Anxiety is a normal reaction to cancer. One may experience anxiety while undergoing a cancer screening test, waiting for test results, receiving a diagnosis of cancer, undergoing cancer treatment, or anticipating a recurrence of cancer. Anxiety associated with cancer may increase feelings of pain, interfere with one's ability to sleep, cause nausea and vomiting, and interfere with the patient's (and their family's) quality of life. If normal anxiety gives way to abnormally high distress, becomes incapacitating, or involves excessive fear or worry, it may warrant its own treatment. In that instance, If left untreated, anxiety may even be associated with lower survival rates from cancer.
Persons with cancer will find that their feelings of anxiety increase or decrease at different times. A patient may become more anxious as cancer spreads or treatment becomes more intense. The level of anxiety experienced by one person with cancer may differ from the anxiety experienced by another person. Most patients are able to reduce their anxiety by learning more about their cancer and the treatment they can expect to receive. For some patients, particularly those who have experienced episodes of intense anxiety before their cancer diagnosis, feelings of anxiety may become overwhelming and interfere with cancer treatment.
Intense anxiety associated with cancer treatment is more likely to occur in patients with a history of anxiety disorders or depression, and patients who are experiencing these conditions at the time of diagnosis. Anxiety may also be experienced by patients who are in severe pain, are disabled, have few friends or family members to care for them, have cancer that is not responding to treatment, or have a history of severe physical or emotional trauma. Central nervous system metastases and tumors in the lungs may create physical problems that cause anxiety. Many cancer medications and treatments can aggravate feelings of anxiety.
Contrary to what one might expect, patients with advanced cancer experience anxiety due not to fear of death, but more often from fear of uncontrolled pain, being left alone, or dependency on others. Many of these factors can be alleviated with treatment.
Description and Cause
Some people may have already experienced intense anxiety in their life because of situations unrelated to their cancer. These anxiety conditions may recur or become aggravated by the stress of a cancer diagnosis. Patients may experience extreme fear, be unable to absorb information given to them by caregivers, or be unable to follow through with treatment. In order to plan treatment for a patient's anxiety, a doctor may ask the following questions about the patient's symptoms:
- Have you had any of the following symptoms since your cancer diagnosis or treatment? When do these symptoms occur (i.e., how many days prior to treatment, at night, or at no specific time) and how long do they last?
- Do you feel shaky, jittery, or nervous?
- Have you felt tense, fearful, or apprehensive?
- Have you had to avoid certain places or activities because of fear?
- Have you felt your heart pounding or racing?
- Have you had trouble catching your breath when nervous?
- Have you had any unjustified sweating or trembling?
- Have you felt a knot in your stomach?
- Have you felt like you have a lump in your throat?
- Do you find yourself pacing?
- Are you afraid to close your eyes at night for fear that you may die in your sleep?
- Do you worry about the next diagnostic test, or the results of it, weeks in advance?
- Have you suddenly had a fear of losing control or going crazy?
- Have you suddenly had a fear of dying?
- Do you worry often about when your pain will return and how bad it will get?
- Do you worry about whether you will be able to get your next dose of pain medication on time?
- Do you spend more time in bed than you should because you are afraid that the pain will intensify if you stand up or move about?
- Have you been confused or disoriented lately?
It may be difficult to distinguish between normal fears associated with cancer and abnormally severe fears that can be classified as an anxiety disorder. Treatment depends on how the anxiety is affecting daily life for the patient. Anxiety that is caused by pain or another medical condition, a specific type of tumor, or as a side effect of medication (such as steroids), is usually controlled by treating the underlying cause. It is often helpful to have a psychiatrist collaborate with your oncologist to diagnose an anxiety disorder if it is present, or help to determine whether chemotherapy or other medicines may be causing anxiety symptoms, and coming up with ways to manage the side effects.
Treatment for anxiety begins by giving the patient adequate information and support. Developing coping strategies such as the patient viewing their cancer from the perspective of a problem to be solved, obtaining enough information in order to fully understand their disease and treatment options, and utilizing available resources and support systems, can help to relieve anxiety. Patients may benefit from other treatment options for anxiety, including: psychotherapy, group therapy, family therapy, participating in self-help groups, hypnosis, and relaxation techniques such as guided imagery (a form of focused concentration on mental images to assist in stress management), or biofeedback. Medications may be used alone or in combination with these techniques. Patients generally should not avoid anxiety-relieving medications for fear of becoming addicted. Their doctors will give them sufficient medication to alleviate the symptoms and decrease the amount of the drug as the symptoms diminish.
After cancer therapy has been completed, a cancer survivor may be faced with new anxieties. Survivors may experience anxiety when they return to work and are asked about their cancer experience, or when confronted with insurance-related problems. A survivor may fear subsequent follow-up examinations and diagnostic tests, or they may fear a recurrence of cancer. Survivors may experience anxiety because of changes in body image, sexual dysfunction, reproductive issues, or post-traumatic stress. Survivorship programs, support groups, counseling, and other resources are available to help people readjust to life after cancer.