© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
Listen to the Cancer.Net Podcast: Cancer and Anxiety, adapted from this content.
- Anxiety is a common, treatable side effect among people with cancer.
- It is important to talk with your health care team if you are experiencing symptoms of anxiety.
- The symptoms of anxiety may be managed with relaxation techniques, counseling, and medication.
- Getting involved in a support group may help relieve anxiety, as well.
Anxiety is defined as a feeling of unease or fear. It is a normal human experience that, in its healthiest form, 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.
Anxiety and cancer
Many people with cancer experience anxiety, with fears triggered by the uncertainties related to a cancer diagnosis. Fear of death is often a primary concern. Other common fears include potentially having the cancer return or spread after treatment, experiencing treatment side effects, losing control over future life decisions, becoming dependent on others, and having relationship dynamics change.
Symptoms of anxiety
The symptoms may be mild or severe, occurring in short episodes that end quickly (acute) or remaining over time (chronic). Some of the symptoms of anxiety may be similar to symptoms of depression, with differences in intensity and frequency.
Acute anxiety. If you have acute anxiety, you may frequently experience the following symptoms, which last 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
- Dizziness or lightheadedness
- Nausea, diarrhea, heartburn, or a change in appetite
- Abdominal pain
Chronic anxiety. If you have chronic anxiety, you may experience one or more of the following symptoms, which typically last for a longer time:
- Excessive worrying
- Muscle tension
- Insomnia (the inability to fall asleep or stay asleep)
- Difficulty concentrating
- Indecision (difficulty making decisions)
It is important to tell your doctor 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.
How anxiety affects cancer treatment
Like depression, anxiety may worsen the physical side effects caused by cancer. For example, fatigue caused by anxiety may heighten fatigue caused by cancer treatment. In addition, indecision caused by anxiety may affect a person’s ability to make choices about cancer treatments. Meanwhile, anxiety affects a person’s quality of life and undermines the emotional and physical strength often required to undergo treatment.
Medication and psychological treatments are available to help you manage your anxiety. Although it may be difficult 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 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)
- 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)
Counseling is another approach to treat anxiety. By talking with a trained professional, you may learn to respond to challenges and the associated emotions in healthy ways. Options include individual counseling, couples or family counseling, and group counseling.
You may also find that sharing your experience with others living with cancer helps reduce anxiety. Consider joining a support group, which often offers a sense of belonging that helps each person feel less alone and more understood. Similarly, involvement in community or spiritual activities may help reduce anxiety.
If your anxiety symptoms are severe, you may require medication. Frequently used medications include the following:
Benzodiazepines. These include alprazolam (Alprazolam Intensol, Niravam, Xanax, Xanax XR), clonazepam (Klonopin), and lorazepam (Ativan, Lorazepam Intensol), which act quickly in the body to relieve the symptoms of anxiety. Common side effects include drowsiness, loss of coordination, fatigue, and mental slowing or confusion. Talk with your doctor about long-term use of benzodiazepines because some people may develop a tolerance for or a dependence on the medication.
Selective serotonin reuptake inhibitors (SSRIs). These include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Rapiflex, Sarafem, Selfemra), paroxetine (Paxil, Paxil CR, Pexeva), and sertraline (Zoloft), which increase the level of serotonin available in the brain. Serotonin is a type of neurotransmitter, which is a chemical that travels between brain cells to communicate information Although some people experience improvement within a couple weeks of starting an SSRI, it often takes up to six to eight weeks for the medication to have its full effect. Side effects of SSRIs may include dry mouth (generally with paroxetine), nausea, insomnia, headache, and sexual dysfunction and are often avoided by starting at lower doses of the medication. (Your doctor will make the judgment on the best starting dose.)
Learn more about specific medications by searching drug databases.