The aims of this study were to assess agreement between Hospital Anxiety and Depression Scale (HADS) and patient self-reported levels of anxiety and depression; and to describe the proportion of patients who would like to be offered professional assistance for anxiety and/or depression. Patients waiting for radiation therapy treatment in one of four Australian metropolitan radiation oncology treatment centres completed a touch screen computer survey. Respondents answered questions regarding socio-demographics, disease characteristics, the HADS, and two single- item questions about their perceptions of their level of anxiety and depression. Respondents’ preferences for psychological support were also assessed. Weighted kappa was calculated in order to assess agreement between the HADS and patients’ perceived levels of anxiety and depression. The intended sample size was 300, and the survey was completed by 304 patients (71% of eligible patients). There was significant agreement between the HADS and patients self-reported single-item responses regarding anxiety and depression when comparing across normal, mild, moderate and severe levels (weighted κ = 0.5, 95% CI: 0.4-0.6, p < 0.0001). Twenty-two per cent of patients (95% CI: 18-27%) indicated that they would like to be offered psychosocial support for their current levels of anxiety and/or depression. Of these patients, moderate to severe anxiety and/or depression levels were identified in 27% (95% CI: 17-39%) according to HADS criteria, and 37% (95% CI: 26-50%) according to patient perceptions. The finding that over one fifth of cancer patients receiving radiotherapy expressed a desire to be offered professional support for their current levels of anxiety and depression suggests high need for psychosocial services for this patient group. Single item patient self-report screening questions may be useful for psychosocial screening in radiotherapy settings, however further examination of how patient self-reported levels of anxiety and depression compares to standardised clinical interview is warranted.