Development and Feasibility of CALORIE CARE^© Programme in Head-and-Neck Cancer Survivors

Head-and-neck cancer (HNC) survivors undergoing concurrent chemoradiotherapy frequently experience treatment-related impairments such as trismus, cervical and shoulder dysfunction, and masticatory muscle weakness. This study aimed to develop and evaluate the feasibility of the CALORIE CARE programme, a tailored exercise intervention for HNC survivors undergoing concurrent chemoradiotherapy (CCRT). The secondary objective was to assess changes in mouth opening measured by maximal interincisal opening (MIO).

A feasibility study was conducted at a tertiary care hospital in Karnataka, India, from January 2024 to January 2025. Eligible participants were HNC survivors with TNM (Tumor, Node, and Metastasis) stages III-IVb and MIO <35 mm undergoing concurrent chemoradiotherapy. The CALORIE CARE programme was developed using the Template for Intervention Description and Replication (TIDeR) checklist. The 8-week intervention included mobility, stretching, strengthening, swallowing exercises, and aerobic activity. Feasibility outcomes included recruitment rate, adherence rate, and withdrawal rate. Exercise adherence was assessed using the Exercise Adherence Rating Scale-Kannada (EARS-Kn). MIO was measured at baseline, week 4, and week 8.

Among 53 eligible patients, 37 consented to participate (recruitment rate 69.81%), and 35 completed the programme (withdrawal rate 5.4%). The adherence rate was 73.94%. The mean EARS score was 17.8, indicating good adherence. A statistically significant change in MIO was observed between baseline and week 4 (p < 0.001), whereas no significant difference was observed between week 4 and week 8 (p = 0.075).

The CALORIE CARE programme appears feasible, well tolerated, and demonstrates good adherence among HNC survivors undergoing chemoradiotherapy. Early implementation of multidomain rehabilitation may help delay functional deterioration during treatment; however, its efficacy for improving clinically meaningful outcomes requires confirmation in controlled trials.