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Safety and feasibility of cardiopulmonary exercise testing in head and neck cancer survivors
Adrian W Midgley1, Andrew R Levy2, Felipe A Cunha3
1Department of Sport & Physical Activity and Cardiorespiratory Research Centre, Edge Hill University, Ormskirk, UK.
Insights
Cardiopulmonary exercise testing (CPET) is safe for most head and neck cancer survivors, but their reduced cardiorespiratory fitness requires adjusted test protocols. Most survivors are insufficiently active.
Area of Science:
- Oncology
- Cardiology
- Pulmonology
- Rehabilitation Medicine
Background:
- Head and neck cancer (HaNC) survivors often experience reduced cardiorespiratory fitness.
- Assessing fitness is crucial for guiding rehabilitation and improving quality of life.
Purpose of the Study:
- To evaluate the safety and feasibility of cardiopulmonary exercise testing (CPET) in HaNC survivors.
- To compare their cardiorespiratory fitness to normative data.
- To determine current physical activity levels.
Main Methods:
- Fifty HaNC survivors (mean age 62 years) completed CPET on a cycle ergometer.
- Participants reported factors influencing test termination via questionnaire.
- Physical activity levels were assessed using a self-reported questionnaire.
Main Results:
- CPET was feasible for most survivors; 3 did not complete due to device fit, pain, or artifacts.
- Peak oxygen uptake was 34% lower than predicted; test duration was significantly shorter than target (p < 0.001).
- Leg discomfort and breathing issues were primary termination factors (78%); 66% were insufficiently active.
Conclusions:
- CPET is safe and feasible for most HaNC survivors with appropriate exclusion criteria.
- Low cardiorespiratory fitness necessitates careful ramp rate calculation for CPET.
- Findings highlight the need for tailored exercise interventions for this population.
Purpose:
Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels.
Methods:
Fifty HaNC survivors [29 male; mean (SD) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire.
Results:
Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (SD) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (p < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active.
Conclusion:
These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.
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