Anxiety Disorder (PDQ®)
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.
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.
Patients are more likely to develop anxiety during cancer treatment if they have any of the following conditions:
- A history of anxiety disorders.
- Severe pain.
- Anxiety at the time of diagnosis.
- Physical disabilities.
- Few family members or friends to care for them.
- Cancer that is not responding to treatment.
- A history of physical or emotional trauma.
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 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.
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.
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.
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.
See the following PDQ summaries for more information:
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.
Studies show that antidepressants are effective in the treatment of anxiety disorders. Children and adolescents being treated with antidepressants, however, have an increased risk of suicidal thinking and behavior. See the Treatment section of the PDQ summary on Depression for more information.
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.
See the following PDQ summaries for more information: