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Barriers and facilitators to physical activity participation in patients with head and neck cancer: a scoping review

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Abstract

Background

Patients with head and neck cancer (HNC) usually experienced disfigurement, dysfunction, and psychosocial distress, leading to a decline in their quality of life. Physical activity (PA) is recommended for such patients. Despite the proven benefits of participating in PA, the compliance of patients with HNC is still poor. Hence, the factors influencing PA participation and adherence in patients with HNC need to be explored.

Objectives

This study aimed to (1) identify barriers and enablers of PA in adult patients living with HNC and (2) map barriers and facilitators to the Capability-Opportunity-Motivation-Behavior (COM-B) model.

Eligibility criteria

Types of studies: Studies with qualitative, quantitative, and mixed designs were included in this review. Types of participants: The current review takes into account patients with HNC aged 18 years or above. Types of interventions: This review considered all studies focusing on full-body PA. Types of outcomes: This scoping review focused on studies examining health behavior, patients’ compliance, and facilitators and/or barriers to PA engagement. Five databases (Ovid Medline, Ovid Embase, CINAHL, Cochrane Library, and PsycINFO) were searched following the methodology for scoping reviews from inception to July 2021.

Data extraction

The extracted data included author(s)/year of publication, country, main purpose of the study, sample size/disease site and stage, methodology and methods, type of treatment, and main findings/barriers, or facilitators.

Results

A total of 22 studies were finally selected. The top three barriers were physical-related issues, time pressures, and low motivation or interest. Most facilitators included perceived psychological, health, and social benefits and preference for the model of PA. The most frequent COM-B model components were physical capability, automatic motivation, and physical opportunity.

Conclusions

Patients with HNC have unique facilitators and barriers to participating in PA. Interventions must leverage facilitators and limit barriers to exercise so as to increase compliance with exercise. Future studies should test the effectiveness of behavioral change measures based on the factors influencing the COM-B model.

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Data availability and material

The data and materials that support the findings of this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  2. Aragón N, Ordoñez D, Urrea MF et al (2021) Head and neck cancer in Cali, Colombia: population-based study. Community Dent Oral Epidemiol. https://doi.org/10.1111/cdoe.12671

    Article  PubMed  Google Scholar 

  3. Moore SC, Lee IM, Weiderpass E et al (2016) Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med 176:816–825. https://doi.org/10.1001/jamainternmed.2016.1548

    Article  PubMed  PubMed Central  Google Scholar 

  4. Capozzi LC, Nishimura KC, McNeely ML, Lau H, Culos-Reed SN (2016) The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sports Med 50:325–338. https://doi.org/10.1136/bjsports-2015-094684

    Article  PubMed  Google Scholar 

  5. Lynch PT, Horani S, Lee R et al (2021) Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: a systematic review. Oral Oncol 117:105253. https://doi.org/10.1016/j.oraloncology.2021.105253

    Article  PubMed  Google Scholar 

  6. Sammut L, Fraser LR, Ward MJ, Singh T, Patel NN (2016) Participation in sport and physical activity in head and neck cancer survivors: associations with quality of life. Clin Otolaryngol 41:241–248. https://doi.org/10.1111/coa.12506

    Article  CAS  PubMed  Google Scholar 

  7. Cohen EE, LaMonte SJ, Erb NL et al (2016) American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin 66:203–239. https://doi.org/10.3322/caac.21343

    Article  PubMed  Google Scholar 

  8. Nguyen N T A, Ringash J (2018) Head and neck cancer survivorship care: a review of the current guidelines and remaining unmet needs. Current Treatment Options in Oncology 19. https://doi.org/10.1007/s11864-018-0554-9

  9. Nekhlyudov L, Lacchetti C, Davis NB et al (2017) Head and neck cancer survivorship care guideline: American society of clinical oncology clinical practice guideline endorsement of the American cancer society guideline. J Clin Oncol 35:1606–1621. https://doi.org/10.1200/JCO.2016.71.8478

    Article  PubMed  Google Scholar 

  10. Rogers LQ, Courneya KS, Robbins KT et al (2006) Physical activity and quality of life in head and neck cancer survivors. Support Care Cancer 14:1012–1019. https://doi.org/10.1007/s00520-006-0044-7

    Article  PubMed  Google Scholar 

  11. Fang YY, Wang CP, Chen YJ et al (2021) Physical activity and fitness in survivors of head and neck cancer. Support Care Cancer. https://doi.org/10.1007/s00520-021-06192-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rogers LQ, Fogleman A, Verhulst S et al (2015) Refining measurement of social cognitive theory factors associated with exercise adherence in head and neck cancer patients. J Psychosoc Oncol 33:467–487. https://doi.org/10.1080/07347332.2015.1067277

