Manuscript title: Analysis of the Status and Influencing Factors of Kinesiophobia in Patients with Head and Neck Cancer (HNC)
Introduction
Head and neck cancer (HNC) is a significant global health concern, ranked as the seventh most prevalent cancer and a leading cause of mortality. In 2022, an estimated 890,000 new cases and 450,000 deaths were attributed to HNC, accounting for 4.7% of global cancer-related deaths. The incidence of HNC in China is particularly high, with approximately 130,000 new cases annually, comprising 3-6% of all systemic malignancies. The median age at diagnosis is around 60, but the incidence in adults under 45 has been rising. Between 2018 and 2030, HNC is projected to cause a cumulative global economic loss of approximately 535 billion US dollars, with a more significant impact on developing countries.
Surgical interventions, including neck dissection, are crucial in the management of HNC, particularly for palpable or occult cervical metastases. However, surgery can lead to complications such as infections, fistulae, facial edema, and restricted neck and shoulder movement, potentially causing upper limb pain. Postoperative physical activity and functional exercise play a vital role in minimizing these complications by enhancing functional capacity, improving quality of life, and reducing fatigue.
Kinesiophobia, the fear and anxiety associated with movement and activity, is a significant clinical challenge. It hinders patients' participation in exercise rehabilitation, leading to insufficient exercise levels and decreased compliance. Research indicates that kinesiophobia impacts mandibular movement and swallowing muscle coordination during head and neck rehabilitation, delaying the restoration of swallowing and speech functions.
Previous studies have identified various factors contributing to kinesiophobia, including joint pain, joint replacement, heart disease, and breast cancer. However, limited research has focused on postoperative kinesiophobia in HNC patients and its influencing factors. This study aims to investigate the current status of postoperative kinesiophobia in HNC patients and analyze its contributing factors.
Materials and Methods
This single-center prospective cross-sectional study was conducted between September 2024 and April 2025 at the Department of Head and Neck Surgery and Thyroid Surgery in Zhejiang Cancer Hospital. The study followed the STROBE guidelines and was registered on the Chinese Clinical Trial Registry (ChiCTR2400088579).
Participants
Inclusion criteria: Patients with a confirmed diagnosis of head and neck squamous cell carcinoma, scheduled for radical head and neck surgery, aged 18-80 years, conscious and capable of cooperation, and who signed the informed consent form and voluntarily participated in the study.
Exclusion criteria: Patients with other malignant tumors or systemic diseases, severe mental disorders, or speech impairments.
Study Size
The sample size was calculated based on Kendall's empirical method, considering a 20% rate of invalid samples. The total required sample size ranged from 186 to 372 cases, with 367 cases included in the study.
Instruments
- Patient General Information Questionnaire: Designed to collect socio-demographic and disease-related data.
- Tampa Kinesiophobia-11 Scale (TSK-11): A validated tool to assess kinesiophobia, comprising three dimensions and 11 items.
- Chinese Version of the Brief Fatigue Inventory (BFI-C): Measures fatigue in cancer patients.
- General Self-Efficacy Scale (GESE): Assesses self-efficacy, a key factor in managing kinesiophobia.
Data Sources/Measurement
Researchers conducted a face-to-face questionnaire survey on the tenth day post-surgery, explaining the study's purpose and time commitment. Research nurses collected and verified the completed questionnaires to ensure data quality.
Ethical Considerations
The study protocol was approved by the Institutional Review Board of Zhejiang Cancer Hospital (approval no. 2024-42). Informed consent was obtained from all participants, and all protected healthcare information was used solely for research purposes and secured throughout the study.
Statistical Analysis
SPSS for Windows (version 26) was used for data analysis. Univariate and correlation analyses were performed, and multivariate analysis was conducted using multiple linear regression methods.
Results
The study included 372 participants, with 367 completing the questionnaire survey (98.65% completion rate). Univariate analysis revealed significant variations in kinesiophobia levels across factors like education level, skin flap transplantation, immobilization, lymph node dissection, and tracheotomy.
The TSK-11 scores in early postoperative HNC patients ranged from 18.42 ± 4.97, with the highest mean score in the Attitude dimension (1.81 ± 0.60). Correlation analysis showed a positive correlation between TSK-11 and BFI-C scores and a negative correlation with GESE scores.
Multiple linear regression analysis identified skin flap transplantation, immobilization, lymph node dissection, tracheotomy, GESE, and BFI-C as significant influencing factors of kinesiophobia in early postoperative HNC patients.
Discussion
The study highlights a high incidence of early postoperative kinesiophobia in HNC patients, with tracheotomy, skin flap transplantation, immobilization, lymph node dissection, self-efficacy, and fatigue as key contributing factors.
Further research and clinical interventions are necessary to address these factors and improve patient outcomes.
