166 An important aspect about the use of objective tests in clinic is that they should be fast and easy to perform. The salivary flow test described in this research often failed, either because the patient did not want to perform this test or because the Lashley cups used to collect the parotid flow did not stay in place. In addition, collecting saliva for 10 minutes often was too long for patients, leading to the termination of the measurement before these 10 minutes. Besides, these measurements are known to have large standard deviations, causing data to be easily over interpreted.16 A recommendation would therefore be to use a simple and highly reproducible test to measure objective changes in patients. This can be difficult to accomplish in case of the salivary flow measurements, because it is important to collect data from both the parotid glands and the submandibular glands. Submandibular gland function is the most significant determinant for dry mouth complaints during the night, while parotid gland function is more important than submandibular gland function for severe complaints of dry mouth during the day.17 Rehabilitation As seen in chapter 8, most subscales of the SWAL-QOL questionnaire returned to baseline levels at 2 years after treatment. However, baseline levels are already worse in comparison to healthy subjects, indicating that problems with food processing and swallowing remain, even 2 years after treatment. To improve the food process, different rehabilitation therapies are available. It is important to refer patients that may benefit from rehabilitation therapy both during and after cancer treatment in a timely manner to the corresponding therapist. Although rehabilitation needs in the HNC population are increasingly being recognized, HNC is still an underrepresented population in cancer rehabilitation research.18 In addition, care is fragmented and referral is inconsistent and often late in recovery when problems have become chronic and are less amendable to intervention.19 It is therefore important to increase awareness about possibilities for patients both during and after treatment. Rehabilitation treatment focused on mastication often consists of physiotherapy in order to increase the maximal mouth opening, and/or increase the muscle force needed to break down food. Chapter 6 describes the patients that will most likely experience problems with masticatory performance after treatment, and will thus most likely benefit from oral physiotherapy. These are elderly patients, patients with a large tumor (mainly disease stage III and IV), and patients with a tumor in the oral cavity who are 3 to 6 months after treatment. By training and exercising the masticatory muscles, oral motor and sensory functions used in mastication will improve.20 In chapter 8, especially the subscale ‘eating duration’ was explored, because this subscale did not return to baseline levels after treatment. Here it was found that patients with a
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