STEP 6: Managing recurrent or progressive disease


It is likely that a patient’s current symptoms will worsen progressively, and this should be managed following discussion with the lead clinician and, as necessary, at an MDM in consultation with palliative care services.


Recurrence or progressive disease is common. Management will vary but may include further surgery, radiation therapy or systemic therapies. The supportive care needs of these patients are particularly important and should be reassessed.

Advance care planning

Advance care planning is important for all patients but especially those with advanced disease. It allows them to plan for their future health and personal care by thinking about their values and preferences. This can guide future treatment if the patient is unable to speak for themselves.

Survivorship and palliative care

Survivorship and palliative care should be addressed and offered early. Early referral to palliative care can improve quality of life.


The lead clinician and team’s responsibilities include:

  • explaining the treatment intent, likely outcomes and side effects to the patient and/or carer and the patient’s GP.