Physical activity correlates and barriers in head and neck cancer patients

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

Background

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.

Barriers to physical activity and healthy eating in young breast cancer survivors: modifiable risk factors and associations with body mass index

Physical activity (PA) and healthy eating (HE) are important behaviors to encourage in breast cancer survivors (BCS). We examined associations between various factors and barriers to PA (BPA) and barriers to HE (BHE), as well as relationships between barriers and body mass index (BMI) in younger BCS. Self-reported data from 162 BCS (mean age 48 years) were used. BPA were assessed with a 21-item scale and BHE with a 19-item scale. Participants were classified as high or low on each scale. Sociodemographic, medical, and psychosocial characteristics were compared by high/low barriers. Correlates of continuous BPA and BHE were assessed as were associations among BHE, BPA, and BMI. 61 % of participants were characterized as having low BHE and low BPA; 12 % were high for both. High BHE/high BPA participants had the least favorable scores for depression, perceived stress, social support, fatigue, bladder control, and weight problems. Factors associated with BHE were lower education, higher perceived stress, and more severe weight problems. Factors associated with BPA were more severe bladder control problems and lower physical well-being. Higher BHE and BPA were significantly and uniquely associated with higher BMI, controlling for covariates. Several biopsychosocial factors (e.g., depression, stress, and fatigue) characterize young BCS who experience barriers to both HE and PA. The correlates of BHE and BPA are distinct. Both BHE and BPA are associated with BMI. These results should be considered in designing interventions for younger women with breast cancer.

Perceived exercise barriers and facilitators among ethnically diverse breast cancer survivors

PURPOSE/OBJECTIVES

To determine whether women with breast cancer were meeting current physical activity recommendations and to describe perceptions of exercise self-efficacy, exercise benefits and barriers, and perceptions of environmental supports for physical activity by race or ethnicity.

DESIGN

Cross-sectional survey.

SETTING

Community wellness workshops held in various locations in central and eastern North Carolina.

SAMPLE

65 breast cancer survivors in treatment or post-treatment. Caucasian women comprised 46% of the sample followed by African Americans (34%) and Hispanics/Latinas (16%).

METHODS

Descriptive statistics were used to determine the percentage of women meeting physical activity guidelines and for comparing exercise-related perceptions. Spearman's rho correlation coefficient tests were conducted to identify associations between physical activity and exercise-related perceptions.

MAIN RESEARCH VARIABLES

Physical activity, perceived exercise self-efficacy, exercise barriers, and benefits.

FINDINGS

Hispanic/Latina women were least likely to meet physical activity recommendations. Hispanic/Latina women were more likely than Caucasian and African American women to report lack of enjoyment from exercise, lack of knowledge on how to exercise, feeling self-conscious because of looks, and discouragement as exercise barriers.

CONCLUSIONS

In a sociocultural context, exercise beliefs need to be considered in the development of culturally responsive exercise interventions that may enhance the health of breast cancer survivors.

IMPLICATIONS FOR NURSING

Considering the increasing number of breast cancer survivors from diverse racial or ethnic backgrounds, a need exists for culturally competent nursing interventions aimed at increasing exercise. When educating breast cancer survivors, nurses should address sociocultural factors that may hinder or facilitate engagement in exercise.

KNOWLEDGE TRANSLATION

Most women were not meeting physical activity recommendations, particularly Hispanic/Latina women. Perceptions of exercise-related beliefs differed, although not significantly, across racial and ethnic groups. More perceived exercise barriers existed for Hispanic/Latina women compared to Caucasian and African American women, which may indicate sociocultural differences.

