Improving the recognition of concerns and affective disorders in cancer patients.

Up to one third of patients with cancer will develop an affective disorder (generalised anxiety disorder, major depressive illness or an adjustment disorder) [1–5] regardless of disease stage [6, 7]. Key psychological factors include the following: difficulties patients have in coming to terms with the inherent uncertainty of their prognosis; a lack of practical or psychological support from relatives, friends and health professionals; the stigma associated with a cancer diagnosis and failure to find an adequate explanation for the development of the illness [8]. Treatment related factors include the development of body image problems, sexual difficulties and adverse effects of chemotherapy. Female gender and a past history of affective disorder are key vulnerability factors.