See validated screening tools mentioned in Principle 4 ‘Supportive care’.

Patients with low-grade lymphomas may undergo another period of watchful waiting before their initial therapy and this can lead to anxieties related to the stress and uncertainty of observation. Ongoing patient education from their lymphoma specialist and, if further support is needed, a referral to a psychologist with experience in lymphoma is recommended (see 3.6.3 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
• cognitive changes as a result of treatment (e.g. altered memory, attention and concentration)
• diet needs – these are likely to change over time during the different phases of treatment
• nutritional assessment and support for malnutrition due to ongoing treatment side effects (including weight loss, reduced oral intake and cachexia), which may require monitoring and nutrition intervention from a dietitian
• management of gastrointestinal symptoms (including vomiting, mucositis, reflux and early satiety), difficulty swallowing and decrease in appetite require optimal symptom control
• management of physical symptoms such as nausea and loss of appetite
• 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 13 11 20, Leukaemia Foundation 1800 620 420 and Lymphoma Australia 1800 953 081 information and support lines can assist with information and referral to local support services.

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