Life after urological cancer - psychological issues

About half of patients treated for urological cancer will experience some degree of psychological distress and about a quarter have some degree of depression at some time in their illness. Patients with prostate cancer have lower levels of anxiety and depression compared to some other cancers. Psychological symptoms may be overshadowed by physical symptoms. However, useful clinical screening tests include the simple question “are you feeling down, depressed or hopeless?” and questions about sleep disturbance may identify depressed patients. The diagnosis of anxiety and depression may be helped by screening tools such as the Hospital Anxiety and Depression Scale (HADS) but we have found simple analogue scales (the Emotion Thermometers) much less laborious to use and equally accurate. Fatigue is one of the most common symptoms amongst cancer patients and can be worsened by radiotherapy and the use of androgen deprivation therapy (ADT). Fatigue is associated with depression in about half of patients. Graded aerobic exercise programmes should be considered for patients suffering from fatigue rather than the classical advice of rest, which could be detrimental. Minor degrees of cognitive dysfunction particularly reduction in immediate and working memory are common in men treated with ADT and occasionally can be severe. Recognition and treatment of distress, anxiety and depression can markedly improve the quality of life in patients treated for urological cancer.