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 support networks, particularly for rural patients who are staying away from home for treatment
• managing physical symptoms such as pain, weight loss, fatigue, altered bowel function and/or diarrhoea (patients can talk about managing these symptoms with specialist nurses such as a stomal therapy nurse or continence nurse)
• gastrointestinal symptoms (e.g. nausea, vomiting, mucositis and loss of appetite) as a result of chemotherapy, requiring optimal symptom control with medication and referral to a dietitian if dietary intake is affected
• odours and flatus arising from stomas, faecal or urinary fistulae (referral to continence nurses or stomal therapy nurses may be useful)
• assistance with managing complex medication regimens, multiple medications, assessment of side effects and assistance with difficulties swallowing medications – referral to a pharmacist may be required
• decline in mobility or functional status as a result of treatment
• reduced sexual interest and sexual dysfunction – particularly in stoma patients compared with patients with intact sphincters (Reese et al. 2014) – may require referral to medical specialists. Sensitive discussion and referral to a clinician skilled in this area may be appropriate
• erectile dysfunction and ejaculation dysfunction, which require sensitive discussion; referral to a clinician skilled in this area may be appropriate (Averyt & Nishimoto 2014)
• fertility issues for patients of reproductive age; refer to a fertility specialist before starting treatment
• 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.

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