Situations that may be associated with increased distress for a patient with cancer:
(1) when a suspicious sign or symptom is recognized
(2) during the clinical workup and while waiting for results
(3) when being told the diagnosis
(4) while awaiting therapy
(5) during any change in treatment
(6) referral to a distant and/or unfamiliar cancer center
(7) when complications of therapy occur
(8) when therapy is completed
(9) when discharged from hospital
(10) stresses associated with being a survivor
(11) during followup and surveillance (tracking of a tumor marker, etc)
(12) treatment failure, disease recurrence or progression
(13) advanced cancer with clinical deterioration
(14) end of life
A clinician should increase surveillance for distress during these situations. It is also a good idea to monitor caregivers and people close to the patient for distress during these periods.
