Análisis de calidad de vida y métodos de tratamiento rehabilitador actuales en pacientes supervivientes de cáncer de cabeza y cuello

Resum

Head and Neck Cancer (HNC) affects the upper digestive airway and is subdivided based on the anatomical region involved. In this way, they are distinguished: cancer of oral cavity, pharynx, larynx, salivary glands, nasal passages and sinuses. During the year 2020 it covered more than 4% of the incidence worldwide, being among the ten most prevalent. Considering the oncological treatments for this type of cancer we find surgery, radiotherapy and / or chemotherapy. The morbidity associated with the treatments is quite limiting, such as hyposalivation and/or xerostomia, oral mucositis, trismus and osteoradionecrosis associated with radiotherapy. Physiotherapy in other types of cancer survivors has already proven to be effective for example to address fatigue, it is imperative to focus scientific research on understanding and knowing more deeply the management of the sequelae presented by HNC survivors, whose problems impact especially on the ability to speak, feed, interact and reintegrate socially. Given the above, this work of Doctoral Thesis is proposed in 2 phases with the following objectives: (i) to systematically analyze, both qualitatively and quantitatively, the current evidence on rehabilitation methods to improve the quality of life in HNC survivors and, (ii) to determine if photobiomodulation therapy is effective and safe to improve quality of life and oral health in HNC survivors who suffer post-RT xerostomia in comparison to a placebo group of the same therapy. To this end, a systematic review with meta-analysis was first conducted, where a synthesis of the most appropriate rehabilitation treatments for improving the quality of life of these patients is presented, and a second phase, in which a pilot trial of photobiomodulation therapy is carried out on the quality of life and oral health of these patients versus a placebo. The results of this Doctoral Thesis show: (i) the meta-analysis described seems to show a trend in favor of therapeutic exercise with respect to the quality of life of HNC survivors; (ii) the potential of exercise and partly electrophysical agents to improve quality of life in these patients appears to be clear, although there is a lack of reliable consensus in terms of the parameters analyzed due to the disparity in the extracted data; (iii) the shortterm efficacy of the application of a therapy by photobiomodulation in HNC survivors who were treated with RT has been demonstrated to cause an increase in sialometry values, thus helping to mitigate some of the side effects suffered by these patients.