Anxiety occurs to varying degrees in patients with cancer and may increase as the disease progresses or as treatment becomes more aggressive. Investigators have found that 44% of patients with cancer reported some anxiety, and 23% reported significant anxiety.[2,3]
Anxiety can be part of normal adaptation to cancer. In most cases, the reactions are time limited and may motivate patients and families to take steps to reduce anxiety (e.g., gain information), which may assist in adjusting to the illness. However, as discussed above, anxiety reactions that are more prolonged or intense are classified as adjustment disorders. These disorders can negatively affect quality of life and interfere with a cancer patient's ability to function socially and emotionally. These anxiety reactions require intervention. Anxiety disorders may also be secondary to other aspects of the medical condition, such as uncontrolled pain, certain metabolic states, or medication side effects.
Other specific anxiety disorders-such as generalized anxiety, phobia, or panic disorder-are not as common among cancer patients and usually predate the cancer diagnosis, but deserve further attention to facilitate cancer care. The stress caused by a diagnosis of cancer and its treatment may precipitate a relapse of pre-existing anxiety disorders. These disorders can be disabling and can interfere with treatment. They require prompt diagnosis and effective management.
Factors that can increase the likelihood of developing anxiety disorders during cancer treatment include the following:
- History of anxiety disorders.
- Severe pain.
- Anxiety at time of diagnosis.
- Functional limitations.
- Lack of social support.
- Advancing disease.
- History of trauma.[1,7]
Some medical conditions and interventions are associated with symptoms that present as anxiety disorders, including central nervous system metastases, dyspnea associated with lung cancer, and treatment with corticosteroids and other medications. A patient's experience with cancer or other illnesses may reactivate associations and memories of previous illness and contribute to acute anxiety. Certain demographic factors, such as being female and developing cancer at a young age, are associated with increased anxiety in medical situations.[2,8] Patients who have problems communicating with their families, friends, and physicians are also more at risk of developing anxiety.
Anxiety, on the other hand, can lead to overestimation of negative prognosis. A longitudinal study of women with ductal carcinoma in situ (N = 487) found that anxiety as measured by the Hospital Anxiety and Depression Scale was the factor that was most consistently and strongly associated with inaccurate perception of and overestimation of future breast cancer-related risks.
In the patient with advanced disease, anxiety is often not caused by the fear of death but by the issues of uncontrolled pain, isolation, abandonment, and dependency. Many of these factors can be managed when adequately assessed and properly treated.