Page 134 - HHR-HNR 2.0

cancer-related fatigue is limited. The guideline Oncological Rehabilitation currently puts the emphasis on awareness and detection of cancer-related fatigue (IKNL 2011). Reducing chronic fatigue is seen as an important determinant in improving the cost-effectiveness of cancer rehabilitation (IKNL 2011).\u000D5.6.3.4 Return-to-work\u000DWhere necessary, the Netherlands Cancer Institute offers occupational therapy interventions to facilitate the return-to-work process. Together with the occupational therapist, the patient draws up a return-to-work plan \u2013 on the condition that the patient returns to their current position and that the company physician has agreed with the intervention. To ensure that the plan is feasible the patient\u2019s coping resources and cognitive limitations are assessed. The return-to-work plan is specified in a time schedule. Should mediation be necessary between the patient, employer and/or company doctor, patients are referred to external authorities for support in the return-to-work process.\u000DIt is recommended in the guideline Oncological Rehabilitation that personalised interventions to facilitate return-to-work should be offered early on (IKNL 2011). On Oncoline (www.oncoline.nl) the specific guideline \u2018Blauwdruk Kanker en Werk\u2019 [Blueprint Cancer and Work; no English version currently available] has been made available for this (IKNL 2009). The guideline does not clarify the specific role of the occupational therapist, but it does recommend the use of timely interventions in case of impediments to resumption of work such as physical limitations and fatigue (IKNL 2009). Multidisciplinary rehabilitation has proven effective for patients with return-to-work issues and its use is recommended in a specialised setting (Van Zanten-Przybysz, De Boer et al. 2008, De Boer, Taskila et al. 2011). A systematic review by Duijts et al. emphasizes the importance of the role of health professionals with expertise in employment issues (Duijts, van Egmond et al. 2014).\u000D5.7 Psychosocial guidance\u000D5.7.1 Psychosocial problems during and after head and neck cancer treatment\u000DDue to the progress made in the detection and treatment of cancer, prognosis and survival rate for cancer patients have improved considerably (Carvalho, Nishimoto et al. 2005, Galway, Black et al. 2013). The higher survival rate places major demands on patients\u2019 and their significant others\u2019 coping resources. Over the past years, the improvement in quantity of life has led to an increased focus on quality of life (Rogers, Courneya et al. 2008, Galway, Black et al. 2013). Psychosocial guidance can improve the effectiveness of medical treatment and enhance quality of life (De Vries 1994).\u000D5.7.1.1 Distress\u000DDiagnosis and treatment of cancer for most patients and their loved ones reduce quality of life and interfere with social, emotional, behavioural and physical functioning (De Haes, Gualtherie van Weezel et al. 2009). Psychological and emotional effects such as depression, anxiety and uncertainty are common (Galway, Black et al. 2013, Semple, Parahoo et al. 2013). The burden experienced by patients on an emotional, social, practical and spiritual level, and as a result of physical problems is summarized by the term distress (Frampton 2001, Hutton and Williams 2001, Zabora, BrintzenhofeSzoc et al. 2001, IKNL-c 2010).\u000D133\u000D