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

Assess the patient’s response to all treatments using clinical outcome measures and patient-reported measures.

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
• access to expert health professionals with specific knowledge about the psychosocial needs of breast cancer patients
• potential isolation from normal support networks, particularly for rural patients who are staying away from home for treatment
• alteration of cognitive functioning in patients treated with chemotherapy and radiation therapy, which requires strategies such as maintaining written notes or a diary and repetition of information
• loss of fertility, sexual dysfunction or other symptoms associated with treatment or surgically or chemically induced menopause, which requires sensitive discussion and possible referral to a clinician skilled in this area
• general healthcare issues (e.g. smoking cessation and sleep disturbance), which can be referred to a general practitioner
• decline in mobility or functional status as a result of treatment
• management of physical symptoms such as pain, arthralgia and fatigue
• early management for acute pain postoperatively to avoid chronic pain
• side effects of chemotherapy such as neuropathy, cardiac dysfunction, nausea and vomiting; managing these side effects is important for improving quality of life
• managing complex medication regimens, multiple medications, assessment of side effects and assistance with difficulties swallowing medications – referral to a pharmacist may be required
• menopause symptoms, which may require referral to a menopause clinic
• upper limb problems following surgery including decreased range of movement, which may delay radiation therapy – referral to a physiotherapist may be required
• upper limb and breast lymphoedema following lymphadenectomy/radiation therapy – this is a potential treatment side effect in patients with breast cancer that has a significant effect on survivor quality of life; referral (preferably preoperatively) to a health professional with accredited lymphoedema management qualifications, offering the full scope of complex lymphoedema therapy, should be encouraged (prospective monitoring, particularly for high-risk patients is recommended)
• disfigurement and scarring from appearance-altering treatment (and possible need for a prosthetic), which may require referral to a specialist psychologist, psychiatrist or social worker
• weight changes – this may require referral to a dietitian before, during and after treatment
• bowel dysfunction, gastrointestinal or abdominal symptoms as a result of treatment, which may require support from a dietitian
• coping with hair loss and changes in physical appearance (refer to the Look Good, Feel Better program; see ’Resource List’ and/or consider scalp cooling)
• assistance with beginning or resuming regular exercise with referral to an exercise physiologist or physiotherapist (COSA 2018; Hayes et al. 2019).

Early involvement of general practitioners may lead to improved cancer survivorship care following acute treatment. General practitioners can address many supportive care needs through good communication and clear guidance from the specialist team (Emery 2014).

Patients, carers and families may have these additional issues and needs:

• financial issues related to loss of income (through reduced capacity to work or loss of work) and additional expenses as a result of illness or treatment
• advance care planning, which may involve appointing a substitute decision-maker and completing an advance care directive
• legal issues (completing a will, care of dependent children) or making an insurance, superannuation or social security claim on the basis of terminal illness or permanent disability.

Cancer Council’s 13 11 20 information and support line can assist with information and referral to local support services.

Breast Cancer Network Australia’s helpline (1800 500 258) and website can assist with information and support services.

For more information on supportive care and needs that may arise for different population groups, see A and B, and special population groups.