{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:05:11Z","timestamp":1784135111309,"version":"3.55.0"},"reference-count":54,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Father Muller Research Centre","award":["FMRC\/FMMC\/ST\/25\/2023"],"award-info":[{"award-number":["FMRC\/FMMC\/ST\/25\/2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Head and neck cancer (HNC) presents a significant challenge in oncology. It has high prevalence rates, especially in India, where 30\u201340% of cancer cases are attributed to HNC. While chemotherapy and radiation therapy are essential components of treatment, they often lead to significant sleep disturbances that negatively impact patients\u2019 quality of life and the effectiveness of their treatment. These sleep disturbances are frequently associated with disruptions in the circadian rhythm, which are commonly seen in cancer survivors. This study aimed to evaluate the effect of an exercise oncology program on sleep quality and circadian rhythm in patients with HNC undergoing chemo-radiation therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with HNC (stage III, IVa, or IVb) undergoing chemo-radiation therapy, aged 18 years or above, of any gender, and with an Eastern Cooperative Oncology Group score &lt; 2 were included. Patients with severe orthopedic or neurological conditions, hemoglobin &lt; 8 g\/dL, platelet count &lt; 30,000\/\u00b5L, or unfit for exercise were excluded. Seventy HNC patients were randomized to exercise oncology and control group. The exercise oncology group received 15\u201320-minute sessions of aerobic (brisk walking) and resistance training (upper and lower limb exercises). Participants in the control group were asked to follow the walking protocol recommended by National Comprehensive Cancer Network guidelines, five days a week for seven weeks. Pittsburgh Sleep Quality Index (PSQI) was used to assess overall sleep quality, while melatonin excretion in urine, quantified using ELISA, was used to evaluate the circadian rhythm. Between-group comparisons were analyzed using mixed analysis of variance for PSQI and analysis of covariance for urinary melatonin. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of PSQI scores and melatonin levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PSQI significantly improved in the exercise group (13.97\u00a0\u00b1\u00a02.29 to 7.09\u00a0\u00b1\u00a01.15), and significantly worsened in controls, (13.06\u00a0\u00b1\u00a01.73 to 14.14\u00a0\u00b1\u00a02.64) (both\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Although urinary melatonin levels increased in the exercise group (284.16\u00a0\u00b1\u00a085.29 ng\/L to 369.75\u00a0\u00b1\u00a091.61 ng\/L) and decreased in controls (368.00\u00a0\u00b1\u00a0100.62 ng\/L to 304.39\u00a0\u00b1\u00a099.50 ng\/L), the between-group difference was not significant after adjusting for baseline values (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.372). Furthermore, ROC curve analysis demonstrated that post-intervention PSQI exhibited excellent diagnostic accuracy for distinguishing between good and poor sleep quality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An exercise oncology program has potential benefits in improving quality of sleep and regulating the circadian rhythm in HNC patients undergoing chemo-radiation therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21409","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T08:18:28Z","timestamp":1782375508000},"page":"e21409","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of an exercise oncology program on sleep quality and circadian rhythm in head and neck cancer patients undergoing chemo-radiation therapy: a randomized controlled trial"],"prefix":"10.7717","volume":"14","author":[{"given":"Cherishma","family":"Dsilva","sequence":"first","affiliation":[{"name":"Nitte (Deemed to be University), Nitte Institute of Physiotherapy (NIPT), Mangalore, Karnataka, India"},{"name":"Father Muller College of Physiotherapy, Father Muller Charitable Institutions, Mangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijith V.","family":"Shetty","sequence":"additional","affiliation":[{"name":"Nitte (Deemed to be University), KS Hegde Medical Academy (KSHEMA), Department of Medical Oncology, Mangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Father Muller Medical College Hospital, Mangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Pierre","family":"Baeyens","sequence":"additional","affiliation":[{"name":"THIM Internationale Hochschule f\u00fcr