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; history of sexual abuse; and interpersonal problems
• counselling for decision regret and fear of cancer recurrence
• management of physical symptoms such as pain and fatigue (Australian Adult Cancer Pain Management Guideline Working Party 2019), incontinence, urinary retention or voiding difficulties
• sexual function/dysfunction and decreased fertility – evidence is limited, but fertility declines when erectile function and libido are affected; referral to counselling specialists for sperm banking may be required (Lotti & Maggi 2018)
• 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.