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e. inadequate housing, financial problems or functional limitations that persist despite adequate medical treatment, we need to consider that psychosocial services attached to cancer care cannot be expected to resolve all the sources of distress and misery that patients and family members face. Our results raise the issue whether screening for distress is the optimal means of identifying unmet needs for psychosocial services and suggest direct inquiry about interest in services might be more efficient. Yet, while relevant to the question of whether to screen for distress, our results do not resolve the question. Rather, ��to screen for distress, or not to screen?�� is a complex issue to be settled with consideration of the unencumbered clinical resources in a setting and the existing flow of patients into services, in the http://www.selleck.cn/products/gsk-j4-hcl.html absence of screening. Without additional resources, introducing routine screening risks the negative effect of withdrawing resources from existing clinical activities 41. Yet, screening may be unnecessary in an exceptionally well-functioning clinical cancer care setting where patients are already routinely accessing services, regardless of whether they are distressed 42. This study was funded by a grant from the Dutch Cancer Society (RUG-2007-3805). The authors wish to express their gratitude to all study patients and to the participating cancer centers for their contribution to the data collection. ""A diagnosis of head and neck cancer (HNC) is a profound event for patients and family members who play http://www.selleckchem.com/products/byl719.html a crucial role in their care. Eating and drinking difficulties affect patients' quality of life (QOL), but the impact on the carers' QOL has not been explored. This preliminary mixed method study reports on carer QOL over time and investigates the relationship with dysphagia. Two hundred and eight HNC patients referred for (chemo)radiotherapy http://www.selleckchem.com/products/BEZ235.html were asked to identify a carer and complete a health-related QOL and a swallowing QOL questionnaire at pre-treatment, 3 and 12?months post-treatment. Carers were given the Caregiver QOL-Cancer (CQOL-C) questionnaire at the same time points. A purposive sample of patient and carer dyads was observed over mealtimes and interviewed. Seventy per cent of carers returned a questionnaire at least once. There was no change in CQOL-C scores between pre-treatment and 3? months, but a significant improvement was found between 3 and 12?months post-treatment (p?=?0.012). Patient-reported outcomes accounted for 52% of variance in carer QOL measurements (R2?=?0.52, p?