Anxiety (a feeling of worry or unease) and fear are common feelings that patients and families sometimes have when coping with cancer. These feelings are normal responses to the stress of cancer, and may be more noticeable around the time the cancer is first diagnosed. Feelings of fear or anxiety may be due to changes in the ability to continue family duties, loss of control over events in life, changes in appearance or body image, or simply the shock of a cancer diagnosis. They may involve uncertainty about the future and concerns about suffering, pain, and the unknown. Fears around loss of independence, changes in relationships with loved ones, and becoming a burden to others may overwhelm the patient and complicate family life.

Family members may have these feelings because they, too, are uncertain about the future or angry that their loved one has cancer. They may feel guilt and frustration at not being able to "do enough." Or they may feel overwhelmed by everything they now have to do. Many caregivers feel stressed because of problems balancing work, child care, self care, and other tasks, along with more responsibility at home. All of this is on top of having to worry about and take care of the person with cancer.

Sometimes a person with cancer may become overly anxious, fearful, or depressed and may no longer cope well with his or her day-to-day life. If this happens, it often helps the patient and family to get help from a professional therapist or counselor.

What to look for

• Feeling anxious
• Trouble thinking or solving problems
• Being nervous, agitated, irritable, or restless
• Feeling or looking tense
• Concern about "losing control"
• Uneasy sense that something bad is going to happen
• Trembling and shaking
• Headaches
• Being cranky or angry with others
• Tiredness or fatigue
• Trouble sleeping or restless sleep

What the patient can do

• Talk about feelings and fears that you or family members may have -- it’s OK to feel sad and frustrated.
• Decide together with your family or caregiver what things you can do to support each other.
• Do not blame yourself and others when you feel anxious and afraid. Instead, look at your emotions, concerns, and beliefs about what has been going on in your life, and talk about those things.
• Get help through counseling and support groups.
• Use prayer, meditation, or other types of spiritual support.
• Try deep breathing and relaxation exercises several times a day. (With closed eyes, breathe deeply, focus on one body part and relax it, starting with toes and working up to head. When relaxed, imagine being in a pleasant place, such as a warm beach at sunset or peaceful mountain meadow.)
• Cut down on caffeine. It can worsen anxiety symptoms.
• Think about asking your doctor or nurse for a referral to a counselor to work with you and your family.
• Talk with your doctor about the possible use of medicine for anxiety.

What caregivers can do

• Gently invite the patient to talk about his or her fears and concerns.
• Do not try to force the patient to talk before he or she is ready.
• Listen carefully without judging the patient’s feelings, or your own.
• Decide together with the patient what you can do to support each other.For severe anxiety, it is usually not helpful to try to reason with the patient. Instead, talk with the doctor about the symptoms and problems you notice.
• To reduce your own stress, try suggestions from the above list, and any others that have worked for you in the past.
• Consider getting support for yourself, through groups or individual counseling.

Call the doctor if the patient:

• has trouble breathing
• is sweating, with a fast or pounding heartbeat
• is feeling very restless

Note that some medicines or supplements can cause or worsen anxiety symptoms. If anxiety gets worse after a new medicine is started, talk with your doctor about it.

For more in-depth information on anxiety and fear, see Anxiety, Fear, and Depression.  This document is also available by calling your American Cancer Society at 1-800-ACS-2345.

Go to a list of symptoms to find other problems in Caring for the Patient with Cancer at Home: A Guide for Patients and Families.

Revised: 04/07/08