See validated screening tools mentioned in Principle 4 ‘Supportive care’.

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

• assistance for dealing with emotional and psychological distress resulting from fear of death or dying, existential concerns, anticipatory grief, communicating wishes to loved ones, interpersonal problems and sexuality concerns
• potential isolation from normal support networks, particularly for rural patients who are staying away from home for treatment
• cognitive changes as a result of treatment and disease progression such as altered memory, attention and concentration (a patient may appoint someone to make medical, financial and legal decisions on their behalf – a substitute decision-maker – before and in case they experience cognitive decline)
• management of physical symptoms including pain, fatigue, loss of appetite or weight loss
• upper and lower limb lymphoedema, which may require referral to a trained lymphoedema specialist
• disfigurement and scarring from appearance-altering treatment (and possible need for a prosthetic), which may require referral to a specialist psychologist, psychiatrist or social worker
• decline in mobility or functional status as a result of recurrent disease and treatments (referral to physiotherapy or occupational therapy may be required)
• coping with hair loss and changes in physical appearance (refer to the Look Good, Feel Better program– see ’Resource List’)
• appointing a substitute decision-maker and completing an advance care directive
• financial issues as a result of disease recurrence such as gaining early access to superannuation and insurance
• legal issues (completing a will, care of dependent children) and making an insurance, superannuation or social security claim on the basis of terminal illness or permanent disability

Rehabilitation may be required at any point of the metastatic care pathway, from preparing for treatment through to palliative care. Issues that may need to be dealt with include managing melanoma-related fatigue, improving physical endurance, achieving independence in daily tasks, returning to work and ongoing adjustment to melanoma and its sequels.

Exercise is a safe and effective intervention that improves the physical and emotional health and wellbeing of melanoma patients. Exercise should be embedded as part of standard practice in cancer care and be viewed as an adjunct therapy that helps counteract the adverse effects of melanoma and its treatment. When exercising outdoors, sun protection should be an important consideration.

The lead clinician should ensure there is adequate discussion with patients and carers about the diagnosis and recommended treatment, including treatment intent and possible outcomes, likely adverse effects and the supportive care options available.

Refer to Principle 6 ‘Communication’ for communication skills training programs and resources.