An individualised clinical assessment is required to meet the identified needs of a patient, their carer(s) and family. Referral should be as required; however, given the generally poor prognosis of this malignancy, early supportive care is strongly encouraged.

In addition to common issues identified in the Appendix, specific needs that may arise at this time include:

• communication to ensure the patient understands that they are being investigated for a possible cancer diagnosis, even prior to a tissue diagnosis being obtained
• support and information to assist with any distress while patients are undergoing these tests – patients with CUP will most likely undergo extensive testing (Wagland et al. 2017)
• psychosocial support and specific interventions – depressive symptoms are higher in people with CUP when compared with people with cancer of a known origin (Hyphantis et al. 2013)
• good communication from experts – CUP patients are more likely to want written information about their type of cancer and tests received but less likely to understand explanations of their condition (Wagland et al. 2017)
• coordination of care – GPs play an important role in coordinating care for patients, including assisting with side effects and offering support when questions or worries arise
• treatment for physical symptoms such as pain and fatigue
• guidance about financial and employment issues (such as loss of income, travel and accommodation requirements for rural patients and caring arrangements for other family members)
• appropriate information for people from culturally and linguistically diverse backgrounds.

Effective communication is essential at every step of the care pathway. Effective communication with the patient and carer is particularly important given the prevalence of low health literacy in Australia, which is estimated at 60 per cent of Australian adults (ACSQHC 2013).

The general or primary medical practitioner who made the referral is responsible for the person until care is passed to another practitioner.

The general or primary medical practitioner may play a number of roles in all stages of the cancer pathway including diagnosis, referral, treatment, coordination and continuity of care as well as providing information and support to the person and their family.

The GP should:

• provide the patient with information that clearly describes who they are being referred to, the reason for referral and the expected timeframe for appointments
• support the patient while waiting for the specialist appointment.