Functional Outcomes In Individuals with Head and Neck Cancer Undergoing Treatment

Abstract

Introduction: Individuals with Head and Neck Cancer (HNC) undergoing treatment may experience functional deficits that could be alleviated by rehabilitation interventions. However, the nature and extent of current evidence for rehabilitation and functional changes during treatment for this population is unknown. Purpose: The overall aim of this thesis was to examine the use of rehabilitation interventions to improve functional outcomes in individuals with HNC undergoing treatment. To address this aim, this thesis was comprised of 2 studies with objectives to: (1) examine the nature and extent of current evidence for rehabilitation to improve functional outcomes during treatment for individuals with HNC, and (2) determine the physical functional changes and describe unmet physical rehabilitation-related needs during chemotherapy. Methods: The first objective was addressed using a scoping review, which identified and described the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used in individuals with HNC during treatment. The International Classification of Functioning Framework (ICF) was used to describe function in this review. For the second objective, we conducted a single-center prospective observational study with 22 participants. Functional changes were assessed at the beginning and end of iv chemotherapy. Rehabilitation-related needs and barriers were also assessed post chemotherapy via a survey. Results: In the scoping review, the majority of rehabilitation interventions (41%) included swallowing exercises led by speech-language pathologists. Most studies (66%) described primary outcomes that fit the ICF “impairment” domain. Within the observational study, clinically significant declines in most functional outcomes occurred post chemotherapy and most participants described unmet physical rehabilitation needs. Conclusion: This thesis provides novel understanding of the current use of rehabilitation during treatment for individuals with HNC and found significant declines in physical functioning during chemotherapy. Together, these results highlight the need of rehabilitation interventions such as physical therapy to improve overall function in this population.