Bauml Joshua, Kim Jiyoung, Zhang Xiaochen, Aggarwal Charu, Cohen Roger B, Schmitz Kathryn
Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Penn State College of Medicine, Hershey, PA, USA.
J Cancer Surviv. 2017 Aug;11(4):462-468. doi: 10.1007/s11764-017-0604-5. Epub 2017 Feb 13.
Patients with human papillomavirus (HPV)-related head and neck cancer (HNC) have a better prognosis relative to other types of HNC, making survivorship an emerging and critical issue. Exercise is a core component of survivorship care, but little is known about how many survivors of HPV-related HNC can safely be advised to start exercising on their own, as opposed to needing further evaluation or supervised exercise.
We utilized guidelines to identify health issues that would indicate value of further evaluation prior to being safely prescribed unsupervised exercise. We performed a retrospective chart review of 150 patients with HPV-related HNC to assess health issues 6 months after completing definitive therapy. Patients with at least one health issue were deemed appropriate to receive further evaluation prior to prescription for unsupervised exercise. We utilized logistic regression to identify clinical and demographic factors associated with the need for further evaluation, likely performed by outpatient rehabilitation clinicians.
In this cohort of patients, 39.3% could safely be prescribed unsupervised exercise 6 months after completing definitive therapy. On multivariable regression, older age, BMI >30, and receipt of radiation were associated with an increased likelihood for requiring further evaluation or supervised exercise.
Over half of patients with HPV-related HNC would benefit from referral to physical therapy or an exercise professional for further evaluation to determine the most appropriate level of exercise supervision, based upon current guidelines.
Development of such referral systems will be essential to enhance survivorship outcomes for patients who have completed treatment.
与人乳头瘤病毒（HPV）相关的头颈癌（HNC）患者相对于其他类型的HNC患者预后更好，这使得生存成为一个新出现的关键问题。运动是生存护理的核心组成部分，但对于有多少HPV相关HNC幸存者可以安全地被建议自行开始运动，而不是需要进一步评估或监督运动，我们知之甚少。
我们利用指南来确定在安全地开具无监督运动处方之前表明进一步评估价值的健康问题。我们对150例HPV相关HNC患者进行了回顾性病历审查，以评估完成确定性治疗6个月后的健康问题。至少有一个健康问题的患者被认为在开具无监督运动处方之前适合接受进一步评估。我们利用逻辑回归来确定与需要进一步评估相关的临床和人口统计学因素，这可能由门诊康复临床医生进行。
在这组患者中，39.3%在完成确定性治疗6个月后可以安全地开具无监督运动处方。在多变量回归分析中，年龄较大、BMI>30以及接受放疗与需要进一步评估或监督运动的可能性增加相关。
根据当前指南，超过一半的HPV相关HNC患者将受益于转诊至物理治疗师或运动专业人员处进行进一步评估，以确定最合适的运动监督水平。
建立这样的转诊系统对于提高完成治疗的患者的生存结局至关重要。
