Screening using a validated screening tool, assessment and referral to appropriate health professionals and community-based support services 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
• physiotherapist or trained lymphoedema massage specialist may be needed) (Beesley et al. 2007)
• physical symptoms including pain and fatigue
• bladder or bowel dysfunction, gastrointestinal or abdominal symptoms, which may need monitoring and assessment
• bowel obstruction due to malignancy (women need to be alerted to possible symptoms and advised to seek immediate medical assessment)
• decline in mobility and/or functional status as a result of treatment (a referral to physiotherapy and occupational therapy may be needed)
• emotional distress arising from fear of disease recurrence, changes in body image, returning to work, anxiety/depression, relationship or interpersonal problems and sexuality concerns
• potential isolation from normal support networks, particularly for rural women who are staying away from home for treatment
• abdominal ascites (abdominal symptoms need monitoring and assessment)
• cognitive changes as a result of treatment (such as altered memory, attention and concentration)
• financial and employment issues (such as loss of income and assistance with returning to work, and cost of treatment, travel and accommodation)
• 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 women from culturally and linguistically diverse backgrounds.