is your experience with home based exercise programs and how do you tackle adherence problems?
> From: Cnossen et al., J Med Internet Res 16 (2015) . All rights reserved to The Author(s). Click here for the Pubmed summary.