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

• optimising dental hygiene and ensuring restorative dental work is up to date
• support to cease smoking
• discussing fertility issues if relevant (see section 6.2)
• vaccinations for seasonal influenza, pneumococcal disease and COVID-19, ideally before starting any immunosuppressive therapy because subsequent responses are greatly impaired (Herishanu et al. 2021)
• correcting vitamin D deficiency (Molica et 2012; Shanafelt et al. 2011)
• immunoglobulin replacement therapy for patients with hypogammaglobulinemia and frequent infections. The National Blood Authority has information on the eligibility criteria for immunoglobulins

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