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5.1.3 Effectiveness of multidisciplinary head and neck rehabilitation\u000DThe Antoni van Leeuwenhoek offers a specialised multidisciplinary rehabilitation programme. The treatment of head and neck cancer patients involves a high level of variety and complexity of problems, which calls for specific expertise and skills. Intensive multidisciplinary collaboration is needed to ensure optimal head and neck rehabilitation. The combined expertise of all the disciplines involved and mutual agreement are vital for achieving the desired result (Timmermans, Van Den Brekel et al. 2012).\u000DTo monitor the effectiveness of the rehabilitation programme described here, a study was conducted by Passchier and colleagues (Passchier, Stuiver et al. 2016). In this prospective study 52 patients were monitored who completed the rehabilitation programme as described in this protocol. Quality-of-life questionnaires were administered at the start and completion of the rehabilitation programme. Analysis of the questionnaires showed that in 90% of cases the main (SMART) goals determined before rehabilitation had been reached and that there was a significant increase in quality of life among the patients who participated. Before rehabilitation, quality of life was lower than the reference range for head and neck cancer patients. After rehabilitation the level of quality of life was comparable to the overall population in the same age category. Furthermore, this effect was reached within an average of 7 months, whereas it is generally assumed rehabilitation takes at least one year.\u000DEades and colleagues performed a study on the effect of a multidisciplinary rehabilitation programme on head and neck cancer patients\u2019 quality of life (Eades, Murphy et al. 2013). They had 27 patients participate in an 8-week rehabilitation programme. Despite the fact that it was a small, uncontrolled study, it too found evidence for the added value of a multidisciplinary approach. The patients improved in a 6-minute walking test, 78% of patients maintained their body weight and the patients reported an improvement in quality of life and fewer symptoms such as insomnia, pain, reduced physical strength, breathing difficulties and depression (Eades, Murphy et al. 2013).\u000DFurthermore, starting rehabilitation before the onset of the oncologic treatment (preventive rehabilitation) to increase self-management was evaluated in a study conducted by Ahlberg et al. (Ahlberg, Engstrom et al. 2011). A group of 190 head and neck cancer patients received preventive speech therapy and physiotherapy consultations, in which they were given advice on how to prevent impaired tongue mobility, problems with swallowing, trismus and neck stiffness. Six months after completion of the oncological treatment no significant differences were found between the groups in terms of the aspects assessed: swallowing problems, speech problems, return to work, trismus and neck stiffness. It should be noted, however, that the intervention was limited to only one preventive speech therapy and physiotherapy consultation. Patients were seen by the speech therapist for evaluation after three months, and by the physiotherapist after two months. Although the study uses the term rehabilitation, this is questionable, since it did not in fact involve a multidisciplinary approach coordinated by a rehabilitation physician nor actual treatment, but rather an intervention aimed at home-based self-management.\u000D5.1.4 Cost-effectiveness of multidisciplinary collaboration\u000DEvidence for the economic impact of cancer rehabilitation is limited; cost-effectiveness studies have primarily been conducted within overall cancer rehabilitation, often aimed at groups of breast cancer patients. To assess cost-effectiveness outcome measures such as life years gained or quality-adjusted\u000D99\u000D