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Adjustment to Cancer: Anxiety and Distress (PDQ®)

  • Last Modified: 10/04/2013

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Overview



Anxiety and distress can affect the quality of life of patients with cancer and their families.

Patients living with cancer feel many different emotions, including anxiety and distress.

  • Anxiety is fear, dread, and uneasiness caused by stress.
  • Distress is emotional, mental, social, or spiritual suffering. Patients who are distressed may have a range of feelings from vulnerability and sadness to depression, anxiety, panic, and isolation.

Patients may have feelings of anxiety and distress while being screened for a cancer, waiting for the results of tests, receiving a cancer diagnosis, being treated for cancer, or worