Anxiety

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

Listen to the Cancer.Net Podcast: Cancer and Anxiety, adapted from this content.

Key Messages

  • Anxiety may occur among people with cancer.
  • Your doctor may periodically ask you questions about your mood during and after cancer treatment to evaluate your risk for anxiety and to find out if you have any symptoms of anxiety.
  • It is important to talk with your health care team if you are experiencing symptoms of anxiety at any point in between your regular appointments.
  • The symptoms of anxiety may be managed using therapy, relaxation techniques, or medication.

Anxiety and cancer

Anxiety is defined as feeling nervous, on edge, or worried much of the time. Anxiety is a normal human emotion that alerts your body to respond to a threat. However, intense and prolonged anxiety is a disorder that may interfere with your daily activities and relationships.

Many people with cancer experience symptoms of anxiety, with fears triggered by the uncertainties of a cancer diagnosis. Fear of death from the cancer may be a concern. Other fears may include having the cancer return or spread after treatment, anxiety about receiving treatment or experiencing treatment-related side effects, losing control over future life decisions, becoming dependent on others, and the possibility of changes in your relationships with family and friends.

A person’s symptoms of anxiety may worsen the physical side effects caused by cancer. For example, fatigue caused by anxiety may heighten fatigue caused by cancer treatment.  Or, worry caused by anxiety may affect a person’s ability to make choices about cancer treatments. Anxiety also affects a person’s other emotions and quality of life.

Symptoms of anxiety

The symptoms may be mild or severe, occurring in short episodes that end quickly (acute anxiety) or remain over time (chronic anxiety). Some of the symptoms of anxiety may be similar to symptoms of depression, with differences in intensity and frequency.

Acute anxiety. With acute anxiety you may frequently experience the following symptoms for a short time:

  • A feeling of intense fear or dread
  • A feeling of detachment from yourself or your surroundings
  • Heart palpitations or rapid heartbeat
  • High blood pressure
  • Chest pain
  • Shortness of breath
  • A feeling of suffocation
  • Sweating
  • Chills
  • Dizziness or lightheadedness
  • Trembling
  • Nausea, diarrhea, heartburn, or a change in appetite
  • Abdominal pain

Chronic anxiety. With chronic anxiety you may experience the above symptoms, in addition to one or more of the following symptoms, which typically last for a longer time:

  • Excessive worrying
  • Restlessness
  • Muscle tension
  • Insomnia (the inability to fall asleep or stay asleep)
  • Irritability
  • Fatigue
  • Difficulty concentrating
  • Indecision (difficulty making decisions)

It is important to tell your doctor or another member of your health care team if you experience any of these symptoms. However, such symptoms are not necessarily related to anxiety; some may instead be side effects of the cancer or cancer treatment (for example fatigue, insomnia, difficulty concentrating).

Screening for anxiety

The American Society of Clinical Oncology (ASCO) recommends you receive an evaluation for anxiety when you are first diagnosed with cancer and at regular periods during your treatment and recovery. This evaluation is part of a comprehensive screening called distress screening that evaluates your emotional health and quality of life. As part of this screening, your doctor will likely ask you how often you experience the following thoughts, feelings, or physical symptoms:

  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying
  • Worrying too much about different things
  • Trouble relaxing
  • Being so restless that it is hard to sit still
  • Becoming easily annoyed or irritable
  • Feeling afraid that something awful will happen

Depending on how many of the above symptoms you have and how often you experience them, your doctor may refer you to supportive care services available at your institution, group therapy, or a mental health professional, such as a licensed counselor, psychologist, or psychiatrist. Learn more about counseling.

Treating anxiety

Medication and psychological treatments are available to help you manage your anxiety. Although it may be difficult to explain the sense of dread or fear you feel, it is important to be open with your health care team about your feelings, specific sources of your fears, physical symptoms you experience, and the effect on your daily life. This will help them address your concerns and identify appropriate techniques or treatments to help lower your anxiety.

Relaxation techniques. Relaxation techniques may be used alone or may supplement other types of treatment, such as counseling or medication, to help control the symptoms of anxiety. Some of the following methods may be done with minimal guidance, while others may require the help of an instructor.

  • Deep breathing
  • Progressive muscle relaxation (a technique that involves tightening and then relaxing muscles, starting at either the toes or the head and progressively relaxing all the muscles across the body)
  • Guided imagery (the use of words and sounds to help you imagine positive settings, experiences, and feelings)
  • Meditation (a practice of focusing attention in one direction to achieve a sense of grounding in the present moment and reduce stress)
  • Hypnosis
  • Biofeedback (the use of the mind to control a response from the body, such as heart rate, by paying attention to signals from the body that are measured with electrodes, which are painless electrical sensors)
  • Yoga (the use of breathing and posture exercises to promote relaxation)

Psychological Treatment. This is another approach used to treat anxiety. By talking with a trained professional, you may learn to respond to challenges of feeling anxious or constantly worrying. Options include individual therapy, couples or family therapy, and group therapy.

Medication. If your anxiety symptoms are moderate to severe, you may benefit from medication. There are different types of medications available. Your doctor will select the most appropriate medication based on potential side effects, your needs, current medications, and medical history. Tell your doctor about all the cancer-related medications and supplements you are taking because they may interfere with some types of anti-anxiety medications.

Follow-up

After a referral to a counselor, psychiatrist, or psychologist, your oncologist will likely follow-up with you about your treatment for anxiety to gauge your satisfaction with your care and address any concerns about side effects of medications. Talk with your doctor to discuss other treatment and additional support options if your anxiety symptoms have not decreased after eight weeks, or the length of time that you and your doctor decide is appropriate.

More Information

Coping and Emotions

Managing Stress

Coping With Uncertainty

Side Effects

American Society of Clinical Oncology Clinical Practice Guideline: Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults with Cancer

Additional Resources

CancerCare: Counseling

National Cancer Institute: Anxiety and Distress