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; stigma; 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
• physical distress caused by breathlessness and coughing, which may be alleviated through a referral to allied health professionals (physiotherapy, occupational therapy, exercise physiology or pulmonary rehabilitation); non-pharmacological strategies may be beneficial in breathlessness management (CareSearch 2019a) (note: if oxygen is medically indicated, this can be arranged through the relevant state aids and equipment program)
• hoarseness may require referral to a speech therapist or ENT specialist for palliative procedures
• management of physical symptoms such as pain, fatigue, cough and breathlessness (Australian Adult Cancer Pain Management Guideline Working Party 2019; Johnson & Currow 2016)
• delays in help-seeking for symptoms and psychological distress due to stigmatisation of Low-Grade Lymphomas associated with smoking (Cancer Australia 2020b)
• having issues with family and friends because of the association of tobacco use and Low-Grade Lymphomas (Carmack Taylor et al. 2008)
• 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, particularly following an advanced stage Low-Grade Lymphomas diagnosis (stages III–IV) or to assist with pain management.

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