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:

• body image in general and issues about feelings of masculinity, and concerns about developing breasts as a result of ADT – providing patients with tailored, accurate information prior to treatment, facilitating patient decision making about appearance-altering treatment, and meeting others with similar personal experiences may assist some men
• mood lability or depression as a result of ADT, which may benefit from referral to a psychologist or consideration of mood-stabilising medication
• erectile and ejaculation dysfunction and impotence as a result of treatment, which will require referral to a medical specialist and clinicians skilled in this area of counselling
• urinary dysfunction, including urinary incontinence, requiring pads, referral to a continence nurse and/or pelvic floor physiotherapist
• bowel dysfunction or rectal bleeding, which may require referral for endoscopic evaluation and dietitian review
• weight gain and fluid retention as a result of ADT, which may require referral to a dietitian and exercise physiologist for review
• fatigue and loss of muscle strength as a result of ADT – all patients on ADT benefit from referral to an exercise physiologist or physiotherapist for an individualised exercise program
• osteoporosis, which can be a delayed outcome of ADT – regular monitoring by a medical practitioner and a baseline bone mineral density may be required
• ‘hot flushes’ as a result of ADT – advice on reducing alcohol intake, avoiding hot drinks, undertaking regular exercise and relaxation may help
• 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.

Rehabilitation may be required at any point of the care pathway from the pre-treatment phase through to disease-free survival and palliative care (Cormie et al. 2017).

Issues that may need to be dealt with include managing cancer-related fatigue, coping with cognitive changes, improving physical endurance, achieving independence in daily tasks, returning to study or work and ongoing adjustment to cancer and its sequels.

Exercise is a safe and effective intervention that improves the physical and emotional health and wellbeing of cancer patients. Exercise should be embedded as part of standard practice in cancer care and be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment.

Cancer survivors may find referral to specific cancer rehabilitation, optimisation programs or community-based rehabilitation appropriate and beneficial. Other options include referral to allied health supports through team care arrangements and mental health plans. Some community support organisations (cancer-related non-government, not-for-profit and charities) provide services to cancer survivors.

The lead clinician (themselves or by delegation) should take responsibility for these tasks:

• explaining the model of post-treatment care and the roles of health professionals involved in post-treatment care including the role of general practice
• explaining the treatment summary and follow-up care plan
• discussing the development of a shared follow-up and survivorship care plan where a model of shared follow-up care has been agreed
• discussing how to manage any of the physical, psychological or emotional issues identified
• providing information on the signs and symptoms of recurrent disease
• providing a survivorship care plan with information on secondary prevention and healthy living
• providing contact details of the care team involved
• providing clear information about the role and benefits of palliative care and advance care planning

The lead clinician should ensure regular, timely, two-way communication with the general practitioner about:

• the patient’s progress
• the follow-up care plan
• potential late effects
• supportive and palliative care requirements
• any shared care arrangements
• clarification of various roles in patient care
• a process for rapid re-entry to medical services for patients with suspected recurrence or if there are other concerns.

Refer to Principle 6 ‘Communication’ for communication skills training programs and resources.