Screening with a validated screening tool, assessment and referral to appropriate health professionals and/or organisations is required to meet the needs of individual women, their families and carers.

In addition to the common issues outlined in the Appendix, specific issues that may arise include:

• treatment-related side effects including loss of fertility, sexual dysfunction and menopause, which require sensitive discussion and possible referral to a clinician skilled in this area
• maintaining vaginal health, managing dryness, bleeding, stenosis, dyspareunia, atrophic vaginitis, fistulas and pain as well as prevention of treatment-induced vaginal stenosis through early referral to a specialist nurse or women’s health physiotherapist for advice
• comorbidities where treatment for depression is required
• coping with hair loss (refer to Look Good, Feel Better; see ’Resource List’)
• malnutrition risk as identified by a validated malnutrition screening tool or unintentional weight loss of greater than five per cent of usual body weight
• lower limb lymphoedema and lymphadenectomy, a common treatment side effect in women with gynaecological cancers (NBCC & NCCI 2003) that can restrict mobility (referral to a lymphoedema clinic or lymphoedema specialist may be needed)
• physical symptoms such as pain and fatigue
• bladder or bowel dysfunction, gastrointestinal or abdominal symptoms, which may need monitoring and assessment
• decline in mobility and/or functional status as a result of treatment (a referral to physiotherapist, occupational therapist or exercise physiologist may be needed)
• assistance with managing complex medication regimens, multiple medications, assessment of side effects and assistance with difficulties swallowing medications (referral to a pharmacist may be required)
• emotional and psychological issues such as body image concerns, fatigue, existential anxiety, treatment phobias, anxiety/depression, relationship or interpersonal problems and sexuality concerns and disclosure of past history of sexual abuse or trauma
• potential isolation from normal support networks, particularly for rural women who are staying away from home for treatment
• financial issues related to loss of income and additional expenses as a result of illness and/or treatment
• legal issues including advance care planning, appointing a power of attorney or enduring guardian, completing a will and making an insurance, superannuation or social security claim on the basis of terminal illness or permanent disability
• the need for appropriate information for Aboriginal and Torres Strait Islander women or women from culturally and linguistically diverse backgrounds.

The lead clinician should:

• discuss the treatment plan with the woman and carer, including the intent of treatment and expected outcomes, and provide a written plan
• provide the woman and carer with information on the possible side effects of treatment, self-management strategies and emergency contacts
• initiate a discussion regarding advance care planning with the woman and carer.

The lead clinician should:

• discuss with the general practitioner their role in symptom management, psychosocial care and referral to local services
• ensure regular and timely two-way communication regarding:
• the treatment plan, including intent and potential side effects
• supportive and palliative care requirements
• the woman’s prognosis and their understanding of this
• enrolment in research and/or clinical trials
• changes in treatment or medications
• recommendations from the multidisciplinary team.