    Article  PubMed  Google Scholar 

  13. Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6:42. https://doi.org/10.1186/1748-5908-6-42

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tzeng HM, Okpalauwaekwe U, Lyons EJ (2020) Barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization: a scoping review. Clin Interv Aging 15:971–989

    Article  PubMed  PubMed Central  Google Scholar 

  15. Redsell SA, Slater V, Rose J, Olander EK, Matvienko-Sikar K (2021) Barriers and enablers to caregivers’ responsive feeding behaviour: a systematic review to inform childhood obesity prevention. Obes Rev 22:e13228. https://doi.org/10.1111/obr.13228

    Article  PubMed  Google Scholar 

  16. Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8:19–32. https://doi.org/10.1080/1364557032000119616

    Article  Google Scholar 

  17. Tricco AC, Lillie E, Zarin W et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473. https://doi.org/10.7326/m18-0850

    Article  PubMed  Google Scholar 

  18. Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100:126–131

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Rogers LQ, Courneya KS, Robbins KT et al (2008) Physical activity correlates and barriers in head and neck cancer patients. Support Care Cancer 16:19–27. https://doi.org/10.1007/s00520-007-0293-0

    Article  PubMed  Google Scholar 

  20. Zhao SG, Alexander NB, Djuric Z et al (2016) Maintaining physical activity during head and neck cancer treatment: results of a pilot controlled trial. Head Neck 38(Suppl 1):E1086-1096. https://doi.org/10.1002/hed.24162

    Article  PubMed  Google Scholar 

  21. Rogers LQ, Anton PM, Fogleman A et al (2013) Pilot, randomized trial of resistance exercise during radiation therapy for head and neck cancer. Head Neck 35:1178–1188. https://doi.org/10.1002/hed.23118

    Article  PubMed  Google Scholar 

  22. Duffy SA, Khan MJ, Ronis DL et al (2008) Health behaviors of head and neck cancer patients the first year after diagnosis. Head Neck 30:93–102. https://doi.org/10.1002/hed.20665

    Article  PubMed  Google Scholar 

  23. Adair M, Murphy B, Yarlagadda S et al (2018) Feasibility and preliminary efficacy of tailored yoga in survivors of head and neck cancer: a pilot study. Integr Cancer Ther 17:774–784. https://doi.org/10.1177/1534735417753540

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wang HL, McMillan SC, Vijayakumar N et al (2019) A behavioral physical activity intervention to manage moderate and severe fatigue among head and neck cancer patients-pre-efficacy study in the National Institutes of Health ORBIT Model. Cancer Nurs 42:E1-e14. https://doi.org/10.1097/ncc.0000000000000568

    Article  PubMed  Google Scholar 

  25. Guo SE, Huang TJ, Huang JC et al (2013) Alcohol, betel-nut and cigarette consumption are negatively associated with health promoting behaviors in Taiwan: a cross-sectional study. BMC Public Health 13:257. https://doi.org/10.1186/1471-2458-13-257

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fong SSM, Ng SSM, Lee HW et al (2015) The effects of a 6-month tai chi qigong training program on temporomandibular, cervical, and shoulder joint mobility and sleep problems in nasopharyngeal cancer survivors. Integr Cancer Ther 14:16–25. https://doi.org/10.1177/1534735414556508

    Article  PubMed  Google Scholar 

  27. Zhou W, Wan YH, Chen Q, Qiu YR, Luo XM (2018) Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial. J Pain Symptom Manage 55:737–744. https://doi.org/10.1016/j.jpainsymman.2017.10.021

    Article  PubMed  Google Scholar 

  28. Jackson C, Dowd AJ, Capozzi LC et al (2018) A turning point: head and neck cancer patients’ exercise preferences and barriers before and after participation in an exercise intervention. Eur J Cancer Care 27:1–1. https://doi.org/10.1111/ecc.12826

    Article  Google Scholar 

  29. Naik H, Qiu X, Brown MC et al (2016) Socioeconomic status and lifestyle behaviours in cancer survivors: smoking and physical activity. Curr Oncol 23:e546–e555. https://doi.org/10.3747/co.23.3166

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Capozzi LC, Boldt KR, Lau H et al (2015) A clinic-supported group exercise program for head and neck cancer survivors: managing cancer and treatment side effects to improve quality of life. Support Care Cancer 23:1001–1007. https://doi.org/10.1007/s00520-014-2436-4

    Article  PubMed  Google Scholar 

  31. Rogers SN, Lowe D, Midgley AW (2021) Patients’ views of physical activity whilst living with and beyond head and neck cancer. Int J Oral Maxillofac Surg. https://doi.org/10.1016/j.ijom.2021.05.006

