J. Med. Internet Res. - Multimodal guided self-help exercise program to prevent speech, swallowing, and shoulder problems among head and neck cancer patients: a feasibility study.


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CKGROUND: During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients' quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment.OBJECTIVE: Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients.METHODS: Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently.RESULTS: Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients' diaries and weekly coaching sessions, patients' perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients' perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators.CONCLUSIONS: Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.

Resumo Limpo

ckground week cours chemoradi mani head neck cancer patient endur radiotherapyinduc toxic negat affect patient qualiti life pretreat counsel combin selfhelp exercis provid inform patient possibl prevent speech swallow shoulder problem treatmentobject goal investig feasibl multimod guid selfhelp exercis program entitl head matter chemoradi head neck cancer patientsmethod head neck cancer patient treat primari chemoradi surgeri ask perform head matter home prophylact exercis program offer three differ format aim reduc risk develop speech swallow shoulder problem stiff neck week coach provid speech swallow therapist patient fill diari keep track exercis activ gain insight possibl barrier facilit exercis adher report week coach session analyz coder independentlyresult elig patient patient will particip uptak particip patient patient complet program adher rate major particip moder high level exercis perform exercis perform level signific associ age p gender p tumor subsit p tumor stage p treatment modal p head matter format webbas paper p base patient diari week coach session patient perceiv barrier exercis decreas physic condit treatmentrel barrier emot problem lack motiv social barrier technic problem patient perceiv facilit includ increas physic condit feel motiv social technic facilitatorsconclus head matter multimod guid selfhelp exercis program feasibl head neck cancer patient undergo chemoradi sever barrier decreas physic condit treatmentrel barrier facilit increas physic condit feel motiv identifi provid direct futur studi next step conduct studi investig costeffect head matter speech swallow shoulder function qualiti life

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