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Exercise program Head Matters


Growing evidence indicates that the delivery of radiotherapy alone or with concomitant chemotherapy (CH)-RT improves tumor control and survival in head and neck cancer (HNC) patients, but to the expense of increased morbidity, such as swallowing , speech, and shoulder dysfunction. Although the introduction of preventive swallowing exercises (PSE)during curative (CH)-RT looks promising, the scientific evidence of this intervention remains to be determined.

This prospective cohort study (phase II) will test the hypothesis that PSE during treatment will reduce the incidence of swallowing dysfunction among patients with HNC treated with curatively intended (CH)-RT using Swallowing Sparing Intensity Modulated Radiotherapy (SWIMRT). As speech, swallowing , and shoulder impairment has a major impact on the general dimensions of quality of life (QOL) and emotional distress, this strategy has the potential to be translated into a significant improvement of QOL in HNC patients.

Study population: previously untreated patients with HNC planned for curative RT alone, after surgery, or (CH)-RT; age > 18 years; stage I-IV tumors originating in the oral cavity, oropharynx, hypopharynx, or larynx. Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule. Eligible patients will be treated according to the current standard in the participating centers, which is SWIMRT. To assess speech, swallowing, and shoulder dysfunction, additional investigations, prior,  during, and after treatment will be performed.
Intervention: the PSE protocol consists of flexibility exercises for head, neck and shoulders and voice, speech and swallowing exercises, including range of motion and resistance exercises. Exercises are demonstrated by video’s on a website (www.halszaken-vumc.nl), by DVD, and in a booklet. In a first face to face session, patients are instructed how to perform the exercises and are guided through the website or DVD, that also contains information, tips and advices. The protocol takes approximately 15 minutes and has to be carried out at least three times per day. The patients will practice during and until 6 weeks after radiotherapy and are asked to fill out a dairy. The PSE protocol is a guided self-help protocol with weekly e-mail or phone contact with a speech language pathologist (SLP) during this period of twelve weeks.
Main study parameters / endpoints: The primary endpoint will be Grade 2 or more swallowing dysfunction at 6 months after completion of CHRT, according to the RTOG / EORTC system. Secondary endpoints are objective speech, swallowing, and shoulder function measures ant patient reported outcomes: the Swallowing Quality of Life Questionnaire (SWAL-QOL), the Speech Handicap Index (SHI), the Shoulder Disability Questionnaire (SDQ), the EORTC QLQ-C30 and the EORTC QLQ-H&N35, and the Hospital Anxiety and Depression Scale, and an economic evaluation.


Results are not yet available.


Example of a screenshot of the exercise program via Internet. (Click on the screenshot to enlarge.)

Permission METC
This project is approved by the Medical Ethical Committee VU University Medical Center (VUmc)

Fonds NutsOhra and Dutch Cancer Society (KWF Kankerbestrijding)

PhD student
I.C. Cnossen MSc, Speech Language Pathologist (SLP), clinical epidemiologist, PhD-student
Project leaders
Prof I.M. Verdonck-de Leeuw, PhD, Psychologist, Speech and Language Therapist, Linguïst, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
Prof J.A.  Langendijk, PhD MD, Radiotherapist-oncologist, dpt. Radiotherapy, University Medical Center Groningen (UMCG)
Project members
Prof C.R. Leemans, PhD MD, Head & Neck Surgeon, ENT-specialist, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
prof. R. de Bree PhD MD, Head & Neck Surgeon, ENT-specialist, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
R.N.P.M. Rinkel, MD,  ENT-specialist, laryngologist, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
Y.J. Aalders, speech therapist, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
C.J.T. de Goede MSc, physiotherapist, dpt. Rehabilitation Medicine, VUmc
D.H.F. Rietveld MD, Radiation oncologist, dpt. of Radiotherapy, VUmc
prof.B. Slotman, PhD MD, head of dpt. of Radiotherapy, VUmc
J. Buter, PhD MD, Medical Oncologist, dpt. of Medical Oncology, VUmc
E.F.L. David, MD, radiologist, dpt of Radiology, VUmc
prof. J.L.N. Roodenburg, PhD MD, dpt. of Medical Oncology, UMCG
prof. B.F.A.M. van der Laan, PhD MD, dpt. Otolaryngology-Head&Neck Surgery, UMCG
H.E. Westerlaan, MD, radiologist, dpt of Radiology, UMCG

For questions, please contact:


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News flashes


Treatment of psychological distress in patients with head and neck or lung cancer cost-effective.
A recent study of PhD-student Femke Jansen and colleagues, recently published in the Journal of Clinical Oncology


PhD thesis Nadine Köhle

December 15, 2016 Nadine Köhle defended her PhD thesis "Hold on, for each other. Supporting partners of cancer patients via eHealth and positive psychology". 


PhD thesis Anne-Marie Krebber

December 2, 2016 Anne-Marie Krebber defended her PhD thesis "Stepped care targeting psychological distress in head and neck cancer and lung cancer patients".


PhD thesis Nadia van der Spek

September 7, 2016, Nadia van der Spek defended her PhD thesis "Meaning-centered group psychotherapy for cancer survivors: development, efficacy, and cost-utility". 


EORTC QLG Newsletter Spring 2016
The EORTC QLG  Spring Meeting took place on April 20th and 21th 2016 in Oslo. The Spring newsletter of the EORTC QLG is now available. 

