Anxiety Disorder and Cancer, Part 2

by National Cancer Institute

(Page 2 of 2)

Phobias

Phobias are ongoing fears about or avoidance of a situation or object. People with phobias usually experience intense anxiety and avoid situations that may frighten them. Cancer patients may fear needles. They may also fear small spaces and avoid having tests in confined spaces, such as magnetic resonance imaging (MRI) scans.

Obsessive-Compulsive Disorder

A person with obsessive-compulsive disorder has persistent thoughts, ideas, or images (obsessions) that are accompanied by repetitive behaviors (compulsions). Patients with obsessive-compulsive disorder may be unable to follow through with cancer treatment because they are disabled by thoughts and behaviors that interfere with their ability to function normally. Obsessive-compulsive disorder is treated with medication and psychotherapy. Obsessive-compulsive disorder is rare in patients with cancer who did not have the disorder before being diagnosed with cancer.

Post-Traumatic Stress Disorder

The diagnosis of cancer may cause a person who has previously experienced a life-threatening event to relive the trauma associated with that event. Patients with cancer who have post-traumatic stress disorder may experience extreme anxiety before surgery, chemotherapy, painful medical procedures, or bandage changes. Post-traumatic stress disorder is treated with psychotherapy.

Generalized Anxiety Disorder

Patients with generalized anxiety disorder may experience extreme and constant anxiety or unrealistic worry. For example, patients with supportive family and friends may fear that no one will care for them. Patients may worry that they cannot pay for their treatment, although they have adequate financial resources and insurance. Generalized anxiety disorder may happen after a patient has been very depressed. A person who has generalized anxiety may feel irritable or restless, have tense muscles, shortness of breath, heart palpitations, sweating, dizziness, and be easily fatigued. Anxiety Disorder Caused by Other General Medical Conditions

Patients with cancer may experience anxiety that is caused by other medical conditions. Patients who are experiencing severe pain feel anxious, and anxiety can increase pain. The sudden appearance of extreme anxiety may be a symptom of infection, pneumonia, or an imbalance in the body's chemistry. It may also occur before a heart attack or blood clot in the lung and be accompanied by chest pain or trouble breathing. A decrease in the amount of oxygen that the blood is able to carry may also make the patient feel as though he or she is suffocating; this can cause anxiety.

Anxiety is a direct or indirect side effect of some medications. Some medications can cause anxiety, while others may cause restlessness, agitation, depression, thoughts of suicide, irritability, or trembling.

Certain tumors may cause anxiety or produce symptoms that resemble anxiety and panic by creating chemical imbalances or shortness of breath.

Treatment

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, is usually controlled by treating the underlying cause.

Treatment for anxiety begins by giving the patient adequate information and support. Developing coping strategies such as the patient viewing his or her cancer from the perspective of a problem to be solved, obtaining enough information in order to fully understand his or her 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 (a method of early detection of the symptoms of anxiety in order to take preventative action). Medications may be used alone or in combination with these techniques. Patients 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.

Post-treatment Considerations

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 due to 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.

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