5.4.1 Supportive care

See validated screening tools mentioned in Principle 4 ‘Supportive care’. Additionally, the ‘Cancer Survivors Unmet Needs (CaSun)’ is another validated screening tool that may help health professionals to identify the unmet needs of patients during survivorship.

A number of specific challenges and needs may arise for cancer survivors:

  • lymphoedema – referral to a trained lymphoedema practitioner may be needed
  • advice for ongoing oral health maintenance by a dentist with experience in head and neck cancer
  • speech pathologist management for:
  • assessing and managing communication and swallowing problems, particularly when a risk of aspiration is identified
  • patients who have undergone a laryngectomy or who have a permanent tracheostomy, to maximise communication, humidification/airway management and swallowing outcomes (referral to a physiotherapist with expertise in the respiratory management may also benefit)
  • dietitian management for patients requiring oral nutrition support or who are fed via gastrostomy or via a nasogastric tube
  • physiotherapy for ongoing musculoskeletal pain and dysfunction at the neck, shoulder and temporomandibular joint (Head and Neck Cancer Guideline Steering Committee 2020)
  • speech pathology to manage and maximise any communication impairments, an occupational therapist or psychologist for social skills training and/or a social worker for family liaison to help reduce psychosocial difficulties (difficulty with communication and social interactions is relatively common for patients with head and neck cancer and can place the patient at high risk of depression)
  • referral to one or more appropriate disciplines (e.g. social work, psychology service, financial advisor) for longer than expected time to return to work or previous level of functioning (Morales et al. 2020)
  • accurate information about HPV aetiology and future transmission risks – some patients may benefit from referral for psychosexual support
  • require referral to the appropriate discipline (e.g. social work, speech pathology, dietetics or nursing) for further assessment and identification of appropriate funding support (additional costs related to managing ongoing impairments, such as communication devices, enteral feeding and chronic wound management)
  • referral for financial and employment issues (e.g. loss of income and assistance with returning to work, and the cost of treatment, travel and accommodation)
  • appointing a substitute decision-maker and completing an advance care directive
  • legal issues such as completing a will.

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