Sheila Lahijani, MD, is an associate clinical professor of psychiatry and behavioral sciences at the Stanford University School of Medicine. She is also the medical director of the Stanford Cancer Center Psychosocial Oncology Program and serves as a physician at Stanford Hospital and Clinics. Dr. Lahijani teaches and supervises residents, faculty, and staff in internal medicine, hematology/oncology, neurology, and psychiatry. Dr. Lahijani's interests include psychotherapy for the medically ill, psychopharmacology, and neuropsychiatric consequences of cancer treatment.
Anxiety can be a normal part of life, including for people with cancer. Anxiety may be associated with a distressing situation, an important decision, or a difficult circumstance. In general, it is a feeling of worry or fear that is temporary. The Latin root of anxiety is “angor,” which means to constrict. Being “constricted” causes someone to feel heavier and less free, or to experience more limitations. Keeping this in mind, it is easy to see how uncomfortable anxiety can be for someone who is diagnosed with cancer and is receiving cancer care.
There are often medical causes of anxiety related to cancer and its treatment that need to be evaluated when someone with cancer is suffering from anxiety. Therefore, it is important to never dismiss a sensation or a thought as “just anxiety.” It is important to determine what it is related to and what can be done to help manage it.
How anxiety affects people with cancer
Anxiety can be experienced not only through thoughts, emotions, and behaviors, but also through physical symptoms. When there is a perceived sense of danger or a threat, a person’s brain sends messages to the rest of the nervous system. Different parts of the body receive these signals, including the heart, lungs, intestines, and muscles. Symptoms like sweating, nausea, chest pain, heart palpitations, shortness of breath, diarrhea, and pain can all be signs of anxiety and should be discussed with your doctor right away. These symptoms can be separate from or add to the effects of cancer or its treatment.
People with cancer who are anxious may have significant problems with sleep, energy levels, appetite, and concentration. They may also feel more down or be less engaged in their daily activities. While anxiety symptoms and disorders are common in people with cancer, they can sometimes be difficult to diagnose because people are all different, as are the different kinds of cancer and cancer treatments
There are also cultural components to how anxiety is expressed. Anxiety in certain cultures can present primarily as a physical symptom, such as a headache, or it can appear as a change in behavior, such as not participating in a routine activity. Therefore, it is important for people with cancer, caregivers, and their doctors to discuss the cultural contexts of anxiety when evaluating their symptoms.
The positive purpose of anxiety in people with cancer
What usually does not receive attention is that anxiety can serve a purpose. Often, anxiety can motivate people, help people advocate for themselves, and help people focus on problem-solving techniques. So, people with cancer can actually use the experience of anxiety to be more involved in their treatment plans, be more physically active, or seek out care from supportive care specialists.
Anxiety, fear, and avoidance can also be adaptive responses to distressing situations. Adaptive responses can help you manage your emotions in certain situations, like when you are anticipating or undergoing cancer treatment, experiencing side effects, waiting for test results, receiving bad news, or even receiving good news. So, not all anxiety is “constricting.” Rather, anxiety can help someone deal with a distressing situation at hand and allow them to focus on what is going on in any given moment.
Coping with anxiety during cancer
For people with cancer and their loved ones, worrying may be a way of feeling like you have more control. However, worrying does not prevent negative possibilities from becoming true. Being anxious can also cause more health problems and disruptions in relationships, work, and finances. Therefore, it is important to think about how experiencing anxiety can help you focus on what you care about most. After all, being anxious in general means you care about something or someone. You care about living and surviving cancer. Being anxious means something.
Identifying why you are anxious, what it feels like, what thoughts are associated with the anxiety, and how to best respond to the anxiety is the basis of cognitive behavioral therapy (CBT). CBT involves identifying negative automatic thoughts and evaluating different patterns of thinking that are associated with feelings of anxiety. CBT is a well-studied approach that is effective in people with cancer in reducing anxiety symptoms and helping those feelings become more tolerable by developing alternative ways of thinking. Through CBT, the source of anxiety may not change, but the way one experiences and deals with the anxiety can. CBT is also used in sleep disorders, such as insomnia, to manage the anxiety that interferes with sleep. Talk with your doctor about whether CBT might be right for you.
Additionally, approaches such as progressive muscle relaxation and grounding techniques can help empower someone who is experiencing a high level of anxiety and who is not as able to focus on their thoughts. Progressive muscle relaxation is when you tense your muscles as you breathe in and then relax them as you breathe out. Grounding techniques are used to help bring you back to the present and involve focusing on the 5 senses. These techniques can help slow down the pace of anxious thoughts and worries. This can help people feel more comfortable during cancer treatment and better cope with the overall cancer experience.
What is most important to realize is that being anxious can be a normal adaptive response. Acknowledging it, understanding what is causing it, and learning to cope with it can improve your quality of life and contribute to a greater sense of self-empowerment. Managing anxiety is a way of advocating for yourself and giving yourself more compassion.
The author has no relationships relevant to this content to disclose.