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
• management of physical symptoms such as pain, fatigue (Australian Adult Cancer Pain Management Guideline Working Party 2019), weight loss and altered bowel function
• malnutrition or undernutrition, identified using a validated nutrition screening tool such as the MST (note that many patients with a high BMI [obese patients] may also be malnourished [WHO 2018])
• pre-surgical education with a stomal therapy nurse wherever a temporary or permanent stoma is a possibility
• guidance for financial and employment issues (e.g. loss of income, travel and accommodation)
• requirements for rural patients and caring arrangements for other family members
• 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
• low self-esteem and disturbed body image, which are more prevalent in stoma patients than in non-stoma patients.

Between 32 and 44 per cent of patients report psychological distress following a diagnosis of colorectal cancer, and patients with stomas are at higher risk (El-Shami et al. 2015; Cancer Council Australia Colorectal Cancer Guidelines Working Party 2019). This large number indicates a need for screening patients to identify those at high risk of anxiety or depression at each visit. Provide patients with tailored and accurate information before treatment, and facilitate patient decision making about appearance-altering treatment and meeting others with a similar personal experience (Hong et al. 2014). Consider pre-surgical referral to a psycho-oncologist for support over body image expectations associated with surgical treatment.

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.