Physiotherapie, Landquart, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchetha","family":"Kumari N.","sequence":"additional","affiliation":[{"name":"Srinivas Institute of Medical Sciences and Research Center, Srinivas University, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumya","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Nitte (Deemed to be University), Nitte Institute of Physiotherapy (NIPT), Mangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Rajan","family":"Samuel","sequence":"additional","affiliation":[{"name":"Division of Health and Life Sciences, College of Arts & Sciences, Mount Vernon Nazarene University,  Ohio, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"10.7717\/peerj.21409\/ref-1","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s41105-020-00258-w","article-title":"Validation of the Pittsburgh Sleep Quality Index (PSQI) with arabic cancer patients","volume":"18","author":"Al Maqbali","year":"2020","journal-title":"Sleep and Biological Rhythms"},{"key":"10.7717\/peerj.21409\/ref-2","doi-asserted-by":"publisher","first-page":"6079","DOI":"10.3390\/cancers14246079","article-title":"Current insights and progress in the clinical management of head and neck cancer","volume":"14","author":"Amaral","year":"2022","journal-title":"Cancers"},{"key":"10.7717\/peerj.21409\/ref-3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fonc.2022.1009064","article-title":"Circadian disruption and cancer- and treatment-related symptoms","volume":"12","author":"Amidi","year":"2022","journal-title":"Frontiers in Oncology"},{"key":"10.7717\/peerj.21409\/ref-4","article-title":"Cancer Chemotherapy. [Updated 2023 Feb 27]. StatPearls [Internet]","author":"Amjad","year":"2024"},{"key":"10.7717\/peerj.21409\/ref-5","doi-asserted-by":"publisher","first-page":"4912","DOI":"10.3390\/cancers13194912","article-title":"An updated review on head and neck cancer treatment with radiation therapy","volume":"13","author":"Anderson","year":"2021","journal-title":"Cancers"},{"key":"10.7717\/peerj.21409\/ref-6","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.tipsro.2020.10.001","article-title":"Sarcopenia in cancer: risking more than muscle loss","volume":"16","author":"Anjanappa","year":"2020","journal-title":"Techical Innovations & Patient Support Radiation Oncology"},{"key":"10.7717\/peerj.21409\/ref-7","first-page":"228","volume-title":"ACSM\u2019s guidelines for exercise testing and prescription","year":"2010","edition":"8"},{"key":"10.7717\/peerj.21409\/ref-8","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1007\/s00520-023-08126-2","article-title":"Effect of exercise across the head and neck cancer continuum: a systematic review of randomized controlled trials","volume":"31","author":"Avancini","year":"2023","journal-title":"Support Care in Cancer"},{"issue":"1","key":"10.7717\/peerj.21409\/ref-9","doi-asserted-by":"publisher","first-page":"66","DOI":"10.5664\/jcsm.27083","article-title":"Measuring melatonin in humans","volume":"4","author":"Benloucif","year":"2008","journal-title":"Journal of Clinical Sleep Medicine"},{"key":"10.7717\/peerj.21409\/ref-10","doi-asserted-by":"publisher","first-page":"723","DOI":"10.3390\/cancers15030723","article-title":"Prognostic impact of sarcopenia\u2019s occurrence during radiotherapy in oropharyngeal cancer patients","volume":"15","author":"Bergamaschi","year":"2023","journal-title":"Cancers"},{"key":"10.7717\/peerj.21409\/ref-11","first-page":"64","article-title":"NCCN clinical practice guidelines in oncology (NCCN Guidelines\u00ae: cancer-related fatigue","author":"Berger","year":"2018"},{"key":"10.7717\/peerj.21409\/ref-12","doi-asserted-by":"publisher","first-page":"100544","DOI":"10.1016\/j.oor.2024.100544","article-title":"The adverse impact of chemo-radiotherapy on the quality of life of oral cancer patients: a review","volume":"10","author":"Bhutani","year":"2024","journal-title":"Oral Oncology Reports"},{"key":"10.7717\/peerj.21409\/ref-13","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1136\/bjsports-2015-094684","article-title":"The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review","volume":"50","author":"Capozzi","year":"2016","journal-title":"British Journal of Sports Medicine"},{"key":"10.7717\/peerj.21409\/ref-14","doi-asserted-by":"publisher","first-page":"e8617","DOI":"10.7717\/peerj.8617","article-title":"Sarcopenia in male patients with head and neck cancer receiving chemo-radiotherapy: a longitudinal pilot