BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
While the right to adequate food is often discussed in the context of developing countries, especially in situations where access to adequate food is a problem on a larger scale, this book focusses on the right to food in two Western countries in which theoretically the circumstances allow this right to be enjoyed by each individual. Through a legal comparative study, the enforceability of the right to food is compared between the Netherlands and Belgium in light of the current UN Human Rights system. There seems to be a difference between what the countries do, what they say they do, and what they should do on the matter. As it appears, the coincidental constitutional circumstances mainly determine the enforceability of the right to food, rather than the content of the human right in itself. This book includes a thorough analysis of suitable comparative legal methodology and the embedment of the right to food in the UN human right system. Furthermore, for both countries, an in-depth analysis of the case law on the right to food (mostly concerning the status of foreigners), the constitutional context in which the Judiciary operates, and the relevant UN reports and subsequent procedures are outlined. Finally, recommendations are made to both countries and the relevant UN Committees.
Innovation is crucial for higher education to ensure high-quality curricula that address the changing needs of students, labor markets, and society as a whole. Substantial amounts of resources and enthusiasm are devoted to innovations, but often they do not yield the desired changes. This may be due to unworkable goals, too much complexity, and a lack of resources to institutionalize the innovation. In many cases, innovations end up being less sustainable than expected or hoped for. In the long term, the disappointing revenues of innovations hamper the ability of higher education to remain future proof. Against the background of this need to increase the success of educational innovations, our colleague Klaartje van Genugten has explored the literature on innovations to reveal mechanisms that contribute to the sustainability of innovations. Her findings are synthesized in this report. They are particularly meaningful for directors of education programs, curriculum committees, educational consultants, and policy makers, who are generally in charge of defining the scope and set up of innovations. Her report offers a comprehensive view and provides food for thought on how we can strive for future-proof and sustainable innovations. I therefore recommend reading this report.
