Psychological Impact of Urologic Cancer.

All involved in the therapeutic alliance feel stress: the patient, the family, and the care giver. Uncertainty breeds anxiety. Distress is minimized when all concerned have a shared, clear understanding of therapeutic goals and when emphasis is focused on what can be done. Openness concerning diagnosis and prognosis demands sustained and supportive follow-up. A shifting balance between denial and integration of reality usually exists. Irrespective of outcome, the patient and family cope with loss and uncertainty. In the presence of progressive illness, repeated losses compound the adjustment problem. Anticipated disfigurement due to radical surgery, alterations in body image particularly where sexual function is concerned, the necessity of urinary or fecal diversion, and side effects of therapy all require careful psychological preparation. Staff burnout may be minimized by attention to staff selection, training, supervision, support and communication. The bereaved constitute a high-risk population. Even a simple follow-up program may help them to adjust to their loss.