Fear of death, disruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle, and financial concerns are all realities in the lives of people diagnosed with cancer. In fact, at least a quarter suffer major depression which, unless treated, can impact negatively on their quality of life. 
That’s not in question. But a major issue for psychosocial oncology is how we get to a place where we rapidly, and in a standardised way, identify and appropriately care for patients and families in need of specialised psychosocial and rehabilitation services.
The issue of screening for distress is gathering momentum internationally; in 2011 delegates at the meeting in China of the Union for International Cancer Control (UICC) voted to endorse the International Psycho-oncology Standard of Care document, which recognised distress as the 6th Vital Sign. 
South Africa needs to urgently rethink its lack of commitment in this area, especially in light of data that shows distress is a risk factor for non-adherence to treatment.
Ultimately it also impacts on patients’ decision-making, which can impact negatively on the oncology team as it manifests in increased visits to doctors and the emergency room, a situation South Africa can ill-afford.  Patients – and their families and carers – deserve the best outcomes possible, and this requires the inclusion of systemic psychosocial care in the continuum of cancer care.
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