Exercise Prehabilitation In Head And Neck Cancer Patients: Preliminary Results Of The FIT4TREAT Trial

Radical chemoradiotherapy (CRT) in head and neck cancer patients (HNC) is associated with several treatment-related toxicities, which have a negative impact on physical fitness and health-related quality of life (HRQoL). PURPOSE: To analyze the impact of an exercise prehabilitation (EP) program on functional capacity and HRQoL in HNC patients proposed for CRT. METHODS: In this randomized-controlled trial (NCT05418842), 33 HNC patients were randomly allocated to EP or usual care (UC). The EP group participated in a combined aerobic and resistance training program (60 minutes), three sessions/week, from randomization to the beginning of radiotherapy (RT). Aerobic capacity (6-minute walk test, 6MWT), isometric handgrip muscle strength (dynamometer), lower limb functional capacity (30 seconds chair sit-to-stand test, STS), and HRQoL (EORTC QLQ-C30 and EORTC QLQ-HN43) were assessed at diagnosis (baseline), and 1-3 days before starting RT. RESULTS: Twenty-nine patients completed both pre-treatment assessments, 14 in the EP (62.5 ± 8.6 years, 92.9% men) and 15 in the UC (65.1 ± 10.3 years, 93.3% men) group. The median length of the pre-treatment phase was 28 days (IQR, 24-40 days) and 29 days (IQR, 23-32 days) in the EP and UC groups (p = 0.947), respectively. Patients adhered to 62.9 ± 37.2% of exercise sessions. No differences between groups were observed at baseline (M0). There were group differences in 30 seconds STS performance over time (EP: Δ4.6 ± 4.3 vs UC: Δ-0.1 ± 2.5 repetitions, p = 0.002). No differences between groups were observed for the change in the 6MWT (p = 0.070); handgrip muscle strength (dominant hand: p = 0.569; non-dominant hand, p = 0.888); or any domain of HRQoL except for body image (p = 0.004) and insomnia (p = 0.034), both favoring the EP group. In the per-protocol analysis (i.e., adherence ≥80% of planned exercise sessions), changes in the 30 seconds STS test (p < 0.001) and body image (p = 0.028) remained significant while the 6MWT improved in EP as compared to the UC (EP: Δ44.7 ± 31.5 vs UC: Δ-7.5 ± 35.1 meters, p = 0.006). No serious adverse events related to exercise were reported in the EP group. CONCLUSIONS: These preliminary results suggest that EP is safe and improves lower limb functionality, self-perceived body image, and insomnia in HNC patients before initiating CRT. CG received a PhD grant from the Portuguese Foundation for Science and Technology (SFRH/BD/149054/2019). Thanks to participants, AICSO, the Functional Unit of Head and Neck Tumors and the Medical Oncology Service of CHVNG/E, Liga dos Amigos do Centro Hospitalar de Gaia; and Nutricia.