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:

• loss of fertility, surgically or chemically induced menopause, and sexual dysfunction (e.g. vaginal dryness, bleeding, stenosis, dyspareunia, atrophic vaginitis and pain) requires sensitive discussion and possible referral to a clinician with skills in the relevant area (Harris 2019)
• lower limb lymphoedema, which is a common side effect in women after complete pelvic lymphadenectomy – referral to a physiotherapist or a trained lymphoedema massage specialist may be appropriate
• bowel dysfunction, gastrointestinal or abdominal symptoms, which may require monitoring and assessment
• 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.