Individualized home training in head and neck cancer patients is safe and has positive short-und medium term effects -results of a multicenter, single-arm intervention trial (OSHO #94)

Sabine Felser^1*Lars Arne Bonke¹Änne Glass²Daniel Strüder³Jana Stolle⁴Susann Schulze^4,5Markus Blaurock⁶Anke Steinmetz⁷Julia Daunheimer¹Ursula Kriesen¹Christina Grosse-Thie^1,8Christian Junghanss¹

• ¹Department of Internal Medicine, Clinic III – Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany
• ²Institut for Biostatistic and Informatics in Medicine, Rostock University Medical Center, Rostock, Germany
• ³Department of Otorhinolaryngology, Head and Neck Surgery "Otto Koerner", Rostock University Medical Center, Rostock, Germany
• ⁴Krukenberg Cancer Center Halle, University Hospital Halle, Halle (Saale), Germany
• ⁵Department of Internal Medicine, Medical Clinic II, Carl-von-Basedow-Klinikum, Merseburg, Germany
• ⁶Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
• ⁷Department of Orthopedics, Trauma and Rehabilitation Medicine, Physical and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
• ⁸Hematology and Oncology Practice, Rostock, Germany

Introduction Despite targeted exercise interventions alleviating functional deficits in head and neck cancer (HNC) patients, many patients are insufficiently physically active. A promising approach to reducing barriers could be individually adaptable home training. The "OSHO #94" study examined the short-term effectiveness, the medium-term sustainability, and the safety of an individualized home exercise program.Methods This three-center, single-arm, interventional study included patients in aftercare or stable remission under immunotherapy. Participants were advised to perform an individualized home exercise program (mobilization, coordination, strengthening, and stretching) at least three times a week and moderate-intensity endurance training two to three times a week. During the 12-week intervention, they kept a training diary and received weekly physiotherapist calls. In the subsequent 12-week followup (FU), participants were asked to continue training. The evaluation of short-term effects (between pre-and post-intervention) and medium-term effects (incl. FU), included the assessment of quality of life (QoL), physical activity levels (Leisure Score Index (LSI); weekly amount), body composition, shoulder/cervical spine range of motion, fall risk, and aerobic performance. Adverse events were recorded.Fifty-three patients (57% male) were enrolled, 83% completed the post assessment, and 72% completed FU. During the intervention, participants exercised for 257 min/week (with 95 minutes individual and 162 minutes endurance). The pre-post intervention effect on the global QoL was small (rw=0.20, p=0.186). Moderate effects were found in emotional (rw=0.38, p=0.011) and social functioning (rw=0.46, p=0.002), fatigue (rw=0.37, p=0.013), and dyspnea (rw=0.32, p=0.035). LSI increased significantly (25 vs. 39, p=0.003), whereas total physical activity duration remained unchanged (280 vs. 290 min/week, p=0.160). Small effects were observed on body composition. The largest effects were found in physical functioning, particularly aerobic performance (rw=0.67, p<0.001). Nine participants (17%) reported training-related adverse events, primarily pain. Half of participants (48%) continuing with individual training during FU. Some short-term effects could be detected medium-term. Discussion Physical activity levels improved despite an unchanged activity duration suggesting an increased training intensity. With individualized home exercises and remote support, home training was effective and safe. After support ended, patients maintained their activity level and the effects were sustained, suggesting suitability for routine care.