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)
• mood lability or depression as a result of ADT, which may benefit from referral to a psychologist or consideration of mood-stabilising medication
• physical symptoms including pain, fatigue, incontinence, urinary retention or voiding difficulties and bladder outlet obstruction
• erectile and ejaculation dysfunction and impotence as a result of treatment, which will require referral to a medical specialist and clinicians skilled in this area of counselling
• urinary dysfunction, including urinary incontinence, requiring pads, referral to a continence nurse and/or pelvic floor physiotherapist
• bowel dysfunction or rectal bleeding, which may require referral for endoscopic evaluation and dietitian review
• rectal complications, which may require the involvement of a continence nurse and stomal therapist
• weight gain and fluid retention as a result of ADT, which may require referral to a dietitian and exercise physiologist for review
• 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.