PhD thesis Ingrid Cnossen

April 12, 2016, Ingrid Cnossen defended her PhD thesis entiteld “Self-management Supporting Rehabilitation in Head and Neck Cancer Patients”. 


VU/VUmc and Red-kite sign agreement for the provision of the Oncokompas in healthcare.

The VU University Amsterdam and VUmc Cancer Center Amsterdam work with Red-kite, distributor of software for hospitals in Netherlands. (November 3, 2015)


PhD thesis Christine van Gogh

December 4, 2015, Christine van Gogh defended her PhD thesis entiteld “Functional outcome of early glottic cancer”. 

Book presentation

On June 15th, 2015, Irma Verdonck presented the book "In Tune Without Cords" (in Dutch: VerderZonderStembanden) to Rob Burdorf, the president of the patient society for patients after laryngectomy.


PhD thesis Florien Boele

May 11 Florien Boele defended her PhD thesis, entitled "Towards improving health-related quality of life in glioma patients and their informal caregvers".


PhD thesis Trille Kristina Kjaer

May 8, Trille Kjaer will defend her PhD thesis entitled "Late effects after treatment of head and neck cancer and use of patient reported outcomes in clinical practice." Irma Verdonck is member of the committee.


Niels Stensen Fellowship
Florien Boele has received a Niels Stensen Fellowship. This is a scholarship that is awarded annually to a number of outstanding researchers who have recently obtained their PhD degree, to gain working experience abroad. Florien Boele will go to Pittsburgh (United States) and Edinburgh (Scotland) in 2015 and 2016.

Key paper

The publication “Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments” of A.M.H. Krebber et.al is chosen by the Editors as one of the key papers in Psycho-oncology, (issue June 2014).


On April 10th, 2014, the first edition of the Value Based Healthcare Prize took place. The prize for the most exceptional initiative in collaborations went to Jippa, a collaborative by VUmc, CZ, Radboud UMC and Tilburg University.


In November 2013 the NVPO organised the International Congress "Innovation in Psycho-Oncology". The researchgroup held several presentations and posters.


Interested in oncological care chain? Come 2 October 2013 to the 3rd MuON symposium in hospital Gelderse Vallei. Keynote speaker Michel van Schaik (Director Rabobank) about Innovation in the care!


12 april 2013: KWF Kankerbestrijding / Alpe d’HuZes has granted the research proposal Netherlands Quality of life and Biomedical Cohort Studies in Cancer (NET-QUBIC).

Marieke de Bruijn will defend her PhD thesis on 10 juni 2013 at 15.45 pm.

Support our bicycle team for Alpe d'HuZes 2013!

On 6 June 2013 our team living together with cancer will cycle the Alpe d'HuZes! This in the fight against cancer. At this moment there is already more than 1500 euro donated. Do you support us too?


The 15th World Congress of Psycho-Oncology and Psychosocial Academy will be held in Rotterdam, 4-8 November 2013. www.ipos-society.org/ipos2013/.


29 January 2013. Pink Ribbon has granted a project to develop and evaluate an online training for cancer patients with insomnia (Annemieke van Straten), and a project to develop and evaluate a breast cancer module for the OncoKompas (Nelly van Uden).


Charity Symposium "Living with cancer"

On December 19, 2012 there will be a Symposium ''Living with Cancer''. This is a charity symposium on meaning centered psychotherapy for cancer patients. Read more about it at the tab News at the left.


15 November 2012: Hoe?Zo! Radio interview with Irma Verdonck on stress and cancer.


October 2012: Interview with Irma Verdonck in Psychologie Magazine.


September 9, 2012. Interview Hans van Willigenburg with Irma Verdonck on Radio 5.


August 2012. Five students finish their MSc thesis and graduate as MSc in Clinical PSychology.


June 28-30, 2012: International symposium on Supportive Care in Cancer (MASCC ISOO) at New York. Kevin Yap and Irma Verdonck organise a workshop on e-health and supportive care.


Record for Alpe d'HuZes 2012. The sponsor action Alpe d'HuZes (6 and 7 June) 2012 has already yielded the record amount of 28.5 million euros.


June 6-8, 2012: Our research group contributes to Alpe d'HuZes as volunteers.


April 20, 2012: Nelly van Uden will give a presentation about OncoKompas at a conference about  ICT in health care in Barcelona.


March 16, 2012: NVPO congress in Utrecht, we contribute with 2 oral and 2 poster presentations and a workshop.


January 1, 2012: The project POLARIS project has officially started.


December 22, 2011: Radio program DeGids.fm, Felix Meurders interviews Corien Eeltink on sexuality and cancer. 


November 2, 2011: KWF / Alpe d'HuZes funds a grant for the development and evaluation of an online intervention for informal caregivers of cancer patients.


October 30, 2011 In the national television program "Gesprek op 2", Daphne Bunskoek interviewed Irma Verdonck on living with cancer.


October 28, 2011: www.oncokompas.nl is online!


October 23, 2011: Alpe d'HuZes hands over more than 20 million euros to the Dutch Cancer Society!



Team work

Our research projects are embedded in the two largest research institutes of VU University in Amsterdam: VUmc CCA-VICI (Cancer Center Amsterdam) www.vumc.nl/afdelingen/CCA-V-ICI/ and EMGO+ (Institute for Health and Care Research emgo.nl

We work closely with patients and their caregivers and with researchers and physicians at VU University and VU University Medical Center in Amsterdam and other research institutes and hospitals in the Netherlands and worldwide. Team work is crucial  improving research and translating results into clinical practice.

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