6.8 Support and communication

6.8 Support and communication

See validated screening tools mentioned in Principle 4 ‘Supportive care’.

A number of specific challenges and needs may arise at this time for patients:

  • assistance for dealing with emotional and psychological distress resulting from fear of death or dying, existential concerns, anticipatory grief, communicating wishes to loved ones, interpersonal problems and sexuality concerns
  • potential isolation from normal support networks, particularly for rural patients who are staying away from home for treatment
  • cognitive changes as a result of treatment and disease progression such as altered memory, attention and concentration (a patient may appoint someone to make medical, financial and legal decisions on their behalf – a substitute decision-maker – before and in case they experience cognitive decline)
  • side effects resulting from high-dose chemotherapy including alopecia, fatigue, damage to the bone marrow and other quickly growing tissues, immunosuppression, fluid retention, dyspnoea, GVHD, organ toxicity (interstitial pneumonitis, veno-occlusive disease), episodic hypotension and pulmonary infiltrates
  • chemically induced menopause that leads to atrophic vaginitis and dyspareunia, and changes in androgens that may alter libido function and orgasm (these issues require sensitive discussion)
  • differentiation syndrome – early recognition and prompt initiation of corticosteroids is required (NCCN 2019) and consideration given to interrupting therapy
  • gastrointestinal symptoms such as nausea, vomiting, severe mucositis, loss of appetite, dysgeusia, diarrhoea or constipation as a result of treatment, which requires optimal symptom control with medicine, total parenteral nutrition, analgesia and mouth care (referral to a dietitian may be required if dietary intake is affected)
  • decline in mobility or functional status as a result of recurrent disease and treatments (referral to physiotherapy or occupational therapy may be required)
  • coping with hair loss and changes in physical appearance (refer to the Look Good, Feel Better program– see ’Resource List’)
  • appointing a substitute decision-maker and completing an advance care directive
  • financial issues as a result of disease recurrence such as gaining early access to superannuation and insurance
  • legal issues (completing a will, care of dependent children) and making an insurance, superannuation or social security claim on the basis of terminal illness or permanent disability.

For patients treated with allo-SCT, additional supportive care may be required to address the immunosuppressive and long-term side effects of therapy. Issues may include infertility, GVHD, increased risk of infection, anaemia, bleeding, mouth ulcers and fatigue.

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 and effective intervention that improves the physical and emotional health and wellbeing of cancer patients. Exercise should be embedded as part of standard practice in cancer care and be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment.

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.