Longitudinal changes in cognition, sleep, and psychological distress following the MORE program in head and neck cancer patients undergoing chemoradiotherapy

The purpose of this study was to evaluate changes in subjective cognitive function, sleep quality and psychological distress among head and neck cancer (HNC) patients receiving concurrent chemoradiotherapy (CRT) participating in the Multimodal Oncology Rehabilitation Exercise (MORE) program. A total of 118 HNC patients (median age 47 years, 78.8% males) participated in the supervised program, which included physical exercises, cognitive exercises and psychosocial strategies, delivered three times weekly over eight weeks. Outcomes were assessed at baseline, four, eight (discharge) and twelve weeks (follow-up) using subjective outcome measures. The linear mixed-effects models were employed to evaluate changes in outcomes over time. Results revealed significant improvements in perceived cognitive impairment (β: 3.45, p < 0.001), sleep (β: 2.8, p < 0.001), and psychological distress (β: - 2.4, p < 0.001) by the 12th week (follow-up). These benefits were not influenced by demographic or clinical characteristics. These findings highlight the potential of structured, multimodal exercise programs as adjuncts to supportive care for improving cognition, sleep and psychological distress among HNC patients, particularly in resource constrained settings. To the best of our knowledge, this is the first study to evaluate the longitudinal changes of such an intervention among Indian HNC patients, underscoring the need for future large-scale randomized controlled trials.