Planning and delivering appropriate cancer care for older women presents a number of challenges. Improved communication between the fields of oncology and geriatrics is required to facilitate the delivery of best practice care, which takes into account physiological age, complex comorbidities, risk of adverse events and drug interactions, as well as the implications of cognitive impairment on suitability of treatment and consent (Steer et al. 2009).

A national interdisciplinary workshop convened by the Clinical Oncology Society of Australia recommended that women over the age of 70 undergo some form of geriatric assessment, in line with international guidelines (COSA 2013). This assessment can be used to determine life expectancy and treatment tolerance as well as identifying conditions that might interfere with treatment including:

• function
• comorbidity
• presence of geriatric syndromes
• nutrition
• polypharmacy
• cognition
• emotional status
• social supports.

Guided intervention using aged care services is appropriate.

Recent years have seen the emergence of adolescent and young adult (AYA) oncology as a distinct field due to lack of progress in survival and quality-of-life outcomes (Ferrari et al. 2010; NCI & USDHHS 2006; Smith et al. 2013). The significant developmental change that occurs during this life stage complicates a diagnosis of cancer during the AYA years, often leading to unique physical, social and emotional impacts for young women at the time of diagnosis and throughout the cancer journey (Smith et al. 2012).

In caring for young women with cancer, careful attention to the promotion of normal development is required (COSA 2011). This requires personalised assessments and management involving a multidisciplinary, disease-specific, developmentally targeted approach informed by:

• understanding the developmental stages of adolescence and supporting normal adolescent health and development alongside cancer management
• understanding and supporting the rights of young women
• communication skills and information delivery that are appropriate to the young woman
• addressing the needs of all involved, including the young woman, her family and/or carer(s)
• working with educational institutions and workplaces
• addressing survivorship and palliative care needs.

An oncology team caring for a young woman with cancer must:

• ensure access to expert AYA health professionals who have specific knowledge about the biomedical and psychosocial needs of the population
• understand the biology and current management of the disease in the AYA age group
• consider clinical trials accessibility and recruitment for each woman
• engage in proactive discussions about fertility preservation and the late effects of treatment and consider the woman’s psychosocial needs
• provide treatment in an AYA-friendly environment.

Youth cancer services are available in each state/territory and can provide further advice and resources. See the resource list for contact information.

The burden of cancer is higher in the Australian Indigenous population (AIHW 2014), with cervical cancer occurring more frequently than among non-Indigenous people (AIHW 2017).

Survival also significantly decreases as remoteness increases, unlike the survival rates of non- Indigenous Australians. Aboriginal and Torres Strait Islander people in Australia have high rates of certain lifestyle risk factors including tobacco smoking, higher alcohol consumption, poor diet and low levels of physical activity (Cancer Australia 2013). The high prevalence of these risk factors is believed to be a significant contributing factor to the patterns of cancer incidence and mortality rates in this population group (Robotin et al. 2008).

In caring for Aboriginal and Torres Strait Islander people diagnosed with cancer, the current gap in survivorship is a significant issue. The following approaches are recommended to improve survivorship outcomes (Cancer Australia 2013):

• Raise awareness of risk factors and deliver key cancer messages.
• Develop evidence-based information and resources for community and health professionals.
• Provide training for Aboriginal and Torres Strait Islander health workers and develop training resources.
• Increase understanding of barriers to care and support.
• Encourage and fund research.
• Improve knowledge within the community to act on cancer risk and symptoms.
• Improve the capacity of Aboriginal and Torres Strait Islander health workers to provide cancer care and support to their communities.
• Improve system responsiveness to cultural needs.
• Improve our understanding of care gaps through data monitoring and targeted priority research.

For specific information about the distinct epidemiology of cancer among Aboriginal and Torres Strait Islander people, and guidance about providing culturally competent health care, please refer to the Optimal care pathway for Aboriginal and Torres Strait Islander people with cancer.

For women from culturally and linguistically diverse backgrounds in Australia, a cancer diagnosis can come with additional complexities, particularly when English proficiency is poor. In many languages there is not a direct translation of the word ‘cancer’, which can make communicating vital information difficult. Perceptions of cancer and related issues can differ greatly in those from culturally diverse backgrounds and can affect the understanding and decision making that follows a cancer diagnosis.

In addition to different cultural beliefs, when English language skills are limited there is potential for miscommunication of important information and advice, which can lead to increased stress and anxiety for women. A professionally trained interpreter (not a family member or friend) should be made available when communicating with people with limited English proficiency. Navigation of the Australian healthcare system can pose problems for those born overseas, and particular attention should be paid to supporting these women (Department of Health 2009).

A number of barriers prevent people with disabilities from accessing timely and effective health care (Victorian Health Promotion Foundation 2012). Barriers include physical limitations, competing health needs, the trauma of undergoing invasive procedures, potential barriers associated with obtaining informed consent, failure to provide assistance with communication, lack of information and discriminatory attitudes among healthcare staff (Victorian Health Promotion Foundation 2012).

In caring for women with disabilities and a cancer diagnosis, the Australian Institute of Health and Welfare disability flag should be used at the point of admittance to correctly identify and address the additional requirements of a woman with limitations. Facilities should actively address access requirements, and health practitioners should consider reasonable adjustments where required.