Anxiety and Cancer

Understand the signs, symptoms, and management of anxiety .

Medically reviewed by C.H. Weaver M.D. Medical Editor 4/2019

Anxiety is a feeling of fear or anticipation. While anxiety is a natural response to some situations, it can develop into a debilitating disorder in some people. There are several types of anxiety disorders, but they all have the common symptoms of excessive, irrational fear and dread. Anxiety is treatable. Usually a combination of medications and psychotherapy is prescribed.

What is anxiety

Anxiety is a feeling of fear or anticipation. All human beings experience anxiety at some time, but the cause and severity is very different for each person. Most people experience relatively mild and brief anxiety before a stressful event, such as an exam, business presentation or a first date. For others, anxiety becomes chronic, relentless, developing into an anxiety disorder. If left untreated, anxiety disorders can grow progressively worse, making it difficult to function in everyday life.

There are many different types of anxiety disorders. Some examples include:

  • Panic disorder
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Phobias
  • Generalized anxiety disorder

While each of these have their own distinct set of symptoms and features, they are all bound together by the characteristic symptoms of excessive, irrational fear and dread. Post-traumatic stress disorder and generalized anxiety disorder may be associated with being diagnosed with or treated for cancer. For more information, go to Post-traumatic stress disorder.

What causes anxiety

Anxiety disorders develop from a complex combination of factors, including:

  • Genetics
  • Brain chemistry
  • Personality
  • Stressful life events

Being diagnosed with or treated for cancer may cause symptoms of an anxiety disorder in some people.

What are the symptoms of anxiety

Generalized anxiety disorder is characterized by excessive, unrealistic worry that lasts six months or more. In adults, the anxiety may focus on issues such as health, money or career.[1] In addition to chronic worry, symptoms of generalized anxiety include:

  • Trembling
  • Muscular aches
  • Insomnia
  • Abdominal upsets
  • Dizziness
  • Irritability

What is the treatment for anxiety

Anxiety is most often treated with a combination of medication and psychotherapy. Medication is often used to ease symptoms so that other therapy can continue. Your doctor may prescribe medication for a short-term therapy, or it may be required for a lengthy period of time, depending on your circumstances.

Drug treatment: A number of medications that were originally approved for treating depression are also effective for anxiety disorders. Most of these medications take 3 to 6 weeks to begin working and may be associated with some side effects. Your doctor may try several different drugs to find the best treatment for you.

Some of the newest of these antidepressants are called selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the level of the neurotransmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders. While SSRIs have gained popularity because they have fewer side effects than other medications, they still do have some side effects (see table 1).

Table 1 Examples of SSRIs and common side effects associated with these medications

Another type of antidepressant drug called a tricyclic antidepressant (TCA) may be prescribed for anxiety. TCAs are associated with more side effects than the SSRIs. TCAs also work by regulating serotonin levels.

Table 2 Examples of TCAs and common side effects

Another type of medication commonly used for anxiety is a class of drugs called benzodiazepines; an example is diazepam (Valium®, Valrelease®).

PET Therapy - Service Animals increasingly play a role in the management of anxiety. Learn more....

Psychotherapy (talk-therapy): There are many different kinds of psychotherapy, also known as talk therapy. The approaches that are commonly used to treat anxiety are Behavior Therapy and Cognitive Therapy. Behavior therapy seeks to modify unwanted behavior and find ways to cope with difficult situations. This provides a sense of having control over your life. Cognitive therapy aims to change harmful or unproductive thoughts that cause anxiety. A combination of these two approaches may also be utilized.

What else can I do

Make sure you are getting enough sleep and try to exercise daily. Being well rested will help you cope with difficult situations, thoughts, or other triggers of your anxiety. Exercise increases the release of natural chemicals in your body called endorphins, which promote a feeling of well-being. A daily exercise program can be as simple as 20-30 minutes of walking.

According to researcgh published in the American Journal of Psychiatry, group-based intervention eases cancer-related anxiety during treatment and one year following treatment among cancer patients.

Patients may experience a range of emotions, including anxiety, with diagnosis and treatment for any type of cancer. They often find if helpful to discuss these issues with other patients who are having similar experiences. As well, therapeutic approaches exist to treat emotional anxiety. Researchers continue to evaluate ways to improve quality of life in terms of emotional well-being for patients diagnosed with and treated for cancer.

Researchers recently conducted a study evaluating a 10-week session of group cognitive behavior stress management intervention. Patients underwent intervention including anxiety reduction through relaxation training, cognitive restructuring (replacing detrimental beliefs with more accurate and beneficial ones), and coping skills. The study included 199 women who were newly treated for early breast cancer. The patients were then followed for one year after the intervention began.

  • Results indicated that intervention reduced intrusion of negative thoughts, anxiety, and emotional distress throughout the year of follow-up.

The researchers concluded that group-based intervention may help to ease cancer-related anxiety and distress for women newly diagnosed with and treated for early breast cancer. Women diagnosed with breast cancer may wish to discuss with their physician intervention approaches or other therapeutic approaches for dealing with emotional issues relating to cancer.

To help you manage your anxiety, you may wish to try relaxation techniques, such as:

Research Suggests Planning in Advance for Cancer Care May Reduce Anxiety

For patients with advanced cancer, making plans for future care does not appear to cause emotional distress and may even reduce anxiety. These findings were published in the Journal of Pain and Symptom Management.

Advance care planning involves making a plan now about future care, including how decisions will be made and who will be responsible. It’s been thought that some doctors might avoid discussions with patients about advance care planning because they worry that such conversations will cause patients to lose hope or feel anxiety about their future health.

Researchers recently evaluated whether advance care planning among patients with cancer would negatively impact feelings of hope (or hopelessness) and anxiety—specifically when care planning was done using online tools.

Participants in the study made advance care plans with an online tool called “Making Your Wishes Known” (makingyourwishesknown.com) or did not make any advance care plans. These 200 patients were undergoing treatment for advanced cancer and were expected to live for two years or less. The researchers evaluated all patients for hope, hopelessness, and anxiety. These levels were compared before and after advance care planning in the group who participated in planning and between patients who made care plans and those who did not. The study also assessed patient knowledge of advance care planning, patient self-determination (taking control of their own life), and satisfaction with the advance care planning process.

Patients who participated in advance care planning did not appear to experience less hope or more hopelessness than patients who did not make care plans. Furthermore, patients who made plans appeared to have slightly less anxiety after the planning process. The planning group also learned more about advance care planning and were more satisfied with the process than those who didn’t participate, though both groups gained knowledge about the process (as measured in the percentage of questions they answered correctly about advance care planning). All patients emerged with higher levels of self-determination.

According to these findings, patients with advanced cancer can make advance care plans using online tools with no risk to their emotional or psychological well-being. The online planning process did not appear to take away feelings of hope or increase hopelessness; it did in fact appear to lower anxiety levels.(3)

References

  1. Anxiety Disorder Association of America. Brief Overview of Anxiety Disorders http://www.adaa.org/AnxietyDisorderInfor/OverviewAnxDis.cfm accessed 1/14/04.
  2. Antoni M, Wimberly S, Lechner S, et al. Reduction of Cancer-Specific Thought Intrusions and Anxiety Symptoms With a Stress Management Intervention Among Women Undergoing Treatment for Breast Cancer. American Journal of Psychiatry. 2006; 163:1791-1797.
  3. Green MJ, Schubart JR, Whitehead MM, et al. Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients with Advanced Cancer. Journal of Pain and Symptom Management. 2014 Dec 23. pii: S0885-3924(14)00939-7. doi: 10.1016/j.jpainsymman.2014.11.293.
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