Lauri Locati

Presentation
Prehabilitation in head and neck cancer (HNC) includes multiple activities such as nutritional support, swallowing exercises, physical exercise, psycho-oncological support and behavioral interventions (smoking and alcohol cessation). The goal is to maintain the continuum of care throughout the treatment journey of patients with HNC. In the past, prehabilitation was offered only before surgery, but today it is proposed at various stages of the oncological pathway, including the more advanced phases of the disease, with targeted and personalized interventions based on the characteristics of each patient. If some of these activities are already being offered in clinical practice for HNC patients (e.g. nutritional support; psycho-oncological intervention), supervised physical exercise is undoubtedly the most challenging component to implement. Sports doctors, physiologists, physiatrists, kinesiologists, physiotherapists, and occupational therapists are the professional figures involved in physical activity. It is important to maintain a balance between aerobic and anaerobic activity, with supervision provided at least during the initial stages. Ongoing monitoring of the patient’s physical activity through the use of activity trackers should also be ensured. The benefits of physical activity are numerous, starting with the reduction of the inflammatory metabolic state that characterizes cancer patients. A recently published study has also shown, for the first time, the survival benefit of physical activity initiated early after the completion of oncological treatment in patients with colorectal cancer. Unfortunately, evidence on prehabilitation is limited in HNC. We have small studies, often retrospective, mainly focused on swallowing exercises, and so far, no prospective studies have been completed yet.

Bio
Prof Laura D. Locati, MD, PhD Medical Oncologist