Objective monitoring of physical activity after a cancer diagnosis: challenges and opportunities for enhancing cancer control

BACKGROUND: Because physical activity (PA) provides multiple medical and psychosocial benefits after a cancer diagnosis, greater integration of objective activity monitoring into research and clinical practice is warranted. OBJECTIVES: To review randomized PA trials in cancer survivors after diagnosis using an accelerometer or pedometer and make recommendations for integrating objective monitoring into research and practice. MAJOR FINDINGS: Ten published PA and post-cancer diagnosis randomized trials have used pedometers (n=3), accelerometers (n=3), or both (n=4). Pedometers were primarily used to motivate PA adherence with several studies also using unblinded pedometers to assess the intervention effect on PA adherence. Accelerometers were primarily used to assess PA adherence after a PA intervention with one study using accelerometers to assess PA increase as a benefit of a non-PA intervention. One study used accelerometers to document sufficient ground forces for improving bone density in cancer survivors. Across studies, the reported objective monitoring outcome varied and was not always consistent with the stated intervention goal. CONCLUSIONS: PA and post-cancer diagnosis randomized trials have used objective monitoring primarily for motivation and/or adherence assessment. Investigators and practitioners are encouraged to expand the use of objective monitoring to also include understanding mechanisms of PA benefits and assess non-PA treatment modality effects. Future clinical and research protocols should consider the 1) outcome to be measured and reported, 2) need (or not) for blinding of the instrument outputs to participants, 3) appropriateness of activity intensity cutpoints for interpreting accelerometer data, and 4) logistical issues relevant to cancer survivors after diagnosis.

Clinical review of physical activity and functional considerations in head and neck cancer patients

Patients facing head and neck cancer treatment are profoundly vulnerable to physiologic and functional disability. Exercise and nutrition have been shown to have many benefits in cancer patients, but much of this work has been performed in groups of breast, colon, and prostate cancer patients. Limited data exists regarding the role of exercise and nutrition in the management of head and neck cancer patients given their unique set of challenges relating to the cancer as well as its treatment. In this paper, we review the existing literature about general or recreational physical exercise as well as nutrition in this patient population as it pertains to lean muscle body composition, functional well-being, and overall quality of life.

Social support and physical activity engagement by cancer survivors

Less than 20% of adult cancer survivors participate in physical activity and, as a result of such inactivity, cancer survivors are at increased risk for developing chronic diseases. Studies have linked social support as a predictor of physical activity participation in healthy adults. The primary goal of this systematic review is to examine the relationship between social support and physical activity engagement in adult cancer survivors and determine whether additional research is needed in this area. Several databases were searched and articles were systematically extracted according to the inclusion and exclusion criteria. That search yielded 69 articles, 22 of which were identified and included in this review. Fifty percent of the studies showed a significant relationship between social support and physical activity engagement; however, 59% of the participants were breast cancer survivors. The findings suggest that additional research is needed to develop social support strategies that will increase physical activity engagement in adult survivors of cancers other than breast cancer.

Factors related to daily life interference in lung cancer patients: a cross-sectional regression tree study

PURPOSE

To identify the symptom combination patterns and symptom severity levels that induce severe symptom interference in daily life activities, including physical and psychological activity interference in lung cancer patients.

METHODS

In a cross-sectional descriptive study using convenience sampling, 131 participants were recruited at a medical center in northern Taiwan. The Eastern Cooperative Oncology Group (ECOG) performance status was used to assess performance status, and the Taiwanese version of the M.D. Anderson Symptom Inventory (MDASI-T) was used to assess symptom severity and symptom interference in daily life activities including physical and psychological activities. Regression tree models were applied to examine variable combinations for symptom interference level in daily life activities, including physical and psychological activity interference.

RESULTS

Study results revealed that the performance status is the key discriminator of the symptom interference level in daily life and physical activities, but distress severity is the key discriminating factor of the symptom interference level in psychological activities. The performance status and distress severity, plus other factors, further specifically show the discrimination paths and interactions between the risk groups.

CONCLUSIONS

This study provided an alternative approach to identify low- and high-risk groups of symptom interference among lung cancer patients in Taiwan. Increased awareness and further understanding of the risk combinations and discriminate levels of symptom severity that induced high symptom interference offer different perspectives to develop patient-centered care planning for lung cancer patient rehabilitation.

Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey

OBJECTIVE

To investigate the exercise barriers, facilitators and preferences of a mixed sample of cancer survivors as well as fatigue levels, quality of life (QoL) and the frequency and intensity of exercise that cancer survivors typically engage in.

METHODS

An anonymous, postal questionnaire-survey with a convenience sample of 975 cancer survivors was used. Standardised measures were used to establish fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30), exercise frequency and intensity (Leisure Score Index).

RESULTS

A 52.3% response rate (n = 456) was achieved. A total of 76.0% were female, with stage I (18.3%) or stage II (21.0%) breast cancer (64.4%), and 62.3% were ≥ 3 years post treatment. A total of 73.5% reported fatigue with 57.2% experiencing fatigue on a daily basis. A total of 68.1% had never been given any advice on how to manage fatigue. A total of 9.4% reported to engage in strenuous physical activity, 43.5% in moderate physical activity and 65.5% in mild physical activity. Respondents experienced difficulties with emotional, cognitive and social functioning and the symptoms of fatigue, insomnia and pain. Barriers that interfered with exercise 'often/very often' were mainly related to respondents' health and environmental factors. A total of 50.2% were interested in exercise and 52.5% felt able to exercise. Exercise facilitators, preferences and motivators provide some insight into cancer survivors' needs in terms of becoming more physically active.

CONCLUSIONS

Although cancer survivors continue to experience fatigue and QoL issues long after treatment completion, over half are willing and feel able to participate in exercise. Exercise barriers were mainly health related or environmental issues, however, the main barriers reported were those that had the potential to be alleviated by exercise.

Better exercise adherence after treatment for cancer (BEAT Cancer) study: rationale, design, and methods

Most breast cancer survivors do not engage in regular physical activity. Our physical activity behavior change intervention for breast cancer survivors significantly improved physical activity and health outcomes post-intervention during a pilot, feasibility study. Testing in additional sites with a larger sample and longer follow-up is warranted to confirm program effectiveness short and longer term. Importantly, the pilot intervention resulted in changes in physical activity and social cognitive theory constructs, enhancing our potential for testing mechanisms mediating physical activity behavior change. Here, we report the rationale, design, and methods for a two-site, randomized controlled trial comparing the effects of the BEAT Cancer physical activity behavior change intervention to usual care on short and longer term physical activity adherence among breast cancer survivors. Secondary aims include examining social cognitive theory mechanisms of physical activity behavior change and health benefits of the intervention. Study recruitment goal is 256 breast cancer survivors with a history of ductal carcinoma in situ or Stage I, II, or IIIA disease who have completed primary cancer treatment. Outcome measures are obtained at baseline, 3 months (i.e., immediately post-intervention), 6 months, and 12 months and include physical activity, psychosocial factors, fatigue, sleep quality, lower extremity joint dysfunction, cardiorespiratory fitness, muscle strength, and waist-to-hip ratio. Confirming behavior change effectiveness, health effects, and underlying mechanisms of physical activity behavior change interventions will facilitate translation to community settings for improving the health and well-being of breast cancer survivors.

Exercise among breast and prostate cancer survivors--what are their barriers?

INTRODUCTION

Despite proven benefits of regular physical activity, estimates indicate that few cancer survivors meet physical activity guidelines. The purpose of this paper is to identify and compare exercise barriers among cancer survivors, both cross-sectionally and longitudinally as they undergo home-based behavioral interventions.

METHODS

Data on a sample of 452 breast and prostate cancer survivors who completed the FRESH START trial were analyzed collectively, as well as separately by cancer type.

RESULTS

More total barriers (3.5 vs. 2.4; p < 0.01) were reported among breast cancer survivors compared with prostate cancer survivors. Commonly reported baseline exercise barriers among both groups were "too busy" (breast, 52% and prostate, 45%) and "no willpower" (breast, 51% and prostate, 44%). At baseline, breast cancer survivors who reported "no willpower" also reported 18.7 fewer minutes of physical activity compared with those not reporting this barrier (p < 0.01). Among prostate cancer survivors, this difference was 39.5 min (p < 0.01). Change in barriers was not associated with change in minutes of physical activity from baseline to post-intervention in either cancer survivor group.

