Consider a referral to a psychologist, psychiatrist, pastoral/spiritual care practitioner, social worker, specialist nurse or a relevant community-based program if the patient has these issues:

• displaying emotional cues such as tearfulness, distress that requires specialist intervention, avoidance or withdrawal
• being preoccupied with or dwelling on thoughts about cancer and death
• displaying fears about the treatment process or the changed goals of their treatment
• displaying excessive fears about cancer progression or recurrence
• worrying about loss associated with their daily function, dependence on others and loss of dignity
• behavioural changes or dementia, particularly in patients treated with postoperative irradiation, which may require specific support
• neurocognitive effects related to the tumour and its treatment
• cognitive dysfunction, which is common and often unrecognised – ask carers about symptoms that may be related to cognitive dysfunction
• alterations in cognitive functioning, which can affect the patient’s ability to remember and maintain concentration (strategies to help manage cognitive impairment, such as maintaining written notes or diary, may be helpful)
• alteration in cognitive function, which can affect the patient’s capacity to make decisions
• becoming isolated from family and friends and withdrawing from company and activities that they previously enjoyed
• feeling hopeless and helpless about the effect that cancer is having on their life and the disruption to their life plans
• depression and anxiety as a result of increased dependency – if loss of independence is a factor contributing to depression, then referral to physiotherapy and occupational therapy may restore some independence and assist some people; refer to a psychologist or psychiatrist to help manage depression
• struggling to communicate with family and loved ones about the implications of their cancer diagnosis and treatment
• experiencing changes in sexual intimacy, libido and function
• struggling with the diagnosis of metastatic or advanced disease
• having difficulties quitting smoking (refer to Quitline on 13 7848) or with other drug and alcohol use
• having difficulties transitioning to palliative care.

Additional considerations that may arise for the multidisciplinary team include:

• support for the carer – encourage referrals to psychosocial support from a social worker, psychologist or general practitioner
• referral to an exercise physiologist or physiotherapist as a therapeutic approach to prevent and manage psychological health
• referral to wellness-after-cancer programs to provide support, information and offer strategies.