The patient’s general practitioner should consider an individualised supportive care assessment where appropriate to identify the needs of an individual, their carer and family. Refer to appropriate support services as required. See validated screening tools mentioned in Principle 4 ‘Supportive care’.

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

• assistance to cope with the emotional distress and/or anger of dealing with a potential cancer diagnosis, anxiety/depression, interpersonal problems and adjustment difficulties
• management of physical symptoms including fatigue and predisposition to infections
• encouragement and support to increase levels of exercise (Cormie et 2018; Hayes et al. 2019)
• referral to a counsellor to help them come to terms with the uncertainty of a CLL diagnosis and the challenges of the ‘watch and wait’ approach
• education on the nature of CLL to help patients form realistic expectations and ease their concerns
• support to deal with fear of the unknown, which can lead to more serious psychological issues including depression and anxiety if not addressed.

For more information refer to the National Institute for Health and Care Excellence 2015 guidelines, Suspected cancer: recognition and referral .

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