    Article  PubMed  Google Scholar 

  32. Midgley AW, Lowe D, Levy AR, Mepani V, Rogers SN (2018) Exercise program design considerations for head and neck cancer survivors. Eur Arch Otorhinolaryngol 275:169–179. https://doi.org/10.1007/s00405-017-4760-z

    Article  PubMed  Google Scholar 

  33. Lønbro S, Dalgas U, Primdahl H, Overgaard J, Overgaard K (2013) Feasibility and efficacy of progressive resistance training and dietary supplements in radiotherapy treated head and neck cancer patients—the DAHANCA 25A study. Acta Oncol 52:310–318. https://doi.org/10.3109/0284186x.2012.741325

    Article  PubMed  Google Scholar 

  34. Lonkvist CK, Lønbro S, Vinther A et al (2017) Progressive resistance training in head and neck cancer patients during concomitant chemoradiotherapy—design of the DAHANCA 31 randomized trial. BMC Cancer 17:400. https://doi.org/10.1186/s12885-017-3388-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Samuel SR, Maiya AG, Fernandes DJ et al (2019) Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy. Support Care Cancer 27:3913–3920. https://doi.org/10.1007/s00520-019-04750-z

    Article  PubMed  PubMed Central  Google Scholar 

  36. Samuel SR, Maiya GA, Babu AS, Vidyasagar MS (2013) Effect of exercise training on functional capacity & quality of life in head & neck cancer patients receiving chemoradiotherapy. Indian J Med Res 137:515–520

    PubMed  PubMed Central  Google Scholar 

  37. Buffart LM, de Bree R, Altena M et al (2018) Demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity in head and neck cancer survivors. Support Care Cancer 26:1447–1456. https://doi.org/10.1007/s00520-017-3966-3

    Article  PubMed  Google Scholar 

  38. Sandmael JA, Bye A, Solheim TS et al (2017) Feasibility and preliminary effects of resistance training and nutritional supplements during versus after radiotherapy in patients with head and neck cancer: a pilot randomized trial. Cancer 123:4440–4448. https://doi.org/10.1002/cncr.30901

    Article  PubMed  Google Scholar 

  39. Felser S, Behrens M, Liese J et al (2020) Feasibility and effects of a supervised exercise program suitable for independent training at home on physical function and quality of life in head and neck cancer patients: a pilot study. Integr Cancer Ther 19:1534735420918935. https://doi.org/10.1177/1534735420918935

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Karczewska-Lindinger M, Tuomi L, Fridolfsson J et al (2021) Low physical activity in patients diagnosed with head and neck cancer. Laryngoscope Investig Otolaryngol 6:747–755. https://doi.org/10.1002/lio2.610

    Article  PubMed  PubMed Central  Google Scholar 

  41. Elshahat S, Treanor C, Donnelly M (2021) Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review. Int J Behav Nutr Phys Act 18:50. https://doi.org/10.1186/s12966-021-01116-9

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bressan V, Stevanin S, Bianchi M et al (2016) The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: a systematic review. Cancer Treat Rev 45:105–119. https://doi.org/10.1016/j.ctrv.2016.03.006

    Article  PubMed  Google Scholar 

  43. Bressan V, Bagnasco A, Aleo G et al (2017) The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis. Support Care Cancer 25:1699–1712. https://doi.org/10.1007/s00520-017-3618-7

    Article  PubMed  Google Scholar 

  44. Van den Bosch L, van der Laan HP, van der Schaaf A et al (2021) Patient-reported toxicity and quality-of-life profiles in patients with head and neck cancer treated with definitive radiation therapy or chemoradiation. Int J Radiat Oncol Biol Phys 111:456–467. https://doi.org/10.1016/j.ijrobp.2021.05.114

    Article  PubMed  Google Scholar 

  45. McNeely ML, Parliament MB, Seikaly H et al (2012) Predictors of adherence to an exercise program for shoulder pain and dysfunction in head and neck cancer survivors. Support Care Cancer 20:515–522. https://doi.org/10.1007/s00520-011-1112-1

    Article  PubMed  Google Scholar 

  46. Bower JE, Bak K, Berger A et al (2014) Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol 32:1840–1850. https://doi.org/10.1200/jco.2013.53.4495

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wang XS, Woodruff JF (2015) Cancer-related and treatment-related fatigue. Gynecol Oncol 136:446–452. https://doi.org/10.1016/j.ygyno.2014.10.013

    Article  PubMed  Google Scholar 

  48. Cramp F, Byron-Daniel J (2012) Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 11:CD006145. https://doi.org/10.1002/14651858.CD006145.pub3

