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
• support for alcohol and drug addiction
• advice and assistance to stop smoking, chewing tobacco or chewing betel quid
• management of physical symptoms such as pain and fatigue (Australian Adult Cancer Pain Management Guideline Working Party 2019)
• a prompt referral to the required discipline if problems are identified (e.g. dietetics, speech pathology)
• a comprehensive speech pathology assessment and education for patients who are being considered for total laryngectomy (they should also be offered the opportunity to speak with a consumer who has undergone a laryngectomy)
• a physiotherapy assessment and introduction to a postoperative exercise regime to minimise/treat any associated shoulder dysfunction for patients who are being considered for neck dissection
• decisions regarding enteral nutrition for high-risk patients, with relevant referrals made (e.g. gastrointestinal surgery, gastroenterology, radiology and dietetics)
• pre-treatment screening for unintentional weight loss, oral health, communication and swallowing 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])
• 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.

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.