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Chapter 5 Scientific evidence for head and neck rehabilitation\u000DIn this chapter, a description can be found of the working methods of the multidisciplinary team, with reference to the latest research. The first paragraph delves into the scientific evidence for multidisciplinary collaboration, with subsequent paragraphs addressing evidence-based screening, diagnostics and treatment protocol per discipline.\u000D5.1 Multidisciplinary rehabilitation\u000D5.1.1 Rehabilitation needs of patients with head and neck cancer\u000DImprovements in early detection and effective treatment have led to an increase in the percentage of head and neck cancer survivors. In Europe, the 5-year survival rate for all types of cancer has risen to \u226547% for men and \u226556% for women, and these numbers are expected to rise in the coming years (Verdecchia, Francisci et al. 2007). In the last few decades, the focus has shifted more and more to quality of life for head and neck cancer patients (Rogers, Ahad et al. 2007). The upper respiratory and digestive tracts and facial integrity are essential for vital functions such as breathing, smelling, swallowing, chewing, phonation, articulation and the patient\u2019s self-image. Disruptions to the anatomy and function of structures in this area can therefore have severe consequences. Most pressing are problems with eating and drinking, communication, physical limitations, fatigue, social isolation and psychosocial problems (Timmermans, Van Den Brekel et al. 2012).\u000DSupportive care needs within the group of patients with (stage III or IV) head and neck cancer was evaluated, among others, by De Leeuw et al. (2013) in an exploratory study with a cohort of 52 patients (De Leeuw, Van den Berg et al. 2013). The patient group was divided into three treatment groups: radiotherapy alone, surgery + radiotherapy and chemoradiation. One month after treatment quality of life was assessed. Symptomatic problems occurred in all three groups. Patients who had undergone radiotherapy alone or chemoradiation reported the most symptomatic problems, such as xerostomia, sticky saliva, pain, weight loss, fatigue and nausea. One third of patients was feeding tube dependent and all patients but four needed clinical nutrition. The group of patients who received chemoradiation reported the biggest role limitations in daily functioning. The authors conclude that this indicates a need for intensive supportive care one month after treatment (De Leeuw, Van den Berg et al. 2013).\u000D5.1.2 International Classification of Functioning, Disability and Health\u000DThe rehabilitation programme employs instruments and terminology in line with the International Classification of Functioning, Disability and Health (ICF) model (Mji 2001). For the model see Figure A, page 86. Within the ICF model, functioning and factors that may impact on functioning are viewed as an interaction between different aspects of the health condition as well as external and personal factors. The ICF model places the patient and their environment at the centre. Using the ICF model, the patient\u2019s health condition and functioning in the context of their environment can be characterised in terms of body functions and body structure, activities and participation level. In treating patients with head and neck cancer a specific (core) set of ICF codes has been defined, in which contextual factors play a prominent role, in addition to specific somatic problems (Tschiesner, Rogers et al. 2009).\u000D98\u000D