Anxiety

Anxiety means feeling uncomfortable, worried, or scared about a real or possible situation. It's important to recognize anxiety and take steps to manage it or prevent it from getting worse.

General anxiety

In general, anxiety is a common problem for patients with a cancer diagnosis. At different times during treatment and recovery, cancer patients and their family and caregivers may feel fearful and anxious. Simply finding a lump or possible other sign or symptom of cancer can cause anxiety and fear, along with finding out that they have cancer or that the cancer has come back. Fear of treatment, doctor visits, and tests might also cause apprehension (the feeling that something bad is going to happen).

What to look for

It’s normal to feel afraid when you’re sick. People may be afraid of uncontrolled pain, dying, or what happens after death, including what might happen to loved ones. And, again, these same feelings may be experienced by family members and friends. Signs and symptoms of anxiety include:

  • Anxious facial expressions
  • Uncontrolled worry
  • Trouble solving problems and focusing thoughts
  • Muscle tension (the person may also look tense or tight)
  • Trembling or shaking
  • Restlessness, may feel keyed up or on edge
  • Dry mouth
  • Irritability or angry outbursts (grouchy or short-tempered)

What the patient and caregiver can do

Cancer patients and caregivers might have signs and symptoms of anxiety. The signs and symptoms might be more serious if they happen most of the day, nearly every day, and they are interfering with daily activities. In these cases, a referral for mental health evaluation could be helpful. Keep in mind that sometimes, despite having all the symptoms, a person may deny having these feelings. But if they’re willing to admit that they feel distressed or uncomfortable, therapy can often help.

  • Encourage, but do not force, each other to talk.
  • Share feelings and fears that you or the anxious person may be having.
  • Listen carefully to each other’s feelings. Offer support, but don’t deny or discount feelings.
  • Remember that it’s OK to feel sad and frustrated.
  • Get help through counseling and/or support groups.
  • Some psychoeducation may help. Psychoeducation combines education with group or individual counseling. 
  • Mindfulness activities such as yoga may help with focus and is recommended for some levels of anxiety.
  • Meditation, prayer, or other types of spiritual support might help.
  • Try deep breathing and relaxation exercises. Close your eyes, breathe deeply, focus on each body part and relax it, start with your toes and work up to your head. When relaxed try to think of a pleasant place such as a beach in the morning or a sunny field on a spring day.
  • Exercise, from light walking to a regular workout routine, may help lower anxiety.
  • Talk with your health care team about using anti-anxiety or anti-depressant medicines.

Things not to do

  • Keep feelings inside.
  • Force someone to talk if they’re not ready to.
  • Blame yourself or another person for feeling fearful or anxious.
  • Try to reason with a person whose fears and anxieties are severe; talk with the doctor about medicines and other kinds of help.

Panic attacks

Panic attacks can be an alarming symptom of anxiety. Panic attacks happen very suddenly and often reach their worst within about 10 minutes. The person may seem fine between attacks, but is usually very afraid that they will happen again.

What to look for

  • Shortness of breath or a feeling of being smothered*
  • Racing heart*
  • Feeling dizzy, unsteady, lightheaded, or faint*
  • Chest pain or discomfort*
  • Feeling as if they’re choking*
  • Trembling or shaking
  • Sweating
  • Fear of losing control or “going crazy”
  • An urge to escape
  • Numbness or tingling sensations
  • Feeling “unreal” or “detached” from themselves
  • Chills (shaking or shivering) or hot flashes (may involve sweating or facial reddening)

*If a person is having any of the first 5 symptoms (marked with *), it can mean an urgent or life-threatening condition. Call 911 or the doctor right away if someone unexpectedly has any of these. These symptoms also can be signs of other, more serious problems such as shock, heart attack, blood chemistry imbalance, collapsed lung, allergic reaction, or others. It’s not safe to assume that they are panic-related until diagnosed by a doctor.

If the person has had panic attacks in the past, and it happens again exactly like it did before, they can often recognize it as a panic attack.

If the person recovers completely within a few minutes and has no more symptoms, it’s more likely to have been a panic attack. If panic attacks are diagnosed by a doctor, brief therapy and medicines have been shown to be helpful.

Things a caregiver can do

  • Check with the doctor to be sure the symptoms are caused by panic and not another medical problem.
  • Stay calm and speak softly during a panic attack.
  • Sit with the person during panic attacks until he or she is feeling better.
  • Call for help if needed.
  • After the panic attack is over, encourage the person to get treatment for the panic attacks.
  • Provide transportation to treatment if needed. The person may be afraid that a panic attack will happen while driving.
  • Things that help a person with anxiety (see above) may also be helpful for someone having a panic attack.

Things not to do

  • Minimize or make light of the person’s terror or fear.
  • Judge the person for feeling scared and acting strangely.
  • Try to talk the person out of their fear or other feelings.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Dahlin C. Anxiety. In Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse. 3rd ed. Pittsburgh, PA: Oncology Nursing Society; 2014; 1383-1390.

Hammelef KJ. Anxiety. In Brown CG (ed.). A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society. 2015; 55-76.

Inhestern L, Beierlein V, Bultmann JC, Möller B, Romer G, Koch U, Bergelt C. Anxiety and depression in working-age cancer survivors: A register-based study. BioMed Central. 2017;17(1):347.

Mehta RD, Roth AJ. Psychiatric Considerations in the Oncology Setting. CA Cancer J Clin. 2015;65:300-314.

National Institute of Mental Health. Anxiety Disorders. Accessed at https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml on January 31, 2020.

Oncology Nursing Society (ONS). Symptom Interventions: Anxiety. Accessed at https://www.ons.org/pep/anxiety on January 31, 2020. 

Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. British Medical Journal. 2018;361:k14-15.

References

Dahlin C. Anxiety. In Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse. 3rd ed. Pittsburgh, PA: Oncology Nursing Society; 2014; 1383-1390.

Hammelef KJ. Anxiety. In Brown CG (ed.). A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society. 2015; 55-76.

Inhestern L, Beierlein V, Bultmann JC, Möller B, Romer G, Koch U, Bergelt C. Anxiety and depression in working-age cancer survivors: A register-based study. BioMed Central. 2017;17(1):347.

Mehta RD, Roth AJ. Psychiatric Considerations in the Oncology Setting. CA Cancer J Clin. 2015;65:300-314.

National Institute of Mental Health. Anxiety Disorders. Accessed at https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml on January 31, 2020.

Oncology Nursing Society (ONS). Symptom Interventions: Anxiety. Accessed at https://www.ons.org/pep/anxiety on January 31, 2020. 

Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. British Medical Journal. 2018;361:k14-15.

Last Revised: February 1, 2020

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