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
• cognitive changes as a result of treatment (e.g. altered memory, attention and concentration)
• nutritional assessment and support:
  • Malnutrition due to ongoing treatment side effects (including weight loss, reduced oral intake and cachexia) is common and requires monitoring and nutrition intervention from a dietitian.
  • Patients requiring oral nutrition support or enteral feeding, or patients with a stent, should receive support from dietitians with expertise in managing these interventions before, during and after treatment.
  • GI symptoms (including vomiting, mucositis, reflux and early satiety), difficulty swallowing and decrease in appetite require optimal symptom control.
• management of physical symptoms such as pain or dysphagia (treating specialists should reassess)
• decline in mobility or functional status as a result of treatment (referral to an occupational therapist may be required)
• a need for increased community supports as the patient recovers from treatment
• 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.