A Comprehensive Prehabilitative Model of Care for Head and Neck Cancer Survivors: A Scoping Review

Objective(s): Primary: To investigate if prehabilitation in head and neck cancer (HNC) populations reduces the severity and incidence of cancer treatment sequelae. Secondary: To investigate evidence-based prehabilitative methods resulting in best occupational outcomes in terms of participation, quality of life, and role satisfaction.

Data Sources: Methods included manual searches through catalogued topics (Cancer) and basic searches for level I articles (Cochrane Library and PEDro), advanced database searches for level II and qualitative articles (PEDro, PubMed, CINAHL, and APA PsychInfo). Limiters included publication date of 2000 or after, English, and full-text availability. Citation chaining was completed using GoogleScholar.

Study Selection: Studies addressing at least one component of the PICO questions (HNC survivors; prehabilitation, occupational therapy; usual care; and occupational performance) were selected for detailed review by the first author. Articles were prioritized if intervention was initiated prior to, during, or within the first year of cancer treatment.

Data Extraction: During detailed review, the citation, article/publication type, purpose, methods, results, conclusions, and recommendations of each article were logged in a literature matrix. Key concepts and direct quotes were grouped together. Themes were developed from these groups and reviewed by project mentors and co-authors.

Data Synthesis: Forty-three articles were included in the final review. There are a number of unmet physical, emotional, informational, and financial needs among HNC survivors. Patients who are single, widowed, live in rural areas, and/or younger tend to report greater negative effects on daily life. Programs focusing on education, self-management, and prospective screening for ongoing rehabilitation needs are most effective in terms of quality of life, lymphedema, dysphagia, fatigue, and shoulder dysfunction. There is a distinct gap noted in the HNC research pertaining to multi-factorial intervention, such as returning to work.

Conclusions: Prehabilitation overall lessens the severity and incidence of cancer treatment sequelae in patients with HNC. Themes developed center on the patient’s experience; education needs; and what, when, and how intervention should be provided. Further research investigating participation-based outcomes and the role of OT is recommended.

Author(s) Disclosures: None.