study","volume":"8","author":"Chauhan","year":"2020","journal-title":"PeerJ"},{"key":"10.7717\/peerj.21409\/ref-15","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.genhosppsych.2023.12.004","article-title":"Global prevalence of poor sleep quality in cancer patients: a systematic review and meta-analysis","volume":"87","author":"Chen","year":"2024","journal-title":"General Hospital Pyschiatry"},{"issue":"1","key":"10.7717\/peerj.21409\/ref-16","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1034\/j.1600-079x.2000.280106.x","article-title":"Morning urinary assessment of nocturnal melatonin secretion in older women","volume":"28","author":"Cook","year":"2002","journal-title":"Journal of Pineal Research"},{"issue":"20","key":"10.7717\/peerj.21409\/ref-17","doi-asserted-by":"publisher","first-page":"6176","DOI":"10.3390\/jcm13206176","article-title":"Head and Neck Cancer (HNC) Prehabilitation: advantages and limitations","volume":"13","author":"Demurtas","year":"2024","journal-title":"Journal of Clinical Medicine"},{"key":"10.7717\/peerj.21409\/ref-18","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.sdentj.2019.05.010","article-title":"Head and neck cancer management and cancer stem cells implication","volume":"31","author":"Elkashty","year":"2019","journal-title":"The Saudi Dental Journal"},{"key":"10.7717\/peerj.21409\/ref-19","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.radonc.2019.04.023","article-title":"The impact of sarcopenia on tolerance of radiation and outcome in patients with head and neck cancer receiving chemoradiation","volume":"137","author":"Ganju","year":"2019","journal-title":"Radiotherapy and Oncology"},{"key":"10.7717\/peerj.21409\/ref-20","doi-asserted-by":"publisher","first-page":"e17053","DOI":"10.7717\/peerj.17053","article-title":"Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis","volume":"12","author":"Gururaj","year":"2024","journal-title":"PeerJ"},{"issue":"6","key":"10.7717\/peerj.21409\/ref-21","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1002\/lio2.664","article-title":"Relationship between physical activity, objective sleep parameters, and circadian rhythm in patients with head and neck cancer receiving chemoradiotherapy: a longitudinal study","volume":"6","author":"Gururaj","year":"2021","journal-title":"Laryngoscope Investigative Otolaryngology"},{"issue":"1","key":"10.7717\/peerj.21409\/ref-22","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1080\/07357907.2024.2446941","article-title":"The Pittsburgh Sleep Quality Index (PSQI) applied to cancer patients: psychometric properties and factors affecting sleep quality","volume":"43","author":"Hinz","year":"2025","journal-title":"Cancer Investigation"},{"key":"10.7717\/peerj.21409\/ref-23","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.3389\/fonc.2019.01561","article-title":"When the loss costs too much: a systematic review and meta-analysis of sarcopenia in head and neck cancer","volume":"9","author":"Hua","year":"2020","journal-title":"Frontiers in Oncology"},{"key":"10.7717\/peerj.21409\/ref-24","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1038\/s41572-020-00224-3","article-title":"Head and neck squamous cell carcinoma","volume":"6","author":"Johnson","year":"2020","journal-title":"Nature Reviews Disease Primers"},{"key":"10.7717\/peerj.21409\/ref-25","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s43046-020-0021-0","article-title":"Effect of melatonin supplementation in combination with neoadjuvant chemotherapy to miR-210 and CD44 expression and clinical response improvement in locally advanced oral squamous cell carcinoma: a randomized controlled trial","volume":"32","author":"Kartini","year":"2020","journal-title":"Journal of Egyptian National Cancer Institute"},{"key":"10.7717\/peerj.21409\/ref-26","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/JOM.0000000000001563","article-title":"Occupations and the risk of head and neck cancer: a pooled analysis of the international head and neck cancer epidemiology (INHANCE) consortium","volume":"61","author":"Khetan","year":"2019","journal-title":"Journal of Occupational and Environmental Medicine"},{"key":"10.7717\/peerj.21409\/ref-27","doi-asserted-by":"publisher","first-page":"e13662","DOI":"10.1111\/ecc.13662","article-title":"Feasibility of a supervised and home-based tailored exercise intervention in head and neck cancer patients during chemoradiotherapy","volume":"31","author":"Kok","year":"2022","journal-title":"European Journal of Cancer Care"},{"key":"10.7717\/peerj.21409\/ref-28","doi-asserted-by":"publisher","first-page":"9205","DOI":"10.3390\/curroncol30100665","article-title":"Toxicities