Assessment is “the assessment of baseline function or status” and it should:

• be individualised to each patient
• include objective baseline measures of physical fitness, nutritional status and psychology
• be undertaken using validated assessment tools

Assessment in practice:

• undertaken by registered health and care professionals (registered, enhanced, advanced, consultant) or unregistered health and care professionals (supportive, assistive) through delegated authority
• implementation and effectiveness should be audited as part of a quality assurance and improvement framework
• a set of standardised assessment methods should be defined and used consistently

Cardiopulmonary Exercise Testing

• dynamic assessment of the cardiopulmonary system at rest and during exercise
• usually performed on an upright or semi-recumbent stationary bike
• produces 9-panel plot and set of variables
• low values for anaerobic threshold and peak oxygen consumption are associated with poorer outcomes

6 Minute Walk Test (6MWT)

• requires no specialist equipment
• measures distance covered on a flat surface over 6 minutes
• self-paced, allowed to rest as needed
• average range in healthy adults is 400-700m
• an improvement of 50m post intervention is considered clinically important
• can identify people at higher risk of complications

Incremental Shuttle Walk Test (ISWT)

• 10m course walked at increasing pace
• similar to the “bleep test”
• achieving >400m correlates to a VO2 peak of >15ml/kg/min

Timed Up and Go (TUG) Test – Very Well Health

WHO Disability Assessment Schedule (WHODAS 2.0)

Brief fatigue inventory – FACIT- Fatigue

Almost 50% of patients admitted to hospital are malnourished or at risk of malnutrition.

Subjective Global Assessment SGA

• Canadian Malnutrition Task Force
• Assessment includes taking a history of recent intake, weight change, gastrointestinal symptoms and a clinical evaluation

Patient Generated Subjective Global Assessment questionnaire (PG-SGA short form)

Blood Tests

• anaemia is a predictor of adverse post-operative outcomes
• measure B12 / folate / iron levels as indicated by sub-type of anaemia
• vitamin D deficiency has been associated with poorer post-operative outcomes
• albumin / prealbumin / zinc have been used as surrogate markers for malnutrition. They may be lowered in inflammatory states (including in patients with cancer) and not accurately reflect true protein state

Sarcopenia

• Sarcopenia is the progressive loss of muscle mass and is associated with poorer outcomes. It can be caused by a combination of lack of exercise and malnutrition
• Gold standard in a research setting is dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) .
• In a clinical setting, cases are identified when a patient reports symptoms or signs of sarcopenia such as feeling weak, slow walking speed or difficulty rising from a chair.
• CT imaging of the psoas muscle can detect sarcopenia. CT scan images obtained as part of radiotherapy planning can also be used to detect sarcopenia.

Assessment

• Everyone should be able to recognise emotional distress
• Avoid causing psychological harm
• Know when to refer to a more specialist service

Intervention

• Communicate honestly and compassionately
• Treat patients with kindness and respect
• Establish and maintain supportive relationships
• Inform people with cancer and their carers about the emotional and support services
• available to them

Anxiety management can have a positive impact for these people. Relaxation techniques such as visualisation and mindfulness discussed earlier can be very helpful in this situation in making people feel more comfortable.

At a universal level no formal psychological assessments would be used.

At a targeted level assessment tools at Level 2 and 2 plus could include:

Patient Health Questionnaire- 9 (PHQ-9)

• The PHQ-9 is an assessment tool used frequently by healthcare professionals to help identify those most in need of support
• It is often used to monitor the severity of depression and response to treatment
• Is often used alongside GAD-7
• Explicitly asks about suicidal thoughts – therefore should be completed in a supportive environment with a practitioner who is skills and able to respond to this

Generalised Anxiety Disorder Assessment (GAD-7)

• Often used alongside PHQ-9
• The GAD-7 is an easy-to-use self-administered patient questionnaire used as a screening tool and severity measure for generalised anxiety disorder

Hospital Anxiety and Depression Scale (HADS)

• commonly used in research
• five-minute self-administered test suitable for use by a range of clinical professionals assessing emotional disorders in adults.
• used internationally, HADS is now available in 115 languages
• has cut-offs for clinical depression/anxiety

For those working at level 2 it is advised these measures are used and depending on the results referral to Level 3 or level 4 may be required.

At a specialist level (level 3) an initial assessment is conducted at the start of therapy. PHQ-9 and GAD-7 would be used as core outcome measures.

• There is also consideration around using the Work and Social Adjustment Scale (WSAS) and a process based measure (PsyFlex).

At a specialist level (level 4) an initial assessment is conducted at the start of therapy. PHQ-9 and GAD-7 would be used as core outcome measures. Level 4 practitioners have the skills to base assessment on individual situation and needs- further detail is outside the scope of this guidance.

• There is also consideration around using the Work and Social Adjustment Scale (WSAS) and a process based measure (PsyFlex).

Other difficulty/ symptom-based measures relevant to therapy (e.g., to assess for symptoms of PTSD or other psychological difficulties) and/or other process-based measures may be used as relevant. These are selected using an individualised, formulation-driven approach.