Functional impairment and cues for rehabilitation of head and neck cancer patients

This thesis retrospectively describes the prevalence of functional impairment after various types of head and neck cancer (HNC) treatments, both short-term, within the first year, and long-term. Next, the development and validation of a new clinical test, called the Swallow Performance Eating And Drinking (SPEAD) test, to evaluate and monitor the swallowing capacity in HNC patients is presented. This test will be useful to objectify and monitor the (safe) swallowing capacity in HNC patients. Additionally, the risk factors for long-term tube dependency were retrospectively unraveled and integrated into a clinical prediction model. This prediction model enables the personalization of feeding tube placement strategies relative to the timing of cancer treatment (proactive tube placement instead of either reactive or prophylactic) and with that may help prevent unnecessary tube placements. A subsequent retrospective study has shown that sarcopenia is an additional, strong determinant for prolonged feeding tube dependency and, since it might be a modifiable factor prior to treatment, it can be a target for pretreatment optimization of patients' condition. Furthermore, the earlier demonstrated effective targeting of the relevant swallowing muscles with a dedicated exercise tool and rehabilitation program, was confirmed in a prospective MRI study. Summarizing, this thesis strengthens and broadens the body of evidence on the prevalence, the prevention, and the rehabilitation of the functional impairment after HNC treatment. This knowledge will aid healthcare professionals and patients in taking informed and shared decisions on treatment choices, using the better anticipated outcomes of the intended treatment and rehabilitation modalities.