Pre‐rehabilitation interventions for patients with head and neck cancers: A systematic review and meta‐analysis

• Published in: Head & neck Vol. 46; no. 1; pp. 86 - 117
• Main Authors: Seth, Ishith, Bulloch, Gabriella, Qin, Kirby R., Xie, Yi, Sebastian, Benjamin, Liew, Hann, Rozen, Warren Matthew, Lee, Chun Hin Angus
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2024; Wiley Subscription Services, Inc
• Subjects: Body mass index; Body weight loss; cancer; Clinical trials; Complications; Deglutition Disorders - etiology; Dietary supplements; Dysphagia; Exercise; Head & neck cancer; head and neck; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - surgery; Humans; Length of Stay; Meta-analysis; Morbidity; Mortality; Nutrition; Postoperative; pre‐rehabilitation; Quality of Life; Rehabilitation; exercise; head and neck; nutrition; pre-rehabilitation; cancer
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.27561

Objective To investigate the effect of pre‐rehabilitation interventions such as nutrition and exercise for patients with head and neck cancer (HNC). Methods Web of Science, PubMed, Scopus, Google Scholar, and Cochrane databases were searched up to December 2022. Quality of life, length of hospital stay, postoperative complications, change in body mass index or muscle mass, and functional assessments were the primary outcomes. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The Cochrane Collaboration tool and Newcastle Ottawa scale assessed the quality of included studies. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). Analysis was conducted using RevMan5.4. Results A total of 31 articles were included for quantitative analysis and 15 for qualitative synthesis. Nutrition alone resulted in significant weight retention (2.60; 2.32, 2.88, p < 0.00001), length of stay (−4.00; −6.87, −1.13), p = 0.0006) and complications (0.64; 0.49, 0.83, p = 0.0009). Nutrition and psychoeducation resulted in a significant reduction in mortality rate (0.70; 0.49, 1.00, p = 0.05 and 0.60; 0.48, 0.74, p < 0.00001), and exercise resulted in a significant reduction in dysphagia (0.55; 0.35, 0.87, p = 0.01). Exercise with nutrition resulted in significant improvements in weight loss, length of stay, complications, and dysphagia. Randomized controlled trials (RCTs) had a moderate risk of bias and cohort studies were of fair to good quality. Conclusion Prehabilitation programs based on exercise, nutrition, or psychoeducation demonstrated improved post‐interventional outcomes in HNC, such as quality of life, and mortality and morbidity. Studies with longer follow‐ups and larger sample sizes, and investigations comparing nutritional supplements with exercise programs are needed.