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5.7.1.2 Prevalence of distress\u000DA 1992 study conducted by the Dutch expertise centre for mental health showed (since 1996 Trimbos Institute) that 86% of patients with cancer experience mental problems (Schrameyer and Brunenberg 1992). Sixty per cent of patients suffer from physical complaints (such as fatigue and pain) and 48% experience relational issues as a consequence of the disease. Depression is more prevalent in cancer patients than in patients with other physical diseases (Van t Spijker, Trijburg et al. 1997). Head and neck cancer patients develop specific problems related to the tumour site (Semple, Parahoo et al. 2013). Head and neck cancer patients experience changes in appearance, speech, swallowing and breathing, in addition to extensive symptomatology (pain, xerostomia, shoulder dysfunction) (Ward and van As-Brooks 2007, Semple, Parahoo et al. 2013). This may lead to mood disorders, anxiety disorders, social problems and sexual problems (Frampton 2001, Petruson, Silander et al. 2003, Singer, Danker et al. 2008, Semple, Dunwoody et al. 2009). Statistics on the prevalence of psychosocial problems in the head and neck cancer population range from 12% to 45% (Frampton 2001, Petruson, Silander et al. 2003, Veer, Kia et al. 2010, Semple, Parahoo et al. 2013, Henry, Habib et al. 2014, Krebber, Buffart et al. 2014). Moubayed and colleagues studied predictive factors for developing depression within the head and neck oncology group (Moubayed, Sampalis et al. 2015). The following factors were found to be significantly associated with the development of depression: smoking at the time of diagnosis, drinking >14 units of alcohol per week, T3 or T4 tumour stage and using >3 medications (Moubayed, Sampalis et al. 2015).\u000DThe patient\u2019s baseline is affected by their coping resources, coping style and illness perceptions. In a study by Scharloo et al. it was found that illness perceptions are related to quality of life. In this study baseline measurements were done to chart negative illness perceptions in a group of head and neck cancer patients (n=86). Those patients with a less strong emotional response, who experience symptoms as cyclical and have less negative illness perceptions, were found to score better on quality of life. The study also showed that negative illness perceptions, such as believing in the likelihood of recurrence, are related to worse quality of life (Scharloo, Baatenburg de Jong et al. 2005). The results seemed to suggest that patients who are optimistic (\u201Cthe glass is half full\u201D) score higher on overall quality of life than patients who are pessimistic (\u201Cthe glass is half empty\u201D) (Allison, Guichard et al. 2000, Mehanna and Morton 2006). With support from their families and the primary oncology team (medical specialists, (oncology) nurses), many patients seem capable of coping with their cancer experience themselves (Zabora, BrintzenhofeSzoc et al. 2001, Galway, Black et al. 2013). Some patients experience so many problems during or after completing treatment that they require referral to specialized psychosocial care (Carlson and Bultz 2004, Henry, Habib et al. 2014). It has been shown, however, that only a small percentage of all patients make use of professional psychosocial supportive care (Carlson, Angen et al. 2004). It is important to note that this may be the result of under-reporting, a lack of services/resources or an over-estimation of the need for psychosocial care.\u000D5.7.2 Detection and screening of psychosocial problems\u000DAs problems may occur from the moment the diagnosis is known, it may be important to implement distress screening before commencement of treatment. Early detection allows for the starting up of preventive psychosocial diagnostics and guidance. At the Netherlands Cancer Institute oncology nurses are responsible for this task. The oncology guideline \u2018Screening for psychosocial distress\u2019 and the guideline \u2018Oncological rehabilitation\u2019 strongly recommend the use of the \u2018Lastmeter\u2019 (or Distress thermometer) for the detection of distress in cancer patients (IKNL-c 2010, IKNL 2011). At the\u000D134\u000D