and quality of life during cancer treatment in advanced solid tumors","volume":"30","author":"Lee","year":"2023","journal-title":"Current Oncology"},{"issue":"2","key":"10.7717\/peerj.21409\/ref-29","doi-asserted-by":"publisher","first-page":"e24085","DOI":"10.1016\/j.heliyon.2024.e24085","article-title":"An RCT META analysis based on the effect of tai chi exercise therapy on the outcome of elderly patients with moderate-to-severe sleep disorders-A systematic review study","volume":"10","author":"Li","year":"2024","journal-title":"Heliyon"},{"key":"10.7717\/peerj.21409\/ref-30","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1038\/s41392-022-01297-0","article-title":"Targeted therapy for head and neck cancer: signaling pathways and clinical studies","volume":"8","author":"Li","year":"2023","journal-title":"Signal Transduction and Targeted Therapy"},{"key":"10.7717\/peerj.21409\/ref-31","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1002\/lio2.88","article-title":"Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy","volume":"2","author":"Lonkvist","year":"2017","journal-title":"Laryngoscope Investigative Otolaryngology"},{"issue":"2","key":"10.7717\/peerj.21409\/ref-32","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/s41999-023-00923-6","article-title":"The effect of Tai Chi exercise intervention on sleep quality in community residing older adults: a systematic review and meta-analysis","volume":"15","author":"Lyu","year":"2024","journal-title":"European Geriatric Medicine"},{"issue":"1","key":"10.7717\/peerj.21409\/ref-33","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/s00405-017-4760-z","article-title":"Exercise program design considerations for head and neck cancer survivors","volume":"275","author":"Midgley","year":"2018","journal-title":"European Archives of Oto-Rhino-Laryngology"},{"key":"10.7717\/peerj.21409\/ref-34","doi-asserted-by":"publisher","first-page":"81","DOI":"10.17925\/ohr.2012.08.2.81","article-title":"Exercise recommendations for cancer-related fatigue, cognitive impairment, sleep problems, depression, pain, anxiety, and physical dysfunction: a review","volume":"8","author":"Mustian","year":"2012","journal-title":"Critical Reviews in Oncology\/Hematology"},{"issue":"26","key":"10.7717\/peerj.21409\/ref-35","doi-asserted-by":"publisher","first-page":"3233","DOI":"10.1200\/JCO.2012.43.7707","article-title":"Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors","volume":"31","author":"Mustian","year":"2013","journal-title":"Journal of Clinical Oncology"},{"key":"10.7717\/peerj.21409\/ref-36","doi-asserted-by":"publisher","first-page":"100016","DOI":"10.1016\/j.bbih.2019.100016","article-title":"Effects of combined exercise training on the inflammatory profile of older cancer patients treated with systemic therapy","volume":"2","author":"Parent-Roberge","year":"2020","journal-title":"Brain, Behavior, and Immunity"},{"key":"10.7717\/peerj.21409\/ref-37","article-title":"Oral Complications of Cancer Therapies (PDQ\u00ae): patient Version. 2024 Jun 6. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US)","author":"PDQ Supportive and Palliative Care Editorial Board","year":"2002"},{"issue":"11","key":"10.7717\/peerj.21409\/ref-38","doi-asserted-by":"publisher","first-page":"7000","DOI":"10.3390\/curroncol31110515","article-title":"Sleep quality in head and neck cancer","volume":"31","author":"Pecorari","year":"2024","journal-title":"Current Oncology"},{"key":"10.7717\/peerj.21409\/ref-39","doi-asserted-by":"publisher","first-page":"8523","DOI":"10.1038\/s41598-023-35503-y","article-title":"Exercise-based rehabilitation on functionality and quality of life in head and neck cancer survivors. A systematic review and meta-analysis","volume":"13","author":"Perez","year":"2023","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.21409\/ref-40","doi-asserted-by":"publisher","first-page":"8523","DOI":"10.1038\/s41598-023-35503-y","article-title":"Exercise-based rehabilitation on functionality and quality of life in head and neck cancer survivors. A systematic review and meta-analysis","volume":"13","author":"P\u00e9rez","year":"2023","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.21409\/ref-41","doi-asserted-by":"publisher","first-page":"e467-e473","DOI":"10.4317\/medoral.25878","article-title":"Psychological impact after treatment in patients with head and neck cancer","volume":"28","author":"Reyes","year":"2023","journal-title":"Medicina Oral Patologia Oral Cirugia