Assess your needs

Many people affected by a cancer diagnosis may need support with some or all of the things listed.

Knowing what you need help with can be difficult.

The Distress Thermometer helps you score the amount of worry or concern you may be experiencing at the moment. The Problem List helps identify the causes of those concerns or worries. You can complete the form download it and take it to your doctor, GP or nurse. You can also email the form to yourself or someone else.

Instructions: Please click the number (0-10) that best describes how much distress you have been experiencing in the past week including today.

If you score 4 or above we recommend you download a copy of the completed Thermometer and Problem List and take it with you to your next hospital or GP appointment. Ask your doctor or nurse to talk through the problems you have identified or you may want to call the Cancer Council Victoria 13 11 20 phone support line.

A score of 7 or above suggests that you are experiencing a very high level of distress. It is important to seek support as soon as possible so that you get the help you need. Click here to find supports and resources.

NCCN DISTRESS THERMOMETER*

Please indicate if any of the following has been a problem for you in the past week including today.
Be sure to tick YES or NO for each.

YES / NO Practical Problems

Child care*

Yes

Food*

Yes

Housing*

Yes

Insurance/financial*

Yes

Transportation*

Yes

Work/school*

Yes

Treatment decisions*

Yes

YES / NO Family Problems

Dealing with children*

Yes

Dealing with partner*

Yes

Ability to have children*

Yes

Family health issues*

Yes

YES / NO Emotional Problems

Depression*

Yes

Fears*

Yes

Nervousness*

Yes

Sadness*

Yes

Worry*

Yes

Loss of interest in usual activities*

Yes

Spiritual/religious concerns*

Yes

YES / NO Physical Problems

Appearance*

Yes

Bathing/dressing*

Yes

Breathing*

Yes

Changes in urination*

Yes

Constipation*

Yes

Diarrhea*

Yes

Eating*

Yes

Fatigue*

Yes

Feeling swollen*

Yes

Fevers*

Yes

Getting around*

Yes

Indigestion*

Yes

Memory/concentration*

Yes

Mouth sores*

Yes

Nausea*

Yes

Nose dry/congested*

Yes

Pain*

Yes

Sexual*

Yes

Skin dry/itchy*

Yes

Sleep*

Yes

Substance use*

Yes

Tingling in hands/feet*

Yes

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Medical Problems Answer

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