Expert consensus on physical activity promotion in survivors of advanced head and neck cancer in Switzerland - a Delphi study

Background: Higher levels of physical activity (PA) are associated with a better quality of life (QoL) in survivors of head and neck cancer (sHNC). Nevertheless, many individuals with head and neck cancer (HNC) exhibit sedentary behavior or engage in very low activity levels. Those with advanced HNC face particularly challenges in engaging in PA due to the sequelae of their extensive treatment regimes. In Switzerland there are no guidelines on how to promote PA in this patient population. Therefore, the aim of the Delphi study is to generate expert consensus on when, how and by whom PA promotion should be delivered to people with locally advanced HNC throughout the Swiss hospital-based care pathway from diagnosis through to survivorship. To establish the foundation for the Delphi survey, a scoping review collected the existing international evidence on PA in people with HNC. Furthermore, a qualitative interview study explored the perspectives of Swiss sHNC with advanced tumors and their relatives on PA engagement and on suggestions for PA. Methods: Clinical experts from the multiprofessional team working with patients with HNC will be invited to participate. The expert panel will complete three rounds of online surveys, in which they will rate and weight statements regarding optimal strategies for delivering PA promotion in people with advanced HNC. Consensus will be defined as an agreement level of ≥80% or ≤20%. Statements not reaching consensus in the second round will undergo a forced decision process in the third round. Expected outcomes: The Delphi study will generate a set of evidence- and expert-informed recommendations on how PA promotion can effectively support people with advanced HNC in engaging in regular PA in the Swiss context. These recommendations will provide practical guidance for health care professionals to integrate PA promotion into the routine care pathway.