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:

• emotional distress arising from fear of disease recurrence, changes in body image, returning to work, anxiety/depression, interpersonal problems and sexuality concerns
• disabling symptoms – patients may benefit from a referral to psychological services
• treating underlying chronic liver disease (e.g. anti-viral therapy and variceal screening)
• managing physical symptoms including pain, weight loss and fatigue
• treating alcohol dependence
• managing drug dependence
• nutrition screening and support
• financial and employment issues (e.g. 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.