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life years gained (QALYs) can be used (IKNL 2011). Economic evaluations are usually conducted only when several high-quality studies have become available in which the effectiveness of the intervention is shown. Since effectiveness is a necessary precondition for cost-effectiveness, evidence for effectiveness always precedes evidence for cost-effectiveness (IKNL 2011). A review by Mewes et al. (2012) evaluates six studies that measured the cost-effectiveness of overall cancer rehabilitation. The studies all varied greatly in the way in which the economic impact was assessed or in method or study protocol. Despite the low comparability, all studies reported a positive cost-effectiveness ratio (Mewes, Steuten et al. 2012).\u000DWithin the Antoni van Leeuwenhoek a cost-effectiveness analysis was performed to compare a preventive (swallowing) exercise program with usual care (Retel, van der Molen et al. 2011). The study was conducted among a group of head and neck cancer patients who received a combination of radiotherapy and chemotherapy. Patients were offered an individualised exercise program with preventive swallowing exercises, and this prevented many of them from becoming feeding tube dependent (Van der Molen, Van Rossum et al. 2009). The study also showed that the probability for the programme being cost-effective was 83%. With the cost of \u20AC3.200/QALY it was well below the prevailing threshold of \u20AC20.000/QALY (Retel, van der Molen et al. 2011). In 2015 a follow-up study was published in which the cost-effectiveness of different approaches of preventive trismus treatment were compared within the same group of patients (Ret\u00E8l, van der Molen et al. 2015). Both groups received preventive exercises, but only one group used the TheraBite Range of Motion device for optimal mouth opening stretch. The probability for the cost-effectiveness of the TheraBite versus the standard preventive exercises was 70% (Ret\u00E8l, van der Molen et al. 2015).\u000D5.1.5 Evidence and self-evaluation\u000DThe Dutch guideline \u2018Oncologische revalidatie\u2019 (oncological rehabilitation) stresses the gaps of knowledge in terms of the effectiveness and suitability of the different forms of cancer rehabilitation protocols used in daily practice (IKNL 2011). It is recommended that further research should be performed using standardized and validated outcome measures, so that in the future multidisciplinary cancer rehabilitation protocols may be drawn up which are based on evidence.\u000DIn this document all available evidence for this head and neck cancer rehabilitation programme has been compiled. The head and neck rehabilitation programme offered at the Antoni van Leeuwenhoek is unique. The quality of care offered here is guaranteed due to continuous evaluation and implementation of evidence-based treatment modalities. In the following chapters, per discipline the functional problems related to the head and neck cancer treatment will be discussed, as well as the importance of good screening, diagnostics, measuring instruments that can be used, and effectiveness of the different interventions to achieve optimal rehabilitation outcomes.\u000D5.2 Case manager / oncological nurse\u000D5.2.1. The role of the head and neck oncology nurse / case manager\u000DHead and neck cancer and its treatment can have a detrimental effect on quality of life (Hammerlid and Taft 2001, Rogers, Ahad et al. 2007, Verdonck-de Leeuw, Buffart et al. 2014). The treatment of head and neck tumours involving surgery and/or chemoradiation/radiotherapy can have a negative impact on patients\u2019 physical and psychosocial functioning (List, D\u0027Antonio et al. 1996). Dealing with\u000D100\u000D