‘Supportive care’ is an umbrella term used to describe all services that may be needed to support people with cancer.7 Significant others, such as partners and families, may also experience supportive care needs related to the diagnosis of breast cancer.43, 44 Assessment and discussion of individuals' supportive care needs should be undertaken at key points, such as diagnosis; at commencement, during, and at the end of treatment; at relapse; and when death is approaching.45
People with cancer represent the full demographic spectrum of the Australian population. They may face pre-existing medical problems, mental illness and social adversity, and life may be further affected by disruptions to their:23
- social role
- family functioning
- occupational or employment status
- financial status.
Other social and demographic factors such as culture, rurality, age and sexual orientation may also influence supportive care needs.23
Many of these demographic, social and personal factors influence how a person responds to a diagnosis and the impact that cancer may have on their lives. For example, although lesbians and bisexual women usually face similar health care issues to heterosexual women, research suggests that they find it difficult to access care that is appropriate, non-discriminatory, and conducive to their specific needs.23
To meet these needs, SCNs should aim to implement supportive care strategies and provide evidence-based information and education for people at these key points. The provision of accurate, appropriate information has been shown to help people comprehend their situation and enhance their well-being.23
Specific supportive care needs are influenced by a range of disease, treatment and person related factors.7, 23 These needs may be broken down into 3 main groups:
These needs are reviewed in more detail in the following sections.
Access the Supportive Care Screening resource page46 or a supportive care screening tool used in your practice setting:
- Discuss the extent to which the tool adequately assesses the specific needs of a person diagnosed with breast cancer.
- Compare the extent to which current assessment tools in your workplace adequately assess the supportive care needs of people diagnosed with breast cancer.
People who are diagnosed with cancer experience a number of disease and treatment-related effects that may affect their quality of life, and can increase the risk of developing serious psychological issues.23
These physical effects may include:47
- loss of range of motion
- loss of fertility
- cognitive dysfunction
- weight gain
- sexual dysfunction
- increased risk of osteoporosis
- cardiac late effects of some treatments.
These may be long-term or late effects of treatment for breast cancer, affecting individuals long after treatment has finished.47
Some of the most significant physical needs of people diagnosed with breast cancer are explored in more detail in the research links below.
Some people receiving cancer treatment have reported a condition affecting cognitive function and memory known as 'chemo brain':48
Most literature on this topic relates to people who have had adjuvant antineoplastic agents, reporting problems with their memory and losing the capacity to think clearly during or after treatment. Impairment of a person's cognitive faculties may affect their quality of life and ability to function.49
Nail, L. (2006). Cognitive changes in cancer survivors, AJN, American Journal of Nursing. 106: 48-5450
Lymphoedema is the regional accumulation of excessive amounts of protein-rich fluid in body tissue causing swelling.51 It occurs when the demand for lymphatic drainage exceeds the capacity of the lymphatic circulation.51
Secondary lymphoedema is estimated to occur in about 30% of women following treatment for breast cancer, and can occur at any time following surgery, radiotherapy, trauma or other damage to the lymphatic system.51
The management of secondary lymphoedema- a guide for health professionals. National Breast and Ovarian Centre (2008)51
Treatment for cancer can affect a person’s sexuality, including their interest in sex and their self-esteem.52 Reduced sexual satisfaction and difficulty maintaining their sexual life have been reported in women with breast cancer. Factors affecting sexual wellbeing include pain, fatigue, decreased vaginal lubrication, decreased sexual interest or desire, decreased sexual arousal and difficulty achieving orgasm.53 An individuals’ sense of sexual wellbeing may be impacted regardless of their sexual preference or relationship status.52
The psychosexual care of women affected by gynaecological cancers (or PSGC) website54 contains six learning modules help all health professionals develop the knowledge and skills to support women and their partners experiencing psychosexual concerns following gynaecological cancer. Principles within this resource may be adapted to the learning needs of SCNs caring for women affected by breast cancer.
Survivorship module – Sexuality factsheet
Loss of fertility
Surgery, radiation, and systemic therapies may all cause varying degrees of infertility.23 Fertility preservation is sometimes possible for people undergoing treatment for cancer.
Cancer Australia webpage – Breast cancer and fertility
Most people with cancer will experience at least transient symptoms of anxiety and/or depression.23 Some of these people will go on to develop severe problems and will require specialised treatment.23 Psychological distress can also be a potential long-term or late effect of being diagnosed with breast cancer.47 People who perceive that they have poor emotional and social support available to them are more likely to experience greater psychological distress,23 as are younger women.56
Breast cancer survivors have reported significant psychological burdens related to altered body image and fear of cancer recurrence.23 Specific emotional issues identified after the experience of cancer involve reflection on values, and challenging assumptions about life, relationships and mortality and sense of personal identity.23
For some people with breast cancer, high levels of intrusive symptoms (such as recurrent thoughts about the cancer diagnosis or aspects of treatment) may interfere with their daily activities.7 People receiving treatment for breast cancer should be screened to identify those at high risk of anxiety or depression at each visit.7 Strategies such as relaxation techniques and meditation may be helpful.7
Some people with cancer will benefit from meeting others who have had similar personal experiences; support and counselling by psychologists, psychiatrists, or social workers may also be helpful.7
Cancer Australia webpage – Managing emotional changes due to breast cancer
People diagnosed with breast cancer may incur considerable costs as a result of this diagnosis.7, 23 These costs may be related to:23
- diagnosis and treatment
- supportive treatments like physiotherapy and reconstructive surgery
- prostheses and wigs.
People who develop lymphoedema will require ongoing physiotherapy, compression garments, and access to trained therapists.23
Those living in rural and remote areas have unique supportive care needs, as they are more likely to face disadvantages in accessing cancer services and support.57 While the emotional needs of people affected by cancer in rural areas are similar to those in urban areas, greater disruption to family life and work may be experienced due to more time spent away from home. In addition: 23
- Geographical isolation can lead to burdensome travel and accommodation costs. Organising and obtaining financial assistance can be difficult. Lack of knowledge of financial assistance may compound the sense of difficulty.
- Access to health and community support services may be limited in rural settings. Telephone and internet peer support groups are recommended.
Some people with cancer may experience extensive periods off work while recovering from treatment.23 This can lead to loss of income, and severe financial burden.23 Many people may experience psychological distress due to the financial effects of their illness.
People receiving treatment for cancer may be unaware of the financial assistance available to them.23 Access the following sites for further information on financial assistance:
- Centrelink has a range of payments that may be paid for people living with illness, injury or disability. They also have a range financial assistance and services for those caring for someone with an illness or disability.
- Some states subsidise the cost of travel for people who are required to travel over 100km to receive specialist medical treatment. For instance, South Australia has the Patient Assistance Transport Scheme (PATS) and Queensland has the Patient Travel Subsidy Scheme (PTSS).
- The Cancer Voices SA website has information on financial issues.
- Veterans and war widows who develop cancer may receive financial assistance from the Department of Veterans Affairs for services, equipment and medications.
- Some state-based cancer organisations provide limited financial assistance; their contact details can be accessed via the Cancer Council Australia website.
- Summarise the key disparities in cancer control efforts in rural and regional Australia
- Critically review recommendations to improve the provision of supportive care to people in rural and remote areas.
- Identify information about travel, accommodation, and financial support that could be provided to people from rural areas.