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
• management of oral side effects of head and neck cancer treatments, which may require input from a special needs dentist
• support for malnutrition, which can occur as a result of disease or treatment – validated malnutrition screening tools such as MST should be used at the key points in the care pathway to identify patients at risk of malnutrition and refer to a dietitian for early nutrition intervention (all patients with a head and neck cancer diagnosis receiving radiation therapy should be referred to a dietitian for assessment and intervention)
• dietitian management of nutrition intake (oral diet and enteral feeding), weight loss and symptom management through dietary counselling
• speech pathology for patients who present with symptoms of aspiration (coughing when eating or drinking), have undergone a laryngectomy, have communication impairments or have swallowing difficulties including trismus
• postoperative physiotherapy for respiratory assessment and treatment, including secretion management, particularly in the case of laryngectomy or temporary tracheostomy
• physiotherapy for musculoskeletal changes such as shoulder and neck pain or dysfunction following treatment
• physiotherapy or occupational therapy (therapist trained in lymphoedema) for neck mobility or head and neck lymphoedema
• occupational therapy for cancer fatigue/endurance
• occupational therapy or psychology support for social skills training and/or a social worker for family liaison to help to reduce psychosocial difficulties
• support with changes in physical appearance that impact on social and mental wellbeing
• support for breathing, swallowing or communicating if a long-term tracheostomy is required or if the patient underwent a total laryngectomy
• referral to prosthesis to restore facial appearance when necessary
• referral to a pharmacist for people managing multiple medications
• help with a 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.

Refer to Quitline 13 78 48 for information and support to quit smoking.

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

Rehabilitation may be required at any point of the care pathway. If it is required before treatment, it is referred to as prehabilitation (see section 3.6.1).

All members of the multidisciplinary team have an important role in promoting rehabilitation. Team members may include occupational therapists, speech pathologists, dietitians, social workers, psychologists, physiotherapists, exercise physiologists, dentists, audiologists, prosthodontists and rehabilitation specialists.

To maximise the safety and therapeutic effect of exercise for people with cancer, all team members should recommend that people with cancer work towards achieving, and then maintaining, recommended levels of exercise and physical activity as per relevant guidelines. Exercise should be prescribed and delivered under the direction of an accredited exercise physiologist or physiotherapist with experience in cancer care (Vardy et al. 2019). The focus of intervention from these health professionals is tailoring evidence-based exercise recommendations to the individual patient’s needs and abilities, with a focus on the patient transitioning to ongoing self-managed exercise.

Other issues that may need to be dealt with include managing cancer-related fatigue, improving physical endurance, addressing shoulder and neck musculoskeletal dysfunction, achieving independence in daily tasks, optimising nutritional intake, returning to work and ongoing adjustment to cancer and its sequels. Referrals to dietitians, psychosocial support, return-to-work programs and community support organisations can help in managing these issues.

Rehabilitation also includes the longer term surgical rehabilitation of patients including adjunctive procedures to improve appearance, and for oral and head and neck functions.

The lead or nominated clinician should take responsibility for these tasks:

• discussing treatment options with patients and carers, including the treatment intent and expected outcomes, and providing a written version of the plan and any referrals
• providing patients and carers with information about the possible side effects of treatment, managing symptoms between active treatments, how to access care, self-management strategies and emergency contacts
• encouraging patients to use question prompt lists and audio recordings, and to have a support person present to aid informed decision making
• initiating a discussion about advance care planning and involving carers or family if the patient wishes.

The general practitioner plays an important role in coordinating care for patients, including helping to manage side effects and other comorbidities, and offering support when patients have questions or worries. For most patients, simultaneous care provided by their general practitioner is very important.

The lead clinician, in discussion with the patient’s general practitioner, should consider these points:

• the general practitioner’s role in symptom management, supportive care and referral to local services
• using a chronic disease management plan and mental health care management plan
• how to ensure regular and timely two-way communication about:
  • the treatment plan, including intent and potential side effects
  • supportive and palliative care requirements
  • the patient’s prognosis and their understanding of this
  • enrolment in research or clinical trials
  • changes in treatment or medications
  • the presence of an advance care directive or appointment of a substitute decision-maker
  • recommendations from the multidisciplinary team.

Refer to Principle 6 ‘Communication’ for communication skills training programs and resources.