Head and Neck Cancer (HNC) is a globally rare cancer that includes a variety of tumors affecting the upper aerodigestive tract. It presents with difficulty breathing or swallowing and is mainly treated with radiation therapy, chemotherapy, or surgery for tumors that have spread locally or throughout the body. Alternatively, exercise can be used during cancer treatment to improve function, including pain relief, increase range of motion and muscle strength, and reduce cancer-related fatigue, thereby enhancing quality of life. Although existing evidence suggests the adjunctive use of exercise in other cancer types, no previous studies have examined the effects on HNC survivors. The aim of this meta-analysis was to quantify the effect of exercise-based rehabilitation on functionality and quality of life in HNC survivors who underwent surgery and/or chemoradiotherapy. A systematic review and meta-analysis were carried out following PRISMA statement and registered in PROSPERO (CRD42023390300). The search was performed in MEDLINE (PubMED), Cochrane Library, CINAHL and Web of Science (WOS) databases from inception to 31st December 2022 using the terms “cancer”, “head and neck neoplasms”, “exercise”, “rehabilitation”, “complications”, “muscle contraction”, “muscle stretching exercises” combining with booleans “AND”/“OR”. PEDro scale, Cochrane Risk of Bias Tool and GRADE were used to assess methodological quality, risk of bias and grade of recommendation of included studies respectively. 18 studies (n = 1322) were finally included which 1039 (78.6%) were men and 283 (21.4%) were women. In patients who underwent radio-chemotherapy, overall pain [SMD = − 0.62 [− 4.07, 2.83] CI 95%, Z = 0.35, p = 0.72] and OP [SMD = − 0.07 [− 0.62, 0.48] CI 95%, Z = 0.25, p = 0.81] were slightly reduced with exercise in comparison to controls. Besides, lower limb muscle strength [SMD = − 0.10 [− 1.52, 1.32] CI 95%, Z = 0.14, p = 0.89] and fatigue [SMD = − 0.51 [− 0.97, − 0.057] CI 95%, Z = 2.15, p < 0.01] were also improved in those who receive radio-chemoradiation. In HNC survivors treated with neck dissection surgery, exercise was superior to controls in overall pain [SMD = − 1.04 [− 3.31, 1.23] CI 95%, Z = 0.90, p = 0.37] and, in mid-term, on shoulder pain SMD = − 2.81 [− 7.06, 1.43] CI 95%, Z = 1.76, p = 0.08]. No differences in quality of life were found at any of the follow-up periods. There is evidence of fair to good methodological quality, low to moderate risk of bias, and weak recommendations supporting the use of exercise-based rehabilitation to increase functionality. However, no evidence was found in favor of the use of this modality for improving the quality of life of HNC survivors who underwent chemoradiotherapy or surgery.

Background and Objectives: Shoulder dysfunction is a frequent complication after cervical lymph node dissection in patients with head and neck cancer (HNC), leading to pain, reduced mobility, and impaired quality of life. Physiotherapy programs that include strength exercises have shown benefits in managing these sequelae, but the potential added value of neurodynamic mobilization techniques (NDMTs) remains unclear. This pilot randomized controlled trial was designed to examine whether a NDMTs program improves pain and shoulder-related function in HNC survivors with shoulder dysfunction, assessing trajectories during treatment and at short-term follow-up. Materials and Methods: A pilot, assessor-blinded, randomized, parallel-group clinical trial was conducted with 20 participants who had undergone HNC surgery and exhibited shoulder dysfunction. Participants were randomized to either a control group (strength exercises alone) or an experimental group (strength exercises plus NDMTs). Outcomes were assessed at baseline, mid-term (1 week), post-treatment, and 3 months post-treatment. The primary outcome was quality of life measured by the QLQ-H&N35 questionnaire. Secondary outcomes included pain intensity (VAS), disability (DASH), and handgrip strength. Results: Significant improvements were observed in the experimental group for all primary and secondary outcomes. The experimental group demonstrated improved quality of life (p = 0.009), lower pain intensity (p < 0.001), reduced disability (p < 0.001), and increased handgrip strength. Interaction effects for time and group were significant across multiple measures, favoring the NDMTs group. Conclusions: NDMTs are a promising addition to strength programs for improving shoulder dysfunction outcomes in HNC patients, with implications for both clinical practice and future research. Registered in ClinicalTrials: NCT05604235 prior to recruitment.