CONCLUSIONS

This is the largest study evaluating barriers and physical activity over time among cancer survivors. There are similarities and differences that both need to be taken into consideration when promoting physical activity among subgroups of survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Knowledge concerning barriers associated with reported physical activity may be helpful in designing optimally targeted physical activity interventions among breast and prostate cancer survivors.

Lessons learned in the trenches: facilitating exercise adherence among breast cancer survivors in a group setting

BACKGROUND

Improving effectiveness of group exercise counseling for breast cancer survivors is needed.

OBJECTIVE

The objective of this study was to describe clinical observations, with research and translation implications, derived during group exercise counseling for breast cancer survivors.

METHODS

While implementing group session components of an effective social cognitive theory-based exercise intervention, observations were made through verbal discussion with study staff, review of participant feedback, and prospective journaling by the group facilitator. The intervention has been implemented 11 times (ie, 63 survivors; 66 group sessions). Thematic consistency, application to intervention goals and design, and implications were reconciled between 2 investigators.

RESULTS

Breast cancer diagnosis was a strong source of commonality among group participants. Participant age, time since diagnosis, and expectation for group sessions (eg, group support vs health education) hindered group commonality. Barriers unique to the breast cancer experience were infrequent, but people-pleasing behavior was often identified as a barrier to adherence. Feeling at risk for cancer recurrence was a major concern. Some participants required referral for mental health evaluation for preexisting conditions (eg, depression). Although participants easily understood time management, application of other behavioral modification techniques was more difficult.

CONCLUSIONS

A breast cancer diagnosis alone is not sufficient for commonality among group members. Teaching time management and positive reframing is essential. Protocols for appropriate mental health referrals are needed.

IMPLICATIONS FOR PRACTICE

Our observations will assist group facilitators in enhancing group dynamics and addressing obstacles hindering counseling effectiveness. Moreover, our results suggest hypotheses related to enhancing behavior change in a group setting worthy of future study.

Graphical modeling can be used to illustrate associations between variables describing functioning in head and neck cancer patients

OBJECTIVE

To examine the associations between variables of functioning measured by the International Classification of Functioning, Disability and Health (ICF) in head and neck cancer (HNC) patients by means of graphical modeling.

STUDY DESIGN AND SETTING

Graphical modeling was used on a data set of a cross-sectional multicentric study of 145 patients with HNC. Functioning was qualified using the extended ICF checklist. Multiple imputation was used to handle missing data. The least absolute shrinkage and selection operator for generalized linear models was used to identify conditional associations between the ICF categories. Bootstrap aggregating was used to enhance the accuracy and validity of model selection.

RESULTS

The resulting graph shows largely meaningful associations between the ICF categories. One central point could be visualized consisting of a circular path of d330 Speaking, d350 Conversation, b510 Ingestion functions, s320 Structure of mouth, and b310 Voice functions. Another important structure in the graph were the bow-shaped associations beginning with d335 Producing nonverbal messages to b130 Energy and drive functions.

CONCLUSION

Graphical modeling can be used to describe associations between different areas of functioning in HNC patients. They found associations can be the basis for improved rehabilitation and gives a deeper understanding of functioning in HNC patients.

Intervention Components Promoting Adherence to Strength Training Exercise in Breast Cancer Survivors With Bone Loss

Numerous studies have reported that exercise is safe and beneficial for breast cancer survivors; however, long-term adherence to exercise programs is not easy to accomplish. This secondary analysis examined the demographic and clinical characteristics, adherence to exercise, and cognitive—behavioral intervention components data collected on 120 postmenopausal women with a history of breast cancer and bone loss who had been randomized to the exercise group in a 24-month study. Hierarchical regression was used to identify variables that predicted adherence to exercise. Mean adherence to exercises was 61.89%. Feedback and support were the most frequently used cognitive—behavioral intervention components. In hierarchical regression, predictors for adherence to exercise were feedback (β = .40, p < .001) and adherence to exercise in the previous time period (β = .31, p < .001). Participants receiving more frequent feedback had higher adherence to exercise.

