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

A number of specific challenges and needs may arise for patients and carers 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
• management of physical symptoms such as pain and fatigue (Australian Adult Cancer Pain Management Guideline Working Party 2019), including pain management for mucositis or peripheral neuropathy
• physiotherapy/exercise support in managing chemotherapy induced peripheral neuropathy and muscle weakness
• neuropsychology supports: referral to neuropsychology should be considered for patients who have experienced potential neurocognitive insult from triggers such as CNS-directed therapy (cranial radiation and intrathecal chemotherapy), those patients receiving high-dose methotrexate and patients who experience any significant CNS morbidity during treatment such as cerebral bleed, stroke, acute meningitis and encephalopathies
• nutritional assessment at diagnosis and subsequently for all This should include malnutrition or undernutrition, noting that many patients with a high BMI (obese patients) may also be malnourished (WHO 2018)
• education and school support (where applicable)
• support for families or carers who are distressed with the patient’s cancer diagnosis (including support for siblings where applicable)
• 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. Additionally, palliative care may be required at this