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 dysphagia
• referral to a dietitian for nutritional assessment and support:
  • Patients may require referral to a dietitian before and, in particular, during treatment and the acute recovery phase. The benefits of enteral nutrition should also be considered at all stages of treatment and recovery.
  • Validated malnutrition screening tools should be used at the key points in the care pathway to identify patients at risk of malnutrition.
  • Patients requiring oral nutrition support or enteral feeding, or patients with a stent, should receive support from dietitians with expertise in managing these interventions before, during and after treatment.
  • GI symptoms (e.g. nausea, vomiting, mucositis, loss of appetite, early satiety and taste changes) can result from chemotherapy treatment, requiring optimal symptom control.
  • Weight loss due to GI symptoms, difficulty swallowing and decrease in appetite can be a significant issue for patients.
  • Ongoing monitoring after a total gastrectomy for vitamin B12 and iron deficiency is often required.
• sensory neuropathy (ongoing monitoring)
• 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 based on 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.

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