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Adjustment to Cancer: Anxiety and Distress (PDQ®)

Health Professional Version
Last Modified: 04/09/2014


Studies examining the prevalence of mental disorders in cancer [1,2] show that most cancer patients do not meet the diagnostic criteria for any specific mental disorder; however, many patients do experience a variety of difficult emotional responses.[3]

Psychosocial distress exists on a continuum (see figure below) ranging from normal adjustment issues through the adjustment disorders of the fourth revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR);[4] to a level close to, but below, the threshold (i.e., meets some diagnostic criteria but not all) of diagnosable mental disorders; to syndromes that meet the full diagnostic criteria for a mental disorder (e.g., major depressive disorder). This summary focuses primarily on the less severe end of this continuum: the normal adjustment issues, psychosocial distress,[5] the adjustment disorders, and cancer-related anxiety. (Refer to the PDQ summaries on Depression and Post-traumatic Stress Disorder for more information.)

Anxiety is often manifested at various times during cancer screening, diagnosis, treatment, or recurrence. It can sometimes affect a person’s behavior regarding his or her health, contributing to a delay in or neglect of measures that might prevent cancer.[6-8] For example, when women with high levels of anxiety learn that they have a genetically higher level of risk of breast cancer than they had previously believed, they might perform breast self-examination less frequently.[9]

For patients undergoing cancer treatment, anxiety can also heighten the expectancy of pain,[10-12] other symptoms of distress, and sleep disturbances and can be a major factor in anticipatory nausea and vomiting. Anxiety, regardless of its degree, can substantially interfere with the quality of life of patients with cancer and of their families and should be evaluated and treated.[13-15]

In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.

  1. Derogatis LR, Morrow GR, Fetting J, et al.: The prevalence of psychiatric disorders among cancer patients. JAMA 249 (6): 751-7, 1983.  [PUBMED Abstract]

  2. Massie MJ, Holland JC: Overview of normal reactions and prevalence of psychiatric disorders. In: Holland JC, Rowland JH, eds.: Handbook of Psychooncology: Psychological Care of the Patient With Cancer. New York, NY: Oxford University Press, 1989, pp 273-82. 

  3. Bisson JI, Chubb HL, Bennett S, et al.: The prevalence and predictors of psychological distress in patients with early localized prostate cancer. BJU Int 90 (1): 56-61, 2002.  [PUBMED Abstract]

  4. American Psychiatric Association.: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th rev. ed. Washington, DC: American Psychiatric Association, 2000. 

  5. NCCN practice guidelines for the management of psychosocial distress. National Comprehensive Cancer Network. Oncology (Huntingt) 13 (5A): 113-47, 1999.  [PUBMED Abstract]

  6. Lauver D, Ho CH: Explaining delay in care seeking for breast cancer symptoms. J Appl Soc Psychol 23 (21): 1806-25, 1993. 

  7. MacFarlane ME, Sony SD: Women, breast lump discovery, and associated stress. Health Care Women Int 13 (1): 23-32, 1992 Jan-Mar.  [PUBMED Abstract]

  8. Gram IT, Slenker SE: Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited. Am J Public Health 82 (2): 249-51, 1992.  [PUBMED Abstract]

  9. Lerman C, Kash K, Stefanek M: Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. J Natl Cancer Inst Monogr (16): 171-6, 1994.  [PUBMED Abstract]

  10. Velikova G, Selby PJ, Snaith PR, et al.: The relationship of cancer pain to anxiety. Psychother Psychosom 63 (3-4): 181-4, 1995.  [PUBMED Abstract]

  11. Glover J, Dibble SL, Dodd MJ, et al.: Mood states of oncology outpatients: does pain make a difference? J Pain Symptom Manage 10 (2): 120-8, 1995.  [PUBMED Abstract]

  12. Ferrell-Torry AT, Glick OJ: The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs 16 (2): 93-101, 1993.  [PUBMED Abstract]

  13. Davis-Ali SH, Chesler MA, Chesney BK: Recognizing cancer as a family disease: worries and support reported by patients and spouses. Soc Work Health Care 19 (2): 45-65, 1993.  [PUBMED Abstract]

  14. Dahlquist LM, Czyzewski DI, Copeland KG, et al.: Parents of children newly diagnosed with cancer: anxiety, coping, and marital distress. J Pediatr Psychol 18 (3): 365-76, 1993.  [PUBMED Abstract]

  15. Payne SA: A study of quality of life in cancer patients receiving palliative chemotherapy. Soc Sci Med 35 (12): 1505-9, 1992.  [PUBMED Abstract]