Introduction: Persistent pain is a common long-term sequela in breast cancer survivors treated with chemotherapy and may involve neuropathic pain and central sensitization (CS). However, few studies have examined these mechanisms together and their association with specific sensory symptoms. Material and methods: A multicenter cross-sectional study was conducted in four Spanish hospitals between September 2022 and January 2025. A total of 254 women with surgically treated breast cancer who had completed chemotherapy were included. Neuropathic pain was assessed using the Spanish version of the Douleur Neuropathique 4 (DN4), CS using the Central Sensitization Inventory (CSI), and pain intensity and sensory symptoms (paresthesia, tingling, and thermal sensitivity) using visual analog scales. Between-group comparisons according to the presence of neuropathic pain and central sensitization, as well as analyses of their independent and combined effects on pain intensity and sensory symptoms, were performed. Results: Participants reported moderate pain intensity, with clinically relevant neuropathic pain features and CS. Patients with neuropathic pain (DN4 ≥ 4) showed significantly higher pain intensity and greater severity of all sensory symptoms (all p < 0.001). Similarly, participants with CS reported higher pain intensity and greater severity of tingling and thermal sensitivity. Neuropathic pain and CS were independently associated with increased symptom burden and frequently coexisted. Conclusions: Neuropathic pain and CS are common and overlapping components of persistent pain in breast cancer survivors treated with chemotherapy and are associated with greater pain intensity and sensory symptom severity. Concurrent assessment of both mechanisms may improve the clinical characterization and management of post-chemotherapy pain.

BACKGROUND Background: The growing number of cancer survivors experiencing persistent physical, psychological, and social limitations is placing increasing pressure on health care systems and this requires more structured, biopsychosocial approaches to care. Oncological physiotherapy plays a key role within multidisciplinary teams; however, assessment practices remain heterogeneous, with limited standardization, unclear clinical applicability, and a lack of consensus on appropriate measurement instruments despite existing conceptual frameworks. OBJECTIVE Objective: This study aims to develop an evidence-informed, consensus-based framework (IN-GUIDE) for the selection, prioritization, and implementation of assessment instruments in oncological physiotherapy, integrating psychometric and clinimetric evidence with clinical applicability to support measurement-based care. METHODS Methods: A multiphase, sequential mixed-methods design will be used. First, a systematic review will be conducted following PRISMA guidelines to identify assessment instruments relevant to oncological physiotherapy with methodological quality, measurement properties, and level of evidence appraised using COSMIN standards. Eligible instruments include patient-reported, clinician-reported, and performance-based outcome measures. This review protocol was previously registered in PROSPERO (CRD42024520846). Second, a three-round electronic Delphi (e-Delphi) process will be conducted via a secure REDCap platform. A multidisciplinary expert panel will evaluate instruments on the basis of an integrated assessment of methodological quality, level of evidence, clinical relevance, and feasibility. Instruments will be organized into eight predefined domains. Structured feedback (median, interquartile range, and percentage agreement) will be provided between rounds. Consensus will be defined a priori as ≥75% agreement. RESULTS Expected results: Preparatory work, including framework development, has been ongoing since late 2024. The systematic review phase began at the end of 2025 and is currently ongoing, with completion expected in 2026. The Delphi consensus process will follow, with the final results anticipated by the beginning of 2027. CONCLUSIONS Conclusions: The IN-GUIDE framework is expected to support standardized, feasible, and clinically applicable assessments in oncological physiotherapy, facilitating measurement-based care, improving clinical decision-making, and promoting integration across multidisciplinary cancer care. CLINICALTRIAL PROSPERO CRD42024520846; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024520846