Bucal"},{"key":"10.7717\/peerj.21409\/ref-42","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1249\/01.MSS.0000048831.15016.2A","article-title":"Concurrent validation of the OMNI perceived exertion scale for resistance exercise","volume":"35 (2)","author":"Robertson","year":"2003","journal-title":"Medicine and Science in Sports and Exercise"},{"key":"10.7717\/peerj.21409\/ref-43","doi-asserted-by":"publisher","first-page":"3600","DOI":"10.3390\/ijerph19063600","article-title":"The role of physical activity in cancer recovery: an exercise practitioner\u2019s perspective","volume":"19","author":"Roscoe","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"10.7717\/peerj.21409\/ref-44","doi-asserted-by":"publisher","first-page":"3913","DOI":"10.1007\/s00520-019-04750-z","article-title":"Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy","volume":"27","author":"Samuel","year":"2019","journal-title":"Supportive Care in Cancer"},{"key":"10.7717\/peerj.21409\/ref-45","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1186\/s40064-015-1456-y","article-title":"Exercise-based interventions for cancer survivors in India: a systematic review","volume":"4","author":"Samuel","year":"2015","journal-title":"Springerplus"},{"key":"10.7717\/peerj.21409\/ref-46","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1055\/s-0043-1766134","article-title":"Effectiveness of structured exercise intervention in cancer-related fatigue among oral cavity cancer patients: randomized controlled trial","volume":"45","author":"Satish","year":"2023","journal-title":"Indian Journal of Medical and Paediatric Oncology"},{"key":"10.7717\/peerj.21409\/ref-47","doi-asserted-by":"publisher","first-page":"c332","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials","volume":"340","author":"Schulz","year":"2010","journal-title":"British Medical Journal"},{"key":"10.7717\/peerj.21409\/ref-48","doi-asserted-by":"publisher","first-page":"1419613","DOI":"10.3389\/fonc.2025.1419613","article-title":"Different exercise interventions on quality of sleep in breast cancer survivors a network meta-analysis of randomized controlled\u00a0trials","volume":"13","author":"Song","year":"2025","journal-title":"Frontiers in Oncology"},{"key":"10.7717\/peerj.21409\/ref-49","doi-asserted-by":"publisher","first-page":"2577","DOI":"10.1002\/cncr.23448","article-title":"Physical and psychological long-term and late effects of cancer","volume":"112","author":"Stein","year":"2008","journal-title":"Cancer"},{"key":"10.7717\/peerj.21409\/ref-50","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3390\/cancers13040753","article-title":"Prospective evaluation of sarcopenia in head and neck cancer patients treated with radiotherapy or radiochemotherapy","volume":"4","author":"Thureau","year":"2021","journal-title":"Cancers"},{"issue":"5","key":"10.7717\/peerj.21409\/ref-51","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1093\/aje\/kwt302","article-title":"First-morning urinary melatonin and breast cancer risk in the Guernsey Study","volume":"179","author":"Wang","year":"2014","journal-title":"American Journal of Epidemiology"},{"key":"10.7717\/peerj.21409\/ref-52","doi-asserted-by":"publisher","first-page":"750507","DOI":"10.3389\/fphar.2022.750507","article-title":"Mechanisms of chemotherapy-induced neurotoxicity","volume":"13","author":"Was","year":"2022","journal-title":"Frontiers in Pharmacology"},{"key":"10.7717\/peerj.21409\/ref-53","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1055\/s-0030-1255330","article-title":"Radiotherapy for head and neck cancer","volume":"24","author":"Yeh","year":"2010","journal-title":"Seminars in Plastic Surgery"},{"key":"10.7717\/peerj.21409\/ref-54","doi-asserted-by":"publisher","first-page":"e1086\u201396","DOI":"10.1002\/hed.24162","article-title":"Maintaining physical activity during head and neck cancer treatment: results of a pilot controlled trial","volume":"38","author":"Zhao","year":"2016","journal-title":"Head & Neck"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/21409.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21409.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21409.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21409.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:22:44Z","timestamp":1784132564000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/21409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":54,"alternative-id":["10.7717\/peerj.21409"],"URL":"https:\/\/doi.org\/10.7717\/peerj.21409","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"article-number":"e21409"}}