Populations with special needs (formerly part of the Appendix)

Planning and delivering appropriate cancer care for older people presents a number of challenges. Improved communication between the fields of oncology and geriatrics is required to facilitate the delivery of best practice care, which takes into account physiological age, complex comorbidities, risk of adverse events and drug interactions as well as the implications of cognitive impairment on the 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:

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

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, careful attention to promoting normal development is required (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 with knowledge specific to 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
  • if the prognosis is favourable, 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.

Youth cancer services

Youth cancer services provide specialist, age-appropriate treatment and support for young cancer patients aged 15–25 years. Youth cancer services are provided at five lead hospitals and linked to a network of more than 25 hospitals across Australia. Each service has a multidisciplinary specialist team of doctors and health professionals who are experienced in treating and caring for young people with a range of different cancers. They can also provide advice and information about the specific needs of AYA with a cancer diagnosis.

The burden of cancer is higher in the Australian Indigenous population (AIHW 2014). Survival also significantly decreases as remoteness increases. Aboriginal and Torres Strait Islander people in Australia 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 2015):

  • 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 impact on 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).