The NCCN Distress Guidelines highlight periods of increased vulnerability to psychosocial distress, such as treatment failure, recurrence or progression of disease, and transition to survivorship (NCCN, 2012). Those may be times when people are at risk for greater distress and require more frequent assessment and support. Nurses, because of the extended periods of time they spend with patients, are ideally suited to direct when further assessment may be warranted. In addition, oncology nurses frequently notice changes in their patients; changes in thought, behavior, or mood may indicate the need for further assessment interventions such as referral or treatment.