Medically Reviewed by Dr. K on 28 April 2021
Anxiety is a normal reaction to cancer. When undergoing a cancer screening test, waiting for test results, receiving a cancer diagnosis, undergoing cancer treatment, or awaiting a cancer recurrence, one may experience anxiety. Anxiety-related to cancer may intensify discomfort, make it more difficult to sleep, induce nausea and vomiting, and negatively impact the patient’s (and their family’s) quality of life. Normal anxiety may need its own medication if it leads to abnormally high distress, becomes incapacitating, or requires excessive fear or concern. In that case, anxiety can also be linked to a lower cancer survival rate if left untreated.
Anxiety levels in cancer patients may rise and fall at various periods. As the cancer spreads or the treatment becomes more intensive, the patient may become more anxious. The level of anxiety felt by one person with cancer can vary from that of another person with cancer. The majority of patients will relieve their anxiety by learning more about their cancer and the treatment options available to them. Anxiety may become overwhelming for some patients, especially those who have had periods of intense anxiety prior to their cancer diagnosis. This may make cancer treatment challenging.
Patients with a history of anxiety disorders or depression, as well as others who are experiencing these symptoms at the moment of diagnosis, are more likely to experience intense anxiety associated with cancer treatment. Patients experiencing severe pain, those that are disabled, those who have few friends or family members who care about them, those that have cancer that is not reacting to treatment, and those who have a background of severe physical or emotional trauma may also suffer anxiety. Physical complications caused by central nervous system metastases and lung tumors may induce anxiety. Anxiety may be worsened with certain cancer medications and treatments.
Patients of advanced cancer, contrary to popular belief, are more likely to be anxious because they are afraid of uncontrolled pain, becoming isolated, or being dependent on others, rather than fear of death. Many of these problems may be resolved through treatment.
Description and Cause
Some patients might have also dealt with severe anxiety as a result of circumstances unrelated to their cancer. The stress of a cancer diagnosis can cause these anxiety conditions to recur or intensify. Patients may be frightened, unable to comprehend knowledge provided to them by caregivers, or unable to carry through with treatment. A doctor may ask the following questions about a patient’s symptoms in order to prepare treatment for anxiety:
- Have you had any of the following signs after being diagnosed with cancer or receiving treatment for it? When and for how long do these symptoms occur (i.e., how many days prior to treatment, at night, or at no particular time)?
- 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?
- Do you have a fear of dying in your sleep if you close your eyes at night?
- Do you get anxious for the upcoming diagnostic test or the results 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 have concerns over getting the next dosage of pain medication on time?
- Do you stay in bed longer than you should because you’re worried the pain will worsen if you get up and walk around?
- Have you been confused or disoriented lately?
Adjustment disorder, panic disorder, phobias, generalized anxiety disorder, and anxiety disorder triggered by some general medical conditions are also forms of anxiety disorders.
It may be challenging to tell the difference between typical cancer-related concerns and abnormally extreme fears that are known as anxiety disorders. Treatment is determined by how the patient’s anxiety affects their everyday life. Anxiety induced by pain or another medical condition, a specific type of tumor, or a medication side effect (such as steroids) is normally controlled by treating the underlying causes. It’s also beneficial to have your psychiatrists work with your oncologist to diagnose an anxiety disorder if one exists, or to figure out what chemotherapy or other medications are triggering anxiety symptoms, and to come up with options to handle the side effects.
Giving the patient enough knowledge and guidance is the first step toward treating anxiety. Developing coping mechanisms such as seeing cancer as a challenge to be overcome, gathering more knowledge to fully comprehend their disease and treatment options, and using available resources and support systems can help to alleviate anxiety. Psychotherapy, group therapy, family therapy, participation in self-help groups, hypnosis, and relaxation techniques such as guided imagery (a type of focused concentration on mental images to aid in stress management) or biofeedback can be beneficial to patients. Medications can be taken on their own or in accordance with these techniques. Patients should not stop taking anti-anxiety medications out of fear of being addicted. Their doctors will prescribe just enough medication to relieve the symptoms, and gradually reduce the dosage as the symptoms decrease.
A cancer survivor may experience new anxieties after completing cancer treatment. When survivors return to work and are questioned about their cancer experience, or when faced with insurance-related issues, they may feel anxious. A survivor might be afraid of any follow-up exams and diagnostic tests, as well as a cancer recurrence. Changes in body appearance, sexual dysfunction, reproductive issues, and post-traumatic stress may also cause anxiety in survivors. To assist patients in readjusting to life after cancer, survivorship programs, support groups, counseling, and other services are accessible.
Referenced on 27/4/2021
- Some of the above information has been provided with the kind permission of the National Cancer Institute (https://www.cancer.gov).
- Anxiety. (2020).
- Anxiety and panic attacks: What are anxiety disorders? (2017).
- Blanton C. (2020). Coping with emotions when you have lung cancer.
- Mitchell AJ, et al. (2013). Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: A systematic review and meta-analysis.
- NCI Staff. (2020). Helping cancer survivors cope with cancer-related anxiety and distress.