See validated screening tools mentioned in Principle 4 ‘Supportive care’.

A number of specific challenges and needs may arise for patients at this time:

• assistance for dealing with psychological and emotional distress while adjusting to the diagnosis; treatment phobias; existential concerns; stress; difficulties making treatment decisions; anxiety or depression or both; psychosexual issues such as potential loss of fertility and premature menopause; history of sexual abuse; and interpersonal problems
• access to expert health professionals with specific knowledge about the psychosocial needs of breast cancer patients
• for some populations (culturally diverse backgrounds, Aboriginal people and lesbian, transgender and intersex communities) a breast cancer diagnosis comes with additional psychosocial complexities, and discrimination uncertainty may also make these groups less inclined to seek regular medical care – access to expert health professionals with specific knowledge about the psychosocial needs of these groups may be required
• preservation of ovarian function should be discussed before starting treatment – goserelin reduces the risk of chemotherapy-induced menopause and should particularly be discussed before chemotherapy for women with ER-negative breast cancer (for some women with ER-positive breast cancer it may also be appropriate to use goserelin before and during chemotherapy; see Breast Cancer Network Australia’s Fertility-related choices booklet
• management of physical symptoms such as pain and fatigue (Australian Adult Cancer Pain Management Guideline Working Party 2019)
• upper limb and breast lymphoedema and cording following lymphadenectomy – this is a potential treatment side effect in people with breast cancer, which has a significant effect on survivor quality of life; referral (preferably preoperatively) to a health professional with accredited lymphoedema management qualifications, offering the full scope of complex lymphoedema therapy, should be encouraged
• limitations in upper limb movement and function, which may affect radiation therapy – referral to a physiotherapist may be required (prospective monitoring, particularly for high-risk patients is recommended)
• weight changes, which can be a significant issue for patients, and may require referral to a dietitian before, during and after treatment
• malnutrition or undernutrition, identified using a validated nutrition screening tool such as the MST (note that many patients with a high body mass index [obese patients] may also be malnourished [WHO 2018])
• support for families or carers who are distressed with the patient’s cancer diagnosis
• support for families/relatives who may be distressed after learning of a genetically linked cancer diagnosis
• specific spiritual needs that may benefit from the involvement of pastoral/spiritual care
• financial and employment issues (such as loss of income and having to deal with travel and accommodation requirements for rural patients and caring arrangements for other family members).

Additionally, palliative care may be required at this stage.

For more information on supportive care and needs that may arise for different population groups, see Appendices A and B, and special population groups.