The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue

BACKGROUND

Despite the evidence to support exercise as an effective management strategy for patients with cancer-related fatigue (CRF), many of the general cancer population are sedentary.

OBJECTIVE

The aim of this study was to explore the barriers to and facilitators of exercise among a mixed sample of patients with CRF.

DESIGN

An exploratory, descriptive, qualitative design was used.

METHODS

Purposive sampling methods were used to recruit patients with CRF who were representative of the cancer trajectory, that is, survivors of cancer and patients in palliative care who were recently diagnosed and undergoing treatment. Focus group discussions were transcribed verbatim and analyzed using a grounded theory approach. Lower-level concepts were identified and ordered into subcategories. Related subcategories then were grouped to form the main categories, which were linked to the core category.

RESULTS

Five focus groups were conducted with 26 participants. Within the core category of the cancer rehabilitation journey were 3 main categories: (1) exercise barriers, (2) exercise facilitators, and (3) motivators of exercise. Exercise barriers were mainly related to treatment side effects, particularly fatigue. Fatigue was associated with additional barriers such as physical deconditioning, social isolation, and the difficulty of making exercise a routine. Environmental factors and the timing of exercise initiation also were barriers. Exercise facilitators included an exercise program being group-based, supervised, individually tailored, and gradually progressed. Exercise motivators were related to perceived exercise benefits.

CONCLUSIONS

Individuals with CRF have numerous barriers to exercise, both during and following treatment. The exercise facilitators identified in this study provide solutions to these barriers and may assist with the uptake and maintenance of exercise programs. These findings will aid physical therapists in designing appropriate exercise programs for patients with CRF.

Advances in quality of life and symptom management for head and neck cancer patients

PURPOSE OF REVIEW

Head and neck cancer and its therapy are associated with marked symptom burden, functional impairment and decreased quality of life. This review will encompass the recent studies addressing supportive care issues facing head and neck cancer patients.

RECENT FINDINGS

Although it has long been recognized that head and neck cancer therapy results in significant acute toxicity, it is now becoming recognized that the late effects of therapy are equally problematic. In addition, it is clear that many acute and late effects of therapy, including oral health issues, nutritional deficiencies and the role of physical therapy and rehabilitation, are under recognized and under studied. Although supporting data are scant, allied health professions play a critical role in managing acute and late effects of therapy.

SUMMARY

Healthcare providers must take an active role in the evaluation and management of the acute and late effects of therapy. Referral for appropriate supportive care and rehabilitative services is critical in order to minimize the acute and late effects of therapy and to maximize long-term function.

A randomized trial to increase physical activity in breast cancer survivors

PURPOSE

Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality. Therefore, we report the feasibility and preliminary outcomes of a pilot randomized trial designed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy.

METHODS

Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I, II, or IIIA breast cancer were randomly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care.

RESULTS

Recruitment was 34%, intervention adherence was 99%, and complete follow-up data were obtained on 93%. Most participants (93%) were white with mean age of 53 +/- 9 yr. Differences favoring the intervention group were noted for accelerometer physical activity counts (mean difference = 72,103; 95% confidence interval (CI) = 25,383-119,000; effect size (d) = 1.02; P = 0.004), aerobic fitness (mean difference = 2.9; 95% CI = -0.1 to 5.8; d = 0.64; P = 0.058), back/leg muscle strength (mean difference = 12.3; 95% CI = 0.4-15.9; d = 0.81; P = 0.017), waist-to-hip ratio (mean difference = -0.05; 95% CI = -0.01 to -0.08; d = -0.77; P = 0.018), and social well-being (mean difference = 2.0; 95% CI = 0.3-3.8; d = 0.76; P = 0.03). However, the intervention group also reported a greater increase in joint stiffness (mean difference = 1.1; 95% CI = 0.1-2.2; d = 0.70; P = 0.04).

