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
• management of physical symptoms such as pain and fatigue
• symptom management – postoperative oestrogen replacement therapy (ERT) may be recommended (after discussion of its risks and benefits), if quality of life is affected or for vaginal symptoms (Angioli et al. 2018)
• loss of fertility, surgically or chemically induced menopause, and sexual dysfunction (e.g. vaginal dryness, bleeding, stenosis, dyspareunia, atrophic vaginitis and pain) requires sensitive discussion and possible referral to a clinician with skills in the relevant area (Harris 2019) (sexual dysfunction may persist for several years after surgery)
• lower limb lymphoedema, which is a common side effect in women after complete pelvic lymphadenectomy and/or radiation therapy – referral to a physiotherapist trained in managing lymphoedema or a trained lymphoedema massage specialist may be appropriate
• bowel dysfunction, gastrointestinal or abdominal symptoms – these may require monitoring and assessment (patients may benefit from discussing these symptoms with a specialist nurse such as a stomal therapist or continence nurse, or referred to a gastroenterologist
• nausea and vomiting – managing both is important for improving quality of life
• managing comorbidities, especially weight
• presenting with unintentional weight loss
• malnutrition/undernutrition as identified using a validated malnutrition screening tool
• obesity – many patients with a high BMI may be malnourished
• appropriate bariatric resources
• decline in mobility or functional status as a result of 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.