168 reducing complaints before and after treatment. Referral to a dietician in order to receive a nutritional assessment or even undergo placement of a feeding tube during treatment to maintain a healthy weight, can minimize patient-reported problems. Another possibility is to refer patients even before the start of treatment, and provide them with prehabilitation exercises that can target nutrition, mental health, and physical health. Before the start of treatment, exercises are recommended that include general stretching and range of motion exercises, mouth opening, and swallowing specific exercises.31 These programs can prevent or limit impairment caused by HNC treatment. Besides, a baseline functional level can be established, and impairments that occur because of treatment can be targeted sooner. In addition to providing (p)rehabilitation exercises, patients can be informed about expected difficulties they may experience after treatment. It is important to set realistic expectations about what to expect after treatment, so patients can cope with the effects of treatment on daily functioning.32 Information about expected difficulties can reduce distress and anxiety during treatment, and can increase active patient participation and satisfaction with provided care.32 The results found in chapter 6, 7 and 8 of this thesis are a first step in detecting patients at risk for developing masticatory and/or swallowing problems. These results can be used to guide patients in their decision about different treatment options, by providing information about expected problems they may experience after treatment, and the duration of these problems. Preferably, in the future, all patients with head and neck cancer with a referral to a head and neck surgeon or dental surgeon for treatment will be informed about possible problems during and after their treatment. In addition, they will be informed about possibilities to consult a physiotherapist, speech therapist or dietician whenever needed. By knowing possible difficulties that may occur, a better evaluation about treatment options can be made and more patient centered care can be provided.
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