Planning and delivering appropriate cancer care for older people presents a number of challenges. Improved communication between the fields of oncology and geriatrics facilitates best practice care that takes into account physiological age, complex comorbidities, risk of adverse events and drug interactions, as well as implications of cognitive impairment on suitability of treatment and consent (Steer et al. 2009).

A national interdisciplinary workshop convened by the Clinical Oncology Society of Australia (COSA) recommended that people over the age of 70 undergo some form of geriatric assessment in line with international guidelines (COSA 2013). Assessment can be used to determine life expectancy and treatment tolerance as well as identifying conditions that might interfere with treatment including:

• cognition
• comorbidity
• emotional status
• function
• nutrition
• polypharmacy
• presence of geriatric syndromes
• social supports.

Guided intervention using aged care services is appropriate.

The rarity and complexity of child cancer provides a real challenge in delivering optimal care. Treatment modalities for paediatric cancer are often prolonged and complicated and have a narrow therapeutic index. Side effects of systemic therapy for treating cancer can be more severe for children, including acute organ toxicities, prolonged immunodeficiency and infection.

As a result of these complexities, high-quality evidence-based care is required not only to deliver therapy and supportive care but is essential in the diagnosis phase, post-treatment surveillance and long-term follow-up care. Children with sarcoma must have their treatment delivered by a statewide referral centre for paediatric oncology. Consider shared care for surveillance once treatment is completed. Children’s cancer services actively participate in clinical trials as a way of participating in research and improving outcomes for children.

Recent years have seen the emergence of adolescent and young adult (AYA) oncology as a distinct field due to lack of progress in survival and quality-of-life outcomes (Ferrari et al. 2010; NCI & USDHHS 2006; Smith et al. 2013). The significant developmental change that occurs during this life stage complicates a diagnosis of cancer during the AYA years, often leading to unique physical, social and emotional impacts for young people at the time of diagnosis and throughout the cancer journey (Smith et al. 2012).

In caring for young people with cancer, pay careful attention to promoting normal development (COSA 2011). This requires personalised assessments and management involving a multidisciplinary, disease-specific, developmentally targeted approach informed by:

• understanding the developmental stages of adolescence and supporting normal adolescent health and development alongside cancer management
• understanding and supporting the rights of young people
• communication skills and information delivery that are appropriate to the young person
• addressing the needs of all involved, including the young person, their family and/or carer(s)
• working with educational institutions and workplaces
• addressing survivorship and palliative care needs.
• An oncology team caring for a young person with cancer must:
• ensure access to expert AYA health professionals who understand the biomedical and psychosocial needs of the population
• understand the biology and current management of the disease in the AYA age group
• consider clinical trials accessibility and recruitment for each patient
• engage in proactive discussions about fertility preservation and the late effects of treatment and consider the patient’s psychosocial needs
• provide treatment in an AYA-friendly environment.

The burden of cancer is higher in the Australian Indigenous population (AIHW 2014). Survival also significantly decreases as remoteness increases, unlike the survivorship rates of non-Indigenous Australians. Aboriginal and Torres Strait Islander people have high rates of certain lifestyle risk factors including tobacco smoking, higher alcohol consumption, poor diet and low levels of physical activity (Cancer Australia 2015). The high prevalence of these risk factors is believed to be a significant contributing factor to the patterns of cancer incidence and mortality rates in this population group (Robotin et al. 2008).

In caring for Aboriginal and Torres Strait Islander people diagnosed with cancer, the current gap in survivorship is a significant issue. The following approaches are recommended to improve survivorship outcomes (Cancer Australia 2013):

• Raise awareness of risk factors and deliver key cancer messages.
• Develop evidence-based information and resources for community and health professionals.
• Provide training for Aboriginal and Torres Strait Islander health workers and develop training resources.
• Increase understanding of barriers to care and support.
• Encourage and fund research.
• Improve knowledge within the community to act on cancer risk and symptoms.
• Improve the capacity of Aboriginal and Torres Strait Islander health workers to provide cancer care and support to their communities.
• Improve system responsiveness to cultural needs.
• Improve our understanding of care gaps through data monitoring and targeted priority research.

For people from diverse backgrounds in Australia, a cancer diagnosis can come with additional complexities, particularly when English proficiency is poor. In some languages there is not a direct translation of the word ‘cancer’, which can make communicating vital information difficult.

Perceptions of cancer and related issues can differ greatly in those from culturally diverse backgrounds and can affect the understanding and decision making that follows a cancer diagnosis. In addition to different cultural beliefs, when English language skills are limited there is potential for miscommunication of important information and advice, which can lead to increased stress and anxiety for patients. A professionally trained interpreter (not a family member or friend) should be made available when communicating with people with limited English proficiency. Navigation of the Australian healthcare system can pose problems for those born overseas, and particular attention should be paid to supporting these patients (Department of Health 2009).