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:

• management of physical symptoms including pain and fatigue
• bowel obstruction due to malignancy (patients should be aware of possible symptoms and advised to seek immediate medical assessment if symptomatic)
• bowel dysfunction, gastrointestinal or abdominal symptoms, which may need monitoring and assessment
• malnutrition risk as identified by a validated malnutrition screening tool or unintentional weight loss of greater than 5 per cent usual body weight
• loss of fertility, surgically or chemically induced menopause, and sexual dysfunction, such as vaginal dryness, dyspareunia, atrophic vaginitis and pain – theses require sensitive discussion and possible referral to a clinician with skills in the relevant area (Harris 2019); sexual dysfunction can be a long-term complication for many women, persisting throughout survivorship (Candy et al. 2016)
• early-onset menopause – the risk continues after chemotherapy and not only immediately following treatment, with ongoing assessment of the effects of surgical menopause required after surgery (symptoms associated with surgery/chemotherapy-induced menopause include night sweats, hot flushes, reduced libido, reduced bone density and more severe vasomotor symptoms compared with women who go through natural menopause)
• abdominal ascites, which may need active management
• chemotherapy-related toxicity (e.g. neuropathy and alopecia)
• lower limb lymphoedema if a lymphadenectomy has been performed, which can restrict mobility – referral to a physiotherapist or trained lymphoedema massage specialist may be appropriate
• 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.