Information for healthcare professionals

About the CLEAR service

The service supports patients who have received radiotherapy for prostate, bladder, colorectal and gynaecological cancers and are experiencing ongoing symptoms that may affect their physical, psychological or social wellbeing. 

Common presentations include bowel dysfunction, urinary symptoms, sexual dysfunction, lymphodema, fatigue, pelvic pain and other treatment related late effects.

CLEAR delivers comprehensive, patient-centred assessment and evidence-based management in line with national guidance and best practice pathways for pelvic radiation disease. 

Patients receive individualised care plans, appropriate investigations, symptom management and referral to specialist services where required.

The service was developed through a co-design process involving patients, clinicians and researchers, ensuring that care is responsive to the needs and priorities of people living with the long-term effects of cancer treatment.

Key aims of the service include

• Early identification and assessment of radiotherapy-related late effects

• Optimisation of symptom management and quality of life

• Improved access to specialist support and rehabilitation services

• Reduction in avoidable healthcare utilisation through coordinated care

• Supporting patients to self-manage where appropriate and achieve their individual goals

Healthcare professionals who identify patients experiencing persistent or progressive symptoms following pelvic radiotherapy are encouraged to discuss referral to the CLEAR service.

FAQs for healthcare professionals

Who can be referred to the CLEAR service?

Patients who have received radical or adjuvant pelvic radiotherapy and are experiencing ongoing symptoms that may be related to their cancer treatment.

Common issues include bowel, bladder, sexual, lymphoedema, fatigue and psychosocial concerns.

How long after radiotherapy can patients be referred?

Patients can be referred three months or more after completing radiotherapy.

Symptoms may develop months or even years after treatment, and patients can benefit from specialist assessment and support regardless of when their symptoms first occur.

What symptoms are appropriate for referral?

Referrals are appropriate for patients experiencing persistent or late-onset symptoms that may be related to pelvic radiotherapy, including:

• Bowel dysfunction
• Urinary symptoms
• Sexual difficulties
• Pelvic pain
• Lymphoedema
• Fatigue
• Psychological or emotional impact of treatment
• Complex survivorship needs

What does the CLEAR service provide?

The service offers comprehensive assessment, evidence-based management, personalised care planning, and referral to other specialist services where required. The aim is to improve quality of life and support long-term recovery following cancer treatment.

Does the service replace oncology follow-up

No. CLEAR complements routine oncology follow-up by providing specialist assessment and management of treatment-related late effects. Patients remain under the care of their oncology team as appropriate.

Can primary care refer directly?

We ask that referrals are made via the patient’s consultant clinical oncologist or oncology team.

This ensures that recurrence or disease progression has been excluded and that the patient’s symptoms are appropriate for specialist late effects assessment.

Healthcare professionals who are unsure whether a referral is suitable are welcome to contact the CLEAR team for advice.

Is the service only for patients with severe symptoms?

No. Early assessment may help prevent symptoms from becoming more problematic. Patients can be referred for mild, moderate or severe symptoms if they are affecting quality of life.