SUPPORTIVE CARE

Cancer has a multidimensional impact necessitating a multidisciplinary care approach. This ideally should commence at diagnosis and continue into survivorship or until end-of-life care. Supportive care arrangements need to be identified in consultation with the patient and their loved ones. A diagnosis of cancer has the potential to inflict extraordinary stress and anxiety on not only the patient, but also their immediate family and support network. When faced with this diagnosis, individuals will cope differently.

Effects of surgery for malignant lesions can have varied outcomes, impacting on daily functioning. Surgical inventions may cause pain and can impact on psychological well-being. Chemotherapy and radiotherapy are toxic, often causing fatigue, nausea, pain, dietary problems, skin problems, sensory impairment and gastrointestinal upset. Feelings of despair and loss of control are entirely normal for survivors of cancer and their families, and survivorship care may continue for many years. This highlights the importance of proper patient education prior to making treatment decisions.

Knowledge of what is important to the family can help the clinician communicate meaningfully and assists in patient adherence to treatment recommendations. Doctors benefit from knowing the carers, enabling them to provide meaningful and constructive feedback and guidance. With proper education, patients and carers will be empowered, more motivated and better able to reflect and consider differing viewpoints. They will feel more comfortable asking questions and more confident in their choices regarding treatment decisions.   Actively involving the patient and family, shifts the focus from the doctor trying to fix the issue and instead empowers the patient to establish healthy lifestyle choices, essential for improved survivorship.

After treatment, the need to communicate the importance of regular monitoring moving forward is vitally important, so that the patient, family and medical team are aligned regarding the outlook. The psychological stress associated with cancer recurrence should not be underestimated and cancer physicians need to factor this aspect into the careplan.  The doctor must effectively communicate the

necessary surveillance plan to patients, identifying their emotional and informational needs at follow up appointments.

Cancer prevention and control demands physicians discuss risk factors and lifestyle choices. Understanding the patient can assist physicians in delivering patient centred care and help foster relevant and purposeful support. 

The uncertainty that results from a cancer diagnosis in a loved one never goes away, and the GP should foster a trusting relationship and provide as much or as little information as each family member needs. There is evidence that dependent children of cancer patients experience constant worry and a feeling of disconnect, and a need to speak to someone about it. This highlights the impact cancer may have and the need to prioritise patient and carer well-being at all times.

Active listening will help facilitate open dialogue about challenging topics. Acknowledging cultural differences and learning how patients see their disease and how it is treated, shows respect for both the patient and carer perspectives. Gaining insight into patient beliefs will help cultivate a positive and respectful relationship.

Building trusting relationships with key health professionals will allow patients and families to navigate through survivorship with the appropriate education and resources, conducive to achieving optimal outcomes. Shifting the narrative to cancer as a chronic disease will promote more regular patient-clinician interactions, actively monitoring for disease recurrence, and prioritising psychological, emotional, psychosocial, mental, physical and spiritual wellbeing.