4.5.1 Supportive care
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
- mood lability or depression as a result of ADT, which may benefit from referral to a psychologist or consideration of mood-stabilising medication
- erectile and ejaculation dysfunction and impotence as a result of treatment, which may require referral to a medical specialist and/or nurse practitioner skilled in counselling in this area
- urinary dysfunction, including urinary incontinence, requiring pads, referral to a continence nurse and/or pelvic floor physiotherapist
- bowel dysfunction or rectal bleeding, which may require referral for endoscopic evaluation and dietitian review
- weight gain and fluid retention, and fatigue and loss of muscle mass as a result of ADT, which may require referral to a dietitian for review and referral to an exercise physiologist or physiotherapist for an individualised exercise program
- assistance with managing complex medication regimens, multiple medications, assessment of side effects and assistance with difficulties swallowing medications – referral to a pharmacist may be required
- 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).
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.