See validated screening tools mentioned in Principle 4 ‘Supportive care’. Additionally, the ‘Cancer Survivors Unmet Needs (CaSun)’ is another validated screening tool that may help health professionals to identify the unmet needs of patients during survivorship.

A number of specific challenges and needs may arise for cancer survivors:

• endocrine effects (gonadal), cardiac effects, osteoporosis, transfusional iron overload and secondary myelodysplasia in the late stages of therapy
• malnutrition due to ongoing treatment side effects, such as gastrointestinal symptoms, reduced appetite and reduced oral intake; this requires monitoring and nutrition intervention where indicated
• financial and employment issues (such as loss of income and assistance with returning to work, and the cost of treatment, travel and accommodation)
• appointing a substitute decision-maker and completing an advance care directive
• legal issues such as completing a will.

For more information on supportive care and needs that may arise for different population groups, see Appendices A and B, and special population groups.