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, which may require support:

• access to expert health professionals with specific knowledge about the psychosocial needs of breast cancer patients
• family distress if familial cancer pathogenic variant is identified
• weight changes, which may be a significant issue for patients and may require referral to a dietitian
• menopause symptoms, which may require referral to a menopause clinic
• general healthcare issues (e.g. smoking cessation and sleep disturbance), which can be referred to a general practitioner
• management of physical symptoms such as pain, arthralgia and fatigue
• decline in mobility and/or functional status as a result of treatment, which may necessitate a referral to physiotherapy or occupational therapy
• upper limb and breast lymphoedema following lymphadenectomy/radiation therapy, which is a potential treatment side effect in patients with breast cancer that has a significant effect on survivor quality of life – referral to a health professional with accredited lymphoedema management qualifications, offering the full scope of complex lymphoedema therapy, may be needed
• bowel dysfunction, gastrointestinal or abdominal symptoms as a result of treatment, which may require support from a dietitian
• neuropathy, cardiac dysfunction, nausea and vomiting (managing these issues is important for improving quality of life)
• coping with hair loss (refer to the Look Good, Feel Better program; see ’Resource List’ and/or consider scalp cooling)
• managing complex medication regimens, multiple medications, assessment of side effects and assistance with difficulties swallowing medications, which may require referral to a pharmacist
• 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.