Anxiety

Aprobado por la Junta Editorial de Cancer.Net, 11/2021

Anxiety is a common emotion. Most people feel anxious from time to time. Feeling anxious may be described as feeling nervous, on edge, or worried. These are emotions that help us respond to a problem or threat. Cancer often brings more anxiety. If you or a loved one have recently been diagnosed with cancer or are going through cancer treatment, anxiety is an expected reaction.

When anxiety interferes with your daily life or lasts a long time, you may want or need additional support. This can include trying new ways to cope with it, including both things to try at home and the help of trained health care professionals.

Anxiety can make it hard to take care of yourself, and it can affect your relationships and health. Symptoms of anxiety can be physical, such as a racing heart, shortness of breath, stomach upset, or restlessness. They can also be emotional, such as feeling fear, dread, or worry about the past or the future. These symptoms can be mild or severe. But you do not need to have severe anxiety to get additional support. Let your health care team know if you are experiencing anxiety symptoms, even if you would describe them as mild. They can help you find the right kind of support for you.

Anxiety and cancer

Many people with cancer have symptoms of anxiety. A cancer diagnosis can trigger these feelings:

While these fears are all understandable when you have cancer, it is important to talk to your health care team about how you are feeling. They will ask you to describe how you are feeling, including any specific symptoms (see below). They have special training, expertise, and knowledge to help you cope with these strong feelings.

Other causes of anxiety symptoms

Common symptoms of anxiety may be a reaction to stress, but they can also have other causes. For example, a fast heartbeat or high blood pressure can be a symptom of anxiety, but it can also be a reaction to a medication or a sign of heart problems. If you are experiencing physical symptoms, be sure to tell your doctor so the exact cause can be found. Some of the medical or physical causes of such symptoms include:

Some medications can also cause anxiety-like symptoms. Examples include:

  • Steroids, like dexamethasone or prednisone

  • Anti-nausea medications

  • Bronchodilators, which are medications that make breathing easier

  • Hormone therapy for breast cancer or prostate cancer

  • Stimulants

Anxiety symptoms may have more than one cause. It is possible to have anxiety and also have a health problem or take medication that makes it worse. Your health care team can do tests to find out if anxiety, something else, or a combination is the cause of your symptom(s).

What is the difference between acute anxiety and chronic anxiety?

There are different ways that you can experience anxiety. In general, anxiety can be considered acute or chronic.

When you have brief periods of intense anxiety, it is considered acute anxiety. Examples include panic attacks, also called anxiety attacks.

Long-term symptoms of anxiety that return frequently or do not go away over time are considered chronic anxiety.

Though the symptoms for chronic anxiety and acute anxiety are different, you can experience both at the same time. There are ways to get help with acute and chronic anxiety.

What are the symptoms of acute anxiety attacks?

When you experience intense, short periods of the symptoms below, you may be experiencing acute anxiety.

  • Feeling intense fear or dread

  • Feeling detached from yourself or your surroundings

  • Heart palpitations or rapid heartbeat

  • High blood pressure

  • Chest pain

  • Shortness of breath

  • Feeling suffocated

  • Sweating

  • Chills

  • Dizziness or feeling lightheaded

  • Trembling

  • Nausea, diarrhea, heartburn, or a change in appetite

  • Abdominal pain

  • Trouble falling asleep or staying asleep

  • Restlessness

  • Pacing

  • Feeling a knot in the pit of your stomach

What are the symptoms of chronic anxiety?

Chronic anxiety lasts for a longer time. You can have acute anxiety episodes along with one or more of the symptoms below:

  • Excessive worrying

  • Restlessness

  • Muscle tension

  • Insomnia, which is not being able to fall or stay asleep

  • Irritability

  • Fatigue

  • Difficulty concentrating

  • Indecision, which is having trouble making decisions

What are the risk factors for anxiety?

People with cancer are more likely to experience anxiety if they have these risk factors:

  • Previous diagnosis of anxiety or depression

  • Family history of anxiety or depression

  • Lack of support from family or friends

  • Financial burdens

However, anxiety can be experienced by anyone, especially after a cancer diagnosis.

Should people with cancer be screened for anxiety?

Yes. The American Society of Clinical Oncology (ASCO) recommends screening for anxiety and depression. Screenings should start at the time of a cancer diagnosis and be repeated regularly during your treatment and recovery.

These screenings can help catch problems related to anxiety. Treatment for anxiety will depend on your specific symptoms and how often you have them. It is important to note that some symptoms of anxiety can also be related to other problems, including side effects of cancer or cancer treatment. For example, fatigue and trouble sleeping or concentrating are common side effects of cancer and cancer treatment.

Although it can be hard, try to talk openly about anxiety with your health care team. This will help them understand your concerns and recommend a treatment plan. Discuss the following:

  • Your feelings

  • Specific sources of your fears or worries

  • Physical symptoms you're having

  • The effect on your daily life

People who experience anxiety are also more likely to experience other mental health concerns, like depression.

Getting treatment for anxiety when you have cancer

There are a variety of ways to cope with anxiety. It can be helpful to combine treatment techniques when you have anxiety. For example, you might try relaxation techniques or meditation at home, prayer, work with a professional counselor, take medication to treat your anxiety, and/or participate in a support group. Talk with your health care team to find the best options for you.