    Article  PubMed  Google Scholar 

  49. Twomey R, Culos-Reed SN, Dort JC (2020) Exercise prehabilitation-supporting recovery from major head and neck cancer surgery. JAMA Otolaryngol Head Neck Surg 146:689–690. https://doi.org/10.1001/jamaoto.2020.1346

    Article  PubMed  Google Scholar 

  50. Berra K, Rippe J, Manson JE (2015) Making physical activity counseling a priority in clinical practice: the time for action is now. JAMA 314:2617–2618. https://doi.org/10.1001/jama.2015.16244

    Article  CAS  PubMed  Google Scholar 

  51. Murphy JL, Girot EA (2013) The importance of nutrition, diet and lifestyle advice for cancer survivors—the role of nursing staff and interprofessional workers. J Clin Nurs 22:1539–1549. https://doi.org/10.1111/jocn.12053

    Article  PubMed  Google Scholar 

  52. Tarasenko YN, Miller EA, Chen C, Schoenberg NE (2017) Physical activity levels and counseling by health care providers in cancer survivors. Prev Med 99:211–217. https://doi.org/10.1016/j.ypmed.2017.01.010

    Article  PubMed  Google Scholar 

  53. Sardi L, Idri A, Fernández-Alemán JL (2017) A systematic review of gamification in e-Health. J Biomed Inform 71:31–48. https://doi.org/10.1016/j.jbi.2017.05.011

    Article  PubMed  Google Scholar 

  54. Slomski A (2017) Gamification shows promise in motivating physical activity. JAMA 318:2419–2419. https://doi.org/10.1001/jama.2017.19987

    Article  PubMed  Google Scholar 

  55. Garett R, Young SD (2019) Health care gamification: a study of game mechanics and elements. Technol Knowl Learn 24:341–353. https://doi.org/10.1007/s10758-018-9353-4

    Article  Google Scholar 

  56. Hammermüller C, Hinz A, Dietz A et al (2021) Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population. BMC Cancer 21:94. https://doi.org/10.1186/s12885-020-07773-6

    Article  PubMed  PubMed Central  Google Scholar 

  57. Doré I, Plante A, Peck SS, Bedrossian N, Sabiston CM (2021) Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors. Support Care Cancer. https://doi.org/10.1007/s00520-021-06469-2

    Article  PubMed  Google Scholar 

  58. Gibson C, O'Connor M, White R et al (2021) ‘I Didn’t Even Recognise Myself’: survivors’ experiences of altered appearance and body image distress during and after treatment for head and neck cancer. Cancers (Basel) 13. https://doi.org/10.3390/cancers13153893

  59. Threader J, McCormack L (2016) Cancer-related trauma, stigma and growth: the ‘lived’ experience of head and neck cancer. Eur J Cancer Care (Engl) 25:157–169. https://doi.org/10.1111/ecc.12320

    Article  CAS  Google Scholar 

  60. Gleeson M, Bishop NC, Stensel DJ et al (2011) The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 11:607–615. https://doi.org/10.1038/nri3041

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported by the National Natural Science Foundation of China (grant number 81872210) and the Research Project Supported by Shanxi Scholarship Council of China (grant number 2020–086).

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Authors and Affiliations

  1. Nursing College of Shanxi Medical University, Taiyuan, 030001, China

    Yan Ning, Qian Wang, Yongxia Ding, Wenting Zhao, Zehuan Jia & Binquan Wang

  2. Shanxi Key Laboratory of Otolaryngology, Head and Neck Cancer, First Hospital of Shanxi Medical University, No.85, Jiefang Road South, Shanxi, Taiyuan, 030001, China

    Yongxia Ding & Binquan Wang

  3. Department of Otolaryngology, Head and Neck Surgery, The First Hospital of Shanxi Medical University, No.85, Jiefang Road South, Taiyuan, 030001, Shanxi, China

    Binquan Wang

  4. Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, 030001, China

    Binquan Wang

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  1. Yan Ning
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  2. Qian Wang
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  3. Yongxia Ding
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  4. Wenting Zhao
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Contributions

Yan Ning and BinQuan Wang conceived and designed the study. Yan Ning, Qian Wang, Wenting Zhao, and Zehuan Jia performed the literature search and data analysis. Yan Ning, Qian Wang, and Yongxia Ding drafted the manuscript. BinQuan Wang, Yongxia Ding, and Wenting Zhao revised the work review and improvement of the manuscript. All the authors have checked and approved the final manuscript.

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Correspondence to Binquan Wang.

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Ning, Y., Wang, Q., Ding, Y. et al. Barriers and facilitators to physical activity participation in patients with head and neck cancer: a scoping review. Support Care Cancer 30, 4591–4601 (2022). https://doi.org/10.1007/s00520-022-06812-1

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