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
• 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)
• explaining sequencing of treatment and the need for different treatments at different times such as surgery, liver-directed therapy, PRRT and SSAs
• surgical recovery including diabetes education where relevant
• screening, assessment and management of flare up of symptoms associated with carcinoid syndrome, which may include flushing diarrhoea, palpitations, anxiety, wheezing and bloating abdominal pain
• management of treatment side effects associated with liver directed therapies such as fatigue, nausea, vomiting and pain around the liver
• administration of medication, which may be before, during and after surgery, to keep blood pressure and heart rate controlled
• management of side effects associated with chemotherapy or molecular targeted therapies such as mouth sores, lowering of blood counts,
• diarrhoea, nausea, vomiting, fatigue and high blood pressure
• management of side effects related to PRRT such as nausea, fatigue and lowering of blood counts
• monitoring of long-term toxicity from PRRT – this involves a 5 per cent risk of myelodysplastic syndrome, which may sometimes progress to acute leukaemia.

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.

NeuroEndocrine Cancer Australia offers online nurse support, a telephone support service (1300 287 363) and a private Facebook community where many patients converse.

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