Relaxation techniques to manage your anxiety

Relaxation techniques can be used alone or along with other types of treatment. Some of the following methods can be done on your own at home. Others may require the help of an instructor. Many of these techniques can be found through free resources on the internet. There are also applications that you can download on your phone that can walk you through some of these techniques.

  • Deep breathing. Slow deep breathing helps lower stress in the body. It sends calming signals from your brain to the rest of your body, slowing your heart rate and how fast you are breathing.

  • Progressive muscle relaxation. This is a technique that involves tightening and then relaxing muscles. You begin at the toes or head and then slowly relax the muscles across the body.

  • Guided imagery. This is the use of words and sounds to help you imagine calming, peaceful settings, experiences, and feelings.

  • Meditation. Meditation is a practice of focusing attention or awareness on your breath, a mantra or verbal phrase, or a part of the body. This can help you achieve a sense of well-being in the present moment and reduce stress. It can also help you to acknowledge uncomfortable emotions and prevent them from building up.

  • Hypnosis or hypnotherapy. Hypnosis is a method performed by a licensed or certified mental health professional that helps people reach a relaxed state.

  • Biofeedback. This technique involves paying attention to and controlling signals from the body, such as heart rate. Signals from the body are measured with painless electrical sensors, called electrodes.

  • Yoga. Yoga combines breathing and posture exercises to promote relaxation.

  • Artistic expression. Music therapy, art therapy, and writing about your feelings can help relieve stress and anxiety.

  • Prayer or other religious practices. For people who have spiritual beliefs, prayer and other religious practices can relieve tension and anxiety.

Work with a counselor or other mental health professional

Seeking the help of a mental health professional can help you with your anxiety. Mental health professionals include licensed counselors, psychologists, and psychiatrists. Psychiatrists are mental health professionals who can prescribe medications.

Counselors and other mental health professionals can provide tools to improve your coping skills, develop a support system, and reshape negative thoughts. You can work with a counselor on your own, through couples or family therapy, and in group therapy. Today, options exist for mental health telemedicine so you may not need to leave your home to get help. Counselors can also lead or direct you to a peer support group.

Medication

If your anxiety symptoms are moderate to severe, anxiety medication may be helpful for you. Different types of medications are available. Your doctor will select the most appropriate medication based on these factors:

  • Your needs

  • Potential side effects

  • Other medications you take

  • Your medical history

Tell your doctor about all medications and supplements you take. This is important to do to avoid unwanted drug interactions. For instance, other medications may interfere with certain types of anti-anxiety medications, making them less effective. And some can also cause anxiety or make it worse.

Medications frequently used to treat anxiety for people with cancer include:

Mild tranquilizers, also called benzodiazepines. This type of medication works quickly to treat anxiety. It is most safely used on an as-needed basis for acute anxiety. Your doctor may prescribe this type of medication for panic attacks. They can also be used for anxiety related to the stress of having scans, tests, or medical procedures, sometimes called scanxiety.

It is possible to become psychologically addicted to benzodiazepines. Your doctor will monitor you closely while you take this medication. And it is important to only take it as prescribed. This is especially important for people who have had experiences with substance abuse in the past.

Most people who take benzodiazepines daily develop physical dependence. This means that you would experience side effects if you stopped taking it abruptly. Benzodiazepines should not be stopped without the help of a doctor. Your doctor may also need to adjust your dosage of this drug. This is because you can develop physiological tolerance over time. This means that you could need a higher dose to get the same effect. Physical dependence and physiological tolerance are not the same as being addicted. Be sure to talk with your doctor about this aspect of this medication.

Antidepressants. This is the general term for medications called selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine inhibitors (SNRIs). These medications can treat general anxiety, panic disorder, and depression.

Improvement in symptoms happens 2 to 5 weeks after starting the medication. This medication needs to be taken every day to be effective. It should not be stopped without the help of a doctor.

Antipsychotic medications. Sometimes, medications called antipsychotics or mood stabilizers can be used to treat anxiety and depression for people with cancer. It is important to only take this medication as prescribed by your doctor. They should not be stopped without the help of a doctor.

No matter what type of medication you take to manage your anxiety, it often works best when it is taken alongside counseling with a mental health professional.

Follow-up care for anxiety

Keep your cancer care team up to date if you work with a mental health professional and receive new anti-anxiety treatments. Let them know how treatment is working and if you have any new symptoms.

If your anxiety symptoms have not decreased after 8 weeks, you may need to change your treatment plan, such as trying a new approach or be prescribed a different medication. You can also add counseling or change how often you are working with a counselor to help.

Questions to ask the health care team

You may want to ask your cancer care team the following questions about anxiety.

  • Who can I talk to if I'm feeling anxiety, depression, or other mental distress?

  • What symptoms and side effects of my cancer treatment could affect my mental health?

  • Are there counseling services at this medical center for patients?

  • Who can I talk with if I need free or lower-cost counseling services?

  • Do you recommend any relaxation techniques or other ways to manage my anxiety?

  • Would you recommend medication for my anxiety?

  • Who should I contact if my anxiety symptoms continue or worsen?

Related Resources

Managing Stress

Finding Support and Information

How to Cope With the Impact of Cancer on Your Mental Health

How Mindfulness Helped Me Cope With Cancer

More Information

CancerCare: Counseling

National Cancer Institute: Anxiety and Distress