Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Objective: Preoperative physical activity is associated with improved postoperative outcomes in various cancer populations, but its impact on head and neck cancer patients remains understudied. This study aims to evaluate the effects of an exercise prehabilitation program on postoperative mobility and outcomes after head and neck cancer surgery.
Study design: Single-institution, randomized controlled trial involving patients undergoing head and neck cancer surgery with free flap reconstruction.
Methods: Participants were randomized into either a 2-5 week exercise prehabilitation group or a control group. Data collection is ongoing, with a goal of 20 patients per group. Baseline testing included 5-minute sit-to-stand and 6-minute walk tests. The prehabilitation program involved walking 2,000-4,000 steps per day (measured using Fitbit devices) and strength exercises performed three times weekly. Postoperative outcomes included daily step counts, complications, length of stay (LOS), discharge disposition, pain scores, and European Organization for Research and Treatment of Cancer (EORTC) QLQ-30 quality of life (QOL), Patient Health Questionnaire-9 (PHQ-9) depression and program satisfaction surveys.
Analysis: Mann-Whitney U tests and t-tests were used to compare continuous variables. Fischer’s exact tests were applied for categorical outcomes.
Results: Preliminary analysis of the ongoing study involved 20 patients (mean age 62±13 years, 50% male), divided into prehabilitation (n=11) and control (n=9) groups. The most common cancer was oral cavity squamous cell carcinoma, reconstructed with anterolateral thigh free flaps. Preoperative Fitbit adherence was >95%. All prehabilitation patients met >80% of their daily walking and exercise goals. Preoperative and postoperative median step counts did not differ significantly between prehabilitation and control groups (5,707 [4797-7743] vs. 4,803 [4300-6488] pre-op, p=0.82; 1,176 [342-2604] vs. 650 [458-947] post-op, p=0.33). There were no differences in postoperative complications (3 vs. 3, p=1.00), average LOS (6.36±1.36 vs. 7±2.75 days, p=0.88), EORTC global QOL scores (4.55±0.82 vs. 4.22±1.54, p=0.29), PSQ-9 scores (7.82±5.46 vs. 6.56±4.13, p=0.88), pain scores (3.24±1.52 vs. 3.14±2.38, p=1.00). A post-hoc analysis showed a trend towards higher median post-op step counts among those who walked more than 5,000 steps per day before surgery compared to those who walked less than 5,000 steps per day (1,407 [639-2706] vs. 640 [391-750], p= 0.07). This difference was significant, however, by POD4 (2148 [1083-4063] vs. 421 [332-643], p=0.03). Survey results demonstrated overall high satisfaction with the Fitbit (8.7/10) and exercise program (8.3/10), and strong likelihood to recommend this program (7.5/10).
Conclusions: Preliminary findings of this study show no significant difference in postoperative step counts or other outcomes between control and prehabilitation groups. However, those who walked more than 5,000 steps per day before surgery were able to walk 1,700 more steps by POD4 compared to those who were sedentary. Additionally, adherence to the Fitbit program and prehabilitation exercises was high, with positive patient feedback. This ongoing study currently suggests that a preoperative goal of 5,000 steps per day may facilitate earlier postoperative mobility. This study also demonstrates the feasibility of preoperative interventions in head and neck cancer patients, as patients and their families are enthusiastic about strategies to optimize and increase agency in their recovery process.