The patient’s general practitioner should consider an individualised supportive care assessment where appropriate to identify the needs of an individual, their carer and family. Refer to appropriate support services as required. 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 the emotional distress and/or anger of dealing with a potential cancer diagnosis, anxiety/depression, interpersonal problems and adjustment difficulties (consider referral to a clinical psychologist and connecting the patient to a face-to-face, online or telephone lung cancer support group)
• management of physical symptoms including pain, fatigue, cough and breathlessness
• physical distress caused by breathlessness and coughing – this may be alleviated through a referral to allied health professionals (physiotherapy, occupational therapy, exercise physiology or pulmonary rehabilitation); non-pharmacological strategies may be beneficial in breathlessness management (CareSearch 2019a)
• haemoptysis (CareSearch 2019b) – ensure patients understand how to manage haemoptysis and obtain medical support
• stigma related to smoking, which may exacerbate distress and cause delays in presentation and lead to isolation (people with non-smoking-related lung cancer may also be affected by stigma, including erroneous assumption of smoking status [Gonzalez & Jacobsen 2012])
• smoking cessation care – this should be implemented from the initial patient visit and offered at all stages of the cancer care continuum including palliative and end-of-life care
• encouragement and support to increase levels of exercise (Cormie et al. 2018; Hayes et al. 2019).

For more information refer to the National Institute for Health and Care Excellence 2015 guidelines, Suspected cancer: recognition and referral.

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

The general practitioner is responsible for:

• providing patients with information that clearly describes to whom they are being referred, the reason for referral and the expected timeframes for appointments
• requesting that patients notify them if the specialist has not been in contact within the expected timeframe
• considering referral options for patients living rurally or remotely
• supporting the patient while waiting for the specialist appointment (Cancer Council nurses are available to act as a point of information and reassurance during the anxious period of awaiting further diagnostic information; patients can contact 13 11 20 nationally to speak to a cancer nurse).

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