Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. (April 2020)

• Record Type: Journal Article
• Authors: Jansen, Femke; Eerenstein, Simone E.J.; Cnossen, Ingrid C.; Lissenberg-Witte, Birgit I.; de Bree, Remco; Doornaert, Patricia; Halmos, György B.; Hardillo, José A.U.; van Hinte, Gerben; Honings, Jimmie; van Uden-Kraan, Cornelia F.; Leemans, C. René; Verdonck-de Leeuw, Irma M.
• Is Part Of: Oral oncology. Volume 103(2020)
• Publication Date: 2020-04
• Subjects: Total laryngectomy -- Head and neck cancer -- Laryngeal cancer -- Exercise program -- Swallowing -- Speech -- Shoulder functioning -- Quality of life -- Randomized controlled trial; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2020.104586
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Almost 60% of the patients in the intervention group exercised >1 per day. The guided self-help exercise program improves swallowing and communication. The exercise program did not improve speech and shoulder problems. The exercise program did not improve patient activation and quality of life. Time since treatment moderated the effectiveness on speech problems. Abstract: Objective: To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). Materials and methods: This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness. Results: Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness. Conclusion: The guided self-help exercise program improves swallowing and communication. Trial registration. NTR5255.