5.4.1 Supportive care
See validated screening tools mentioned in Principle 4 ‘Supportive care’. Additionally, the ‘Cancer Survivors Unmet Needs (CaSun)’ is another validated screening tool that may help health professionals to identify the unmet needs of patients during survivorship.
A number of specific challenges and needs may arise for cancer survivors:
- body image in general and issues about feelings of masculinity, and concerns about developing breasts as a result of ADT – providing patients with tailored, accurate information prior to treatment, facilitating patient decision making about appearance-altering treatment, and meeting others with similar personal experiences may assist some men
- 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 will require referral to a medical specialist and clinicians skilled in this area of counselling
- 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 as a result of ADT, which may require referral to a dietitian and exercise physiologist for review
- fatigue and loss of muscle strength as a result of ADT – all patients on ADT benefit from referral to an exercise physiologist or physiotherapist for an individualised exercise program
- osteoporosis, which can be a delayed outcome of ADT – regular monitoring by a medical practitioner and a baseline bone mineral density may be required
- ‘hot flushes’ as a result of ADT – advice on reducing alcohol intake, avoiding hot drinks, undertaking regular exercise and relaxation may help
- financial and employment issues (e.g. loss of income and assistance with returning to work, and the cost of treatment, travel and accommodation)
- appointing a substitute decision-maker and completing an advance care directive
- legal issues such as completing a will.
For more information on supportive care and needs that may arise for different population groups, see Appendices A and B, and special population groups.