Efficacy of an exercise oncology program on sleep quality and circadian rhythm in head and neck cancer patients undergoing chemo-radiation therapy: a randomized controlled trial

Background Head and neck cancer (HNC) presents a significant challenge in oncology. It has high prevalence rates, especially in India, where 30–40% of cancer cases are attributed to HNC. While chemotherapy and radiation therapy are essential components of treatment, they often lead to significant sleep disturbances that negatively impact patients’ quality of life and the effectiveness of their treatment. These sleep disturbances are frequently associated with disruptions in the circadian rhythm, which are commonly seen in cancer survivors. This study aimed to evaluate the effect of an exercise oncology program on sleep quality and circadian rhythm in patients with HNC undergoing chemo-radiation therapy. Methods Patients with HNC (stage III, IVa, or IVb) undergoing chemo-radiation therapy, aged 18 years or above, of any gender, and with an Eastern Cooperative Oncology Group score < 2 were included. Patients with severe orthopedic or neurological conditions, hemoglobin < 8 g/dL, platelet count < 30,000/µL, or unfit for exercise were excluded. Seventy HNC patients were randomized to exercise oncology and control group. The exercise oncology group received 15–20-minute sessions of aerobic (brisk walking) and resistance training (upper and lower limb exercises). Participants in the control group were asked to follow the walking protocol recommended by National Comprehensive Cancer Network guidelines, five days a week for seven weeks. Pittsburgh Sleep Quality Index (PSQI) was used to assess overall sleep quality, while melatonin excretion in urine, quantified using ELISA, was used to evaluate the circadian rhythm. Between-group comparisons were analyzed using mixed analysis of variance for PSQI and analysis of covariance for urinary melatonin. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of PSQI scores and melatonin levels. Results PSQI significantly improved in the exercise group (13.97 ± 2.29 to 7.09 ± 1.15), and significantly worsened in controls, (13.06 ± 1.73 to 14.14 ± 2.64) (both p < 0.001). Although urinary melatonin levels increased in the exercise group (284.16 ± 85.29 ng/L to 369.75 ± 91.61 ng/L) and decreased in controls (368.00 ± 100.62 ng/L to 304.39 ± 99.50 ng/L), the between-group difference was not significant after adjusting for baseline values ( p = 0.372). Furthermore, ROC curve analysis demonstrated that post-intervention PSQI exhibited excellent diagnostic accuracy for distinguishing between good and poor sleep quality. Conclusion An exercise oncology program has potential benefits in improving quality of sleep and regulating the circadian rhythm in HNC patients undergoing chemo-radiation therapy.