Patients who have undergone stem cell transplants may have cognitive impairments for up to three years post procedure (Sharafeldin et al. 2018). Long-term follow-up and identification of strategies (e.g. maintaining written notes and repeating information) to enable patients to cope with alterations in cognitive function may be required.

High-dose chemotherapy is both physically and emotionally demanding. People undergoing this treatment may feel exhausted, depressed or anxious for years after treatment. Some patients may present with symptoms of post-traumatic stress (Ciavarella et al. 2017). Regular screening and ongoing monitoring for depression by clinicians is part of long-term follow-up. Referral to a psychologist or psychiatrist may be required.

Consider a referral to a psychologist, psychiatrist, pastoral/spiritual care practitioner, social worker, specialist nurse or a relevant community-based program if the patient has these issues:

• displaying emotional cues such as tearfulness, distress that requires specialist intervention, avoidance or withdrawal
• being preoccupied with or dwelling on thoughts about cancer and death
• displaying fears about the treatment process or the changed goals of their treatment
• displaying excessive fears about cancer progression or recurrence
• worrying about loss associated with their daily function, dependence on others and loss of dignity
• becoming isolated from family and friends and withdrawing from company and activities that they previously enjoyed
• feeling hopeless and helpless about the effect that cancer is having on their life and the disruption to their life plans
• struggling to communicate with family and loved ones about the implications of their cancer diagnosis and treatment
• experiencing changes in sexual intimacy, libido and function
• struggling with the diagnosis of advanced disease
• having difficulties quitting smoking (refer to Quitline on 13 7848) or with other drug and alcohol use
• having difficulties transitioning to palliative care.

Additional considerations that may arise for the multidisciplinary team include:

• support for the carer – encourage referrals to psychosocial support from a social worker, psychologist or general practitioner
• referral to an exercise physiologist or physiotherapist as a therapeutic approach to prevent and manage psychological health
• referral to wellness-after-cancer programs to provide support, information and offer strategies.