See validated screening tools mentioned in Principle 4 ‘Supportive care’. A number of specific challenges and needs may arise for patients at this time: assistance for dealing with emotional and psychological distress from anticipatory grief, fear of death or dying, anxiety/depression and interpersonal problems management of physical symptoms including altered bowel function and incontinence stoma…

Rehabilitation may be required at any point of the metastatic care pathway, from preparing for treatment through to palliative care. Issues that may need to be dealt with include managing cancer-related fatigue, improving physical endurance, achieving independence in daily tasks, returning to work and ongoing adjustment to cancer and its sequels. Exercise is a safe…

The lead clinician is responsible for: being open to and encouraging discussion with the patient about the expected disease course, considering the patient’s personal and cultural beliefs and expectations discussing palliative care options, including inpatient and community-based services as well as dying at home and subsequent arrangements providing the patient and carer with the contact…

The lead clinician should ensure there is adequate discussion with patients and carers about the diagnosis and recommended treatment, including treatment intent and possible outcomes, likely adverse effects and the supportive care options available. More information Refer to Principle 6 ‘Communication’ for communication skills training programs and resources.

4.2.4 Targeted therapies and immunotherapy There are several targeted therapies that may be used as part of treatment for colorectal cancer. These include bevacizumab and cetuximab, among others. They are only used for metastatic disease in conjunction with chemotherapy. There is a role for immunotherapy in selected metastatic cancer cases and currently only in microsatellite…

4.2.5 Emerging therapies The key principle for precision medicine is prompt and clinically oriented communication and coordination with an accredited laboratory and pathologist. Tissue analysis is integral for access to emerging therapies and, as such, tissue specimens should be treated carefully to enable additional histopathological or molecular diagnostic tests in certain scenarios. There is an…

See validated screening tools mentioned in Principle 4 ‘Supportive care’. A number of specific challenges and needs may arise for patients at this time: assistance for dealing with emotional and psychological issues, including body image concerns, fatigue, quitting smoking, traumatic experiences, existential anxiety, treatment phobias, anxiety/depression, interpersonal problems and sexuality concerns potential isolation from normal…

Rehabilitation may be required at any point of the care pathway. If it is required before treatment, it is referred to as prehabilitation (see section 3.6.1). All members of the multidisciplinary team have an important role in promoting rehabilitation. Team members may include occupational therapists, speech pathologists, dietitians, social workers, psychologists, physiotherapists, exercise physiologists and…

Some patients may benefit from radiation therapy: patients with high-risk rectal cancer (neoadjuvant therapy) patients with symptomatic, non-resectable locally advanced rectal cancer who may benefit from radiation therapy with or without concurrent chemotherapy given with palliative intent patients with colon cancer where the tumour has penetrated a fixed structure. Timeframe for starting treatment Neoadjuvant radiation…