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, fatigue, nausea and vomiting – some patients are bothered more by nausea than by vomiting; managing both is important for improving quality of life
• bowel dysfunction, gastrointestinal or abdominal symptoms, which may need monitoring and assessment
• malnutrition risk as identified by a validated malnutrition screening tool or unintentional weight loss of greater than 5 per cent usual body weight
• loss of fertility, surgically or chemically induced menopause, reduced sexual interest and sexual dysfunction, such as vaginal dryness, dyspareunia, atrophic vaginitis and pain (these issues require sensitive discussion and possible referral to a clinician with skills in the relevant area [Harris 2019]; sexual dysfunction can be a long-term complication for many patients, persisting throughout survivorship [Candy et al. 2016])
• early-onset menopause – the risk continues after chemotherapy and not only immediately following treatment
• chemotherapy-related toxicity (e.g. neuropathy and alopecia)
• assessment and management from a pelvic floor physiotherapist
• lower limb lymphoedema if a lymphadenectomy has been performed, which can restrict mobility – referral to a physiotherapist or trained lymphoedema massage specialist may be appropriate
• 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’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.