Anxiety Disorder and Cancer

by National Cancer Institute

This patient summary on anxiety is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Anxiety is a normal reaction to cancer, but it can interfere with a patient's quality of life and the ability to follow through with cancer therapy. This brief summary describes the causes and treatment of anxiety experienced by cancer patients. Anxiety that may arise after cancer therapy has been completed is also discussed in this summary.

Overview

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 his or her family's) quality of life. If left untreated, severe anxiety may even shorten a patient's life.

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. Most patients who have not had an anxiety condition before their cancer diagnosis will not develop an anxiety disorder associated with cancer.

Intense anxiety associated with cancer treatment is more likely to occur in patients with a history of anxiety disorders and patients who are experiencing anxiety 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 persons 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 often worry 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?

Anxiety disorder includes adjustment disorder, panic disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and anxiety disorder caused by other general medical conditions. Each of these is explained below.

Adjustment Disorder

Adjustment disorder includes behaviors or moods more extreme than expected in a reaction to a cancer diagnosis. Symptoms include severe nervousness, worry, jitteriness, and the inability to go to work, attend school, or be with other people. Adjustment disorder is more likely to occur in cancer patients during critical times of the disease. These include being tested for the disease, learning the diagnosis, and experiencing a relapse of the disease. Many cancer patients can achieve relief from adjustment disorder in several ways, including receiving reassurance from caregivers, exercising relaxation techniques, taking medication, and participating in support and education programs.

Panic Disorder

Patients with panic disorder experience intense anxiety. Patients may suffer shortness of breath, dizziness, rapid heart beat, trembling, profuse sweating, nausea, tingling sensations, or fears of "going crazy." Attacks may last for several minutes or several hours and are treated with medication. Symptoms of panic disorder may be very similar to other medical conditions.

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