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effortful swallows) and had also maintained full oral intake, group two who had performed the exercises but had only partially maintained oral intake, group three who had performed the exercises but had NOT maintained oral intake, and groups 4, 5 and 6 who had performed NO exercises but had maintained oral intake fully, only partially or not at all The authors concluded that maintaining oral intake (partially or fully) or adhering to exercise resulted in fewer swallowing impairments and less feeding tube dependence. More importantly, the group of patients who maintained oral intake and exercised showed the best results.\u000DIn the few studies that report no benefits from preventive swallowing therapy (Ahlberg, Engstrom et al. 2011, Van den Berg 2014, Mortensen, Jensen et al. 2015), it should be noted that compliance (adherence to therapy) was low to poor, many patients dropped out, study groups were heterogeneous (treatment modalities varied), and they tended to involve home-practice programmes, in which patients received little or no guidance in performing the exercises and/or were offered \u2018unique\u2019 exercise programmes. These study aspects are crucial and may have negatively impacted the results.\u000DAlthough not all studies were randomised, the patient groups were usually small and research methods varied, making it difficult to compare the results, we conclude that a preventive exercise programme is meaningful. In one of our own studies, too, we have found evidence for the effectiveness and importance of a preventive exercise programme even in the long run (>7 years post- CRT) (Kraaijenga, van der Molen et al. 2015). Since we have recently been able to show this preventive exercise programme to be cost-effective, we have integrated it in our head and neck rehabilitation programme (Retel, van der Molen et al. 2011, Ret\u00E8l, van der Molen et al. 2015).\u000D5.3.2 Voice disorders resulting from head and neck cancer\u000DTumour and treatment result in alterations of the quality and abilities of the voice. In patients with laryngeal tumours, for instance, vocal fatigue and hoarseness are the most common complaints (Starmer, Tippett et al. 2008). As the daily medium for communication and the carrier of emotions, personality and identity of the patient (Rosen and Sataloff 1997), the voice has a major impact on the patient\u2019s well-being (Fung, Yoo et al. 2001, Peeters, van Gogh et al. 2004). A deterioration of the voice is often perceived as a handicap (Fung, Yoo et al. 2001, Van Gogh, Verdonck-de Leeuw et al. 2006, Ma and Yiu 2011).\u000D5.3.2.1 Effects of oncological treatment on voicing\u000DDependent on the size and location of the tumour in the head and neck area treatment modalities may vary, and so will the effects they have on voice function. Smaller tumours can be treated with a single modality: laser, surgical resection or radiation. More advanced tumours usually require multi- modal treatment (such as radiation and chemotherapy, or surgical resection and radiation) (Ward and Van As 2014). Laser surgery may lead to scarring and loss of tissue, resulting in impaired vocal fold vibration or a glottal gap (Van Loon, Sj\u00F6gren et al. 2012). Van Gogh et al. studied a group of patients with laryngeal tumours (n=106) who were treated with laser surgery (n=67) and radiotherapy (n=39). The patients were seen before treatment, and 3, 6, 12 and 24 months after treatment. Faster recovery was seen in the group of patients treated with laser surgery, except with fundamental frequency. In patients treated with laser surgery a higher pitch was detected, even after 24 months (Van Gogh, Verdonck-de Leeuw et al. 2012).\u000D107\u000D