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) and weight loss
• support for alcohol and/or substance misuse
• 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]; if necessary, refer to a dietitian for nutritional intervention
• 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 and who have common risk factors to the patient, especially HBV
• specific spiritual needs that may benefit from the involvement of pastoral/spiritual care
• 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).

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.