CONCLUSIONS

A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes. Confirmation in a larger study is warranted.

Exercise adherence in patients with trismus due to head and neck oncology: a qualitative study into the use of the Therabite

Trismus is a common problem after treatment of head and neck cancer. The Therabite is an effective treatment for trismus. To explore the factors that may influence Therabite exercise adherence, how these interrelate and to provide aims for interventions to increase adherence, the authors conducted a multi-centre, formal-evaluative qualitative retrospective study. 21 patients treated for head-neck cancer were interviewed in semi-structured, in-depth interviews. Internal motivation to exercise, the perceived effect, self-discipline and having a clear exercise goal influenced Therabite exercise adherence positively. Perceiving no effect, limitation in Therabite opening range and reaching the exercise goal or a plateau in mouth opening were negative influences. Pain, anxiety and the physiotherapist could influence adherence both positively and negatively. Based on the results, a model for Therabite exercise adherence was proposed. It is important to signal and assess the factors negatively influencing Therabite adherence, specifically before there is a perceived effect. Research is needed to examine why some patients do not achieve results despite high exercise adherence, to identify effective exercise regimens and to assess proposed interventions aimed to increase Therabite exercise adherence.

Correlates of physical activity among lung cancer survivors

OBJECTIVE

Lung cancer survivors commonly experience impairments in quality of life, which may be improved through regular physical activity. However, little is known regarding correlates of physical activity in this survivor population. The current study addressed this research gap.

METHODS

The participants were 175 survivors of early-stage non-small cell lung cancer who completed surgical treatment from 1 to 6 years previously. Information regarding medical factors was obtained from chart records and from participant self-report. Participants also answered questions about demographic and social cognitive factors that may be associated with physical activity, which was assessed as reported engagement in moderate/strenuous activities and leisurely walking.

RESULTS

Participants reported an average of 77.7 min of moderate/strenuous weekly activity and 64.6% reported engaging in leisurely walking at least three times per week. Less leisurely walking was reported by older individuals (p=0.001) and those with a lower education level (p<0.001), who also reported less engagement in moderate/strenuous activities (p=0.004). Individuals with poorer pre-operative pulmonary function reported less moderate/strenuous physical activity (p=0.014) and the number of surgical complications was inversely associated with leisurely walking (p=0.003). Multiple social cognitive constructs were associated with moderate/strenuous activity and leisurely walking.

CONCLUSIONS

The study identified several lung cancer survivor subgroups who may be most in need of physical activity interventions. Identification of social cognitive correlates of physical activity provides valuable information regarding theory-guided constructs that should be targeted in future physical activity interventions for lung cancer survivors.

Factors associated with fatigue, sleep, and cognitive function among patients with head and neck cancer

BACKGROUND

Fatigue, sleep disturbances, and cognitive impairment are prevalent and clinically important problems among head and neck cancer patients. Our study aim was to determine the most important correlates of these problems among patients with head and neck cancer.

METHODS

A cross-sectional, self-administered survey was completed by 58 (response rate 79%) patients with head and neck cancer in an academic oncology clinic.

RESULTS

Multiple linear-regression analyses demonstrated that fatigue was associated with younger age (beta=-0.22), previous radiation therapy (beta=0.23), fewer months since cancer diagnosis (beta=-0.25), and depression (beta=0.40). Sleep dysfunction was associated with younger age (beta=-0.31) and higher symptom index (beta=0.39). Cognitive dysfunction was associated with higher symptom index only (beta=-0.49).

CONCLUSIONS

Younger age, previous radiation, more recent cancer diagnosis, depression, and more severe symptoms may be associated with fatigue, sleep, and/or cognitive dysfunction. These results suggest at-risk subgroups warranting more aggressive screening and potentially supportive care interventions.