Effect of Exercise on Upper Extremity Pain and Dysfunction in Head and Neck Cancer Survivors

Abstract

Head and neck cancers (HNC) account for only 4% to 5% of all malignant tumors. The etiology of most HNC is related to lifestyle factors such as smoking tobacco and heavy alcohol consumption. Survivors of HNC often have considerable post treatment morbidity affecting eating, speaking, function and cosmesis that heighten the impact of the disease. Shoulder pain is a well-recognized complication resulting from surgery for HNC and is associated with poorer quality of life and increased risk for longterm disability. As a result of their demographic and disease profile, HNC survivors represent a unique and challenging cancer group in terms of exercise rehabilitation. PURPOSE: This study was designed to examine the effects of progressive resistance exercise training (PRET) as an adjunct to standard physical therapy (SPT) on upper extremity pain and dysfunction in post-surgical head and neck cancer survivors. METHODS: Fifty-two head and neck cancer survivors were randomly assigned to PRET (n = 27) or SPT (n =25) for 12 weeks. The primary endpoint was change in patient-rated shoulder pain and disability from baseline to post-intervention. Secondary endpoints were upper extremity strength and endurance, shoulder range of motion, fatigue and quality of life. RESULTS: Follow-up assessment for the primary outcome was 92% and adherence to the supervised PRET and SPT programs were 95% and 87%, respectively. Based on intention-to-treat analyses, PRET was superior to SPT for improving shoulder pain and disability [−10.0; 95% CI: −15.8 to −4.2; p = .001], upper extremity strength [+10.8 kg; 95% CI: 5.4 to 16.2; p < .001], and upper extremity endurance [+189 repetitions × kg; 95% CI: 5 to 374; p =.045]. Changes in neck dissection impairment, fatigue, and quality of life favored the PRET group but did not reach statistical significance. CONCLUSIONS: The PRET program significantly reduced shoulder pain and disability and improved upper extremity muscular strength and endurance in cancer survivors with shoulder dysfunction due to spinal accessory nerve damage. Clinicians may consider PRET as an adjunct to SPT in the rehabilitation of post-surgical head and neck cancer survivors.