Page 18 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

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Chapter 1
Outline of the thesis
This thesis aimed to provide answers to the abovementioned knowledge gaps by further exploring functional impairment in patients treated HNC, find relevant risk factors for functional loss and aid in the improvement of rehabilitation to ultimately improve quality of life of HNC survivors.
In chapter 2, surgery and radiotherapy for early-stage stage oropharyngeal carcinoma are compared with respect to patient-reported swallowing function outcomes; to enable informed decisions on treatment choice and inform patients prior to treatment on the likely outcome of their intended treatment.
To extend the options for objective assessment of swallowing ability and to improve insight of the interplay between function, capacity, and perceived ability, the Swallowing Proficiency for Eating And Drinking (SPEAD) test was developed, as described in chapter 3. This test entails the timed ingestion of thin liquid, thick liquid and solid and is hypothesized to provide a link between objective and subjective swallowing outcomes.
In chapter 4, swallowing, trismus and speech function ten years after CRT and preventive rehabilitation for head and neck cancer are described, and sustainability of the effect of preventive rehabilitation in this cohort of HNC patients is discussed.
Chapter 5 describes the functional limitations, including dysphagia, trismus, and speech problems, within the first year after (C)RT for oropharyngeal carcinoma. This cohort includes patients from the implementation of a dedicated preventive rehabilitation program until now, and facilitates the evaluation of implementation of such a program in clinical practice.
In chapter 6, further insight is obtained in which muscles are activated during the training with the SEA, using Magnetic Resonance Imaging.
In chapter 7 a prediction model is developed to predict the risk for long-term feeding tube dependency before CRT for head and neck cancer, to select patients for proactive tube placement and to avoid unnecessary prophylactic tube placement.
In chapter 8, the association between pretreatment low muscle mass, i.e., sarcopenia, and long-term feeding tube dependency is explored. Sarcopenia might be an important lead for pretreatment optimization of patient condition to prevent long-term functional (swallowing) impairment.
Chapter 9 is a general discussion of the results of the studies within this thesis and a summary is provided in chapter 10.