An individualised clinical assessment is required to meet the identified needs of a patient, their carer(s) and family. Referral should be as required; however, given the generally poor prognosis of this malignancy, early supportive care is strongly encouraged.

In addition to common issues identified in the Appendix, specific needs that may arise at this time include:

• communication to ensure the patient understands that they are being investigated for a possible cancer diagnosis, even prior to a tissue diagnosis being obtained
• support and information to assist with any distress while patients are undergoing these tests – patients with CUP will most likely undergo extensive testing (Wagland et al. 2017)
• psychosocial support and specific interventions – depressive symptoms are higher in people with CUP when compared with people with cancer of a known origin (Hyphantis et al. 2013)
• good communication from experts – CUP patients are more likely to want written information about their type of cancer and tests received but less likely to understand explanations of their condition (Wagland et al. 2017)
• coordination of care – GPs play an important role in coordinating care for patients, including assisting with side effects and offering support when questions or worries arise
• treatment for physical symptoms such as pain and fatigue
• guidance about financial and employment issues (such as loss of income, travel and accommodation requirements for rural patients and caring arrangements for other family members)
• appropriate information for people from culturally and linguistically diverse backgrounds.