Patients who have the following symptoms may be experiencing a specific anxiety disorder that was present before they became ill with cancer and that recurs because of the stress of the diagnosis and treatment: intense fear, the inability to absorb information, or the inability to cooperate with medical procedures. Somatic symptoms include shortness of breath, sweating, lightheadedness, and palpitations. Patients with cancer can present with the following anxiety disorders: adjustment disorder, panic disorder, phobias, obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, or anxiety disorder that is caused by other general medical conditions. These patients are generally distressed about their symptoms and are usually compliant with behavioral and psychopharmacologic intervention.
Adjustment disorder is diagnosed in patients who experience maladaptive behaviors and/or moods in response to an identified stressor. The maladaptive behaviors or moods include severe nervousness, worry, jitteriness, and impairment in normal functioning, such as the inability to work, attend school, or interact with others. These symptoms are in excess of normal reactions to cancer and occur within 6 months of the stressor event; however, this determination can be complicated in the patient with cancer, where the stressor is ongoing. Patients diagnosed with an adjustment disorder generally do not have a history of other psychiatric disorders. Patients with other chronic disorders, however, are likely to have had adjustment problems earlier in life that will recur in the cancer setting. Adjustment disorder is prevalent among cancer patients, particularly at critical times such as at diagnostic work-up, diagnosis, or relapse. Most patients with adjustment disorder respond to reassurance, relaxation techniques, low doses of short-acting benzodiazepines, and patient support and education programs.[2,3] (Refer to the PDQ Summary on Adjustment to Cancer: Anxiety and Distress for more information.)
In panic disorder, intense anxiety is the predominant symptom. Severe somatic symptoms can also be present. These include shortness of breath, dizziness, palpitations, trembling, diaphoresis, nausea, tingling sensations, or fears of going crazy. Attacks or discrete periods of intense discomfort can last for several minutes or for hours. Patients with panic attacks often present with symptoms that can be difficult to differentiate from other medical disorders, though a known history of panic disorder can help clarify the diagnosis. Panic disorder in patients with cancer is most often managed with benzodiazepines and antidepressant medications.
Phobias are persistent fears or avoidance of a circumscribed object or situation. People with phobias usually experience intense anxiety and avoid potentially frightening situations. Phobias are experienced by cancer patients in a number of ways, such as fear of witnessing blood or tissue injury (also known as needle phobia) or claustrophobia (for example, during a magnetic resonance imaging scan). Phobias can complicate medical procedures and can result in the refusal of necessary medical intervention or tests.