Cancer patients most often consider the oncologist as their main resource in order to answer their needs in oncological situations [1] . Indeed, when it comes to cancer, the medical needs generally take prevalence over psychological needs. Pain [2] , fatigue [3] , and nausea [4] are among the most frequent symptoms expressed during cancer treatment and are generally difficult to manage by most patients. However, patients also frequently report and express psychological distress [5] [6] , most often to the specialist physician in charge of their treatment [7] - [9] . Surveys have shown that the patients’ psychological needs will mainly concern difficulties that they feel during medical interactions and lack of communication about their cancer and treatment, as well as psychological symptoms such as worries about the disease [10] [11] .

Therefore, besides medical intervention, the psychological intervention of the oncologist is of paramount importance. In conjunction to the oncologist’s intervention, psychologists have developed specific skills to listen to patients during their oncological treatment [12] , to support their emotional regulation abilities [13] [14] , and to evaluate the possible occurrence of psychopathological comorbidities or coincidences [15] - [17] . To answer cancer patients’ specific needs, the Belgian National Cancer Plan [18] has supported and financed the development of psycho-oncological support teams in all oncological centres across Belgium. Shortly after the implementation of the Belgian National Cancer Plan, we thus decided to investigate the characteristics of the population that consults the psycho-oncologist and the expectations toward this consultation. Up to now, psycho-on- cological interventions are either supportive clinical interviews, with no systematic questioning of the expectations of patients [19] , or totally structured interviews with systematic check lists [20] . The systematic consultation is an intermediate semi-directive method that has been implemented in our hospital. It occurs within 7 days after a diagnosis of cancer has been established and provided to the patient. This consultation is seen as a way to answer cancer patients’ psychological needs [21] . The systematic consultation includes 1) a reciprocal presentation; 2) an anamnesis of the patient (family and professional life), his/her medical history, and his/her potential psychological difficulties; 3) an evaluation of the patient’s level of psychological distress and adaptation skills; 4) a discussion about the patient’s expectations concerning an eventual psychological follow-up.

In this paper, the evaluation of this systematic consultation is performed. Therefore, the aim of the survey is to evaluate 1) the patients’ satisfaction one year after they have their systematic consultation; 2) the profile of the patients who begin a psychological follow-up during that year; 3) patients’ suggestions with regard to potential improvements for the systematic consultation¹.

Besides a primary role for the specialist physician in the psychological support of cancer patients [1] , which is due to his important place in the patients’ cancer treatment, a specific psycho-oncological intervention may also be of importance [22] . However, when this intervention is only suggested, only a part of the patients will ask for it. The aims of the study were two-fold: 1) to obtain a clearer insight on the needs for a psychological interview among breast cancer patients; 2) to assess which fraction of them will ask for a specific psycho-oncological follow-up. Up to now, psycho-oncological interventions have either been supportive clinical interviews, with no systematic questioning of the expectations of patients [19] , or totally structured interviews with systematic check-lists [20] . The first approach does not question systematically the patient’s needs. The second approach is too structured to allow patients to freely express their needs and expectations. Hence, in order to address these two issues, we have developed a psychological semi-structured interview that is systematically proposed to all inpatients during their stay for a breast cancer surgical intervention. In these interviews, patients can freely express their feelings about the type of support they expect from a psycho-oncological interview.

We analysed this first meeting, all patients are free to pursue a further psycho-oncological support and we analyse the psychosocial and medical factors that are related to that choice.

Several features can be highlighted from this first interview. Firstly, patients expect principally from the interview a support for emotional expression and for reassurance, an opportunity to express their fears and to obtain complementary medical information on illness and treatment. Secondly, we can also identify the factors that predicted the search for psychological support: Those who accept further psychological care after hospitalization are among the youngest of the population and most often have a job. It thus seems that the sudden lifestyle change after cancer diagnosis, for those who are active professionals motivates psychological support seeking. Thirdly, the burden of the disease, that is increased in situations such as invasive surgical treatment (mastectomy) or when radiotherapy or chemotherapy is necessary, does not influence the psychological follow-up. Fourthly, requests for counselling on how to communicate with children or other family members are also not a priority for asking for an intervention by the psychologist. We and others have observed that these types of requests usually must come in a second step, after remission of the disease [23] .

Furthermore, our survey shows that 28.8% of patients wish to consult a psychologist after the first consultation. These figures are in keeping with the data found in the literature. A research by Libert et al. (2006) in Belgium indicated that 78.8% of cancer patients wanted to be supported by medical specialists. Obtaining medical information and reassurance about vital prognosis of the disease motivates preferential search for medical support [1] . The support that physicians can provide has an important role in listening and discussing with their patients [24] . Furthermore, physicians are most often the only professionals to provide psychological care for patients [1] .

Therefore, what is the role of the psycho-oncologist? It is important to understand the specificity of the psychologist in oncological units. In most situations, members of the multidisciplinary team and especially physicians are usually sufficient to provide emotional support to patients. The psychologist will intervene in situations where patients expect to obtain the assurance of a support in case of difficulty to cope with the cancer evolution, when they look for more reassurance about their fears. The psychologist will also be expected to provide the opportunity to the patients to express their feelings about their cancer and its consequences/after- maths. However, the study also supports that mainly a category of patients will ask for this type of psychological support: patients that are young and still active professionally. We hypothesise that for this category of patients, the psychologist has an important role in the psycho-social reintegration after the remission of cancer, as previous studies have pointed out [23] [25] . In the case of metastatic patients, the therapeutic process is also important in the adaptation to successive bereavements [26] .

Like many studies, this survey has some limitations. Firstly, it was based on a questionnaire designed by ourselves, which was aimed at evaluating our services. The use of validated tools would be more appropriate. Secondly, the breast cancer population was studied, but we would suggest studying patients with various types of cancer, and including both genders in order to better represent the systematic interview. Furthermore, a prospective study would also permit a better assessment and give more reliable results than a retrospective study.

In oncology, physicians are most often the only professionals to provide psychological care for patients. However, multidisciplinary work is in full development, and the psycho-oncologist, as a part of this multidisciplinary team has an important role in the emotional support during treatment and the psychosocial reintegration after the remission of cancer. A systematic consultation with a psychologist at entry may potentially also decrease negative stereotypes toward psychological help, improve therapeutic alliance and help patients to cope with their cancer-related biopsychosocial needs.