Why Wait Until After Surgery? The Case for Pre-habilitation in Head and Neck Cancer Care

by By Marna A. List, MD, Jason P. Calligas, MD, John Pang, MD, Ameya A. Asarkar, MD, and Cherie-Ann O. Nathan, MD •

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summary below includes the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

BACKGROUND

Surgery is the foundation for curative treatment in many head and neck cancers (HNC); due to the nature of HNC surgery and patient population, however, complications are not uncommon. Enhanced Recovery After Surgery protocols have aimed to reduce complications after surgery through interventions on modifiable aspects of the care pathway. A focus in many protocols emphasizes both pre-habilitation and rehabilitation for optimization of patients’ overall health and recovery. Several modifiable factors are associated with increased complications, cost, morbidity, and mortality following major cancer surgery. There is a push for high-level evidence supporting early intervention. Most of the current data are on the gastrointestinal cancer population, which may be broadly applied to the HNC population. Multimodal pre-habilitation and rehabilitation have been an important topics in the literature, aiming to combat modifiable patient factors like sarcopenia, malnutrition, and psychological status.

The aim of this review is to evaluate the impact of nutritional and exercise interventions and synthesize best practices surrounding the modifiable characteristics that negatively impact surgical outcomes in HNC.

BEST PRACTICE

Patients undergoing major surgery for HNC are often deconditioned from malnutrition and fatigue at the time of diagnosis. Pre- and postoperative intervention in nutrition, exercise, and counseling should be included in the multidisciplinary care of HNC patients. Such interventions decrease postoperative complications, hospital and intensive care unit length of stay, treatment- and diagnosis-related anxiety, and muscle and lean body mass loss, and increase physical activity. The duration, formulation, and frequency of intervention require further investigation with robust randomized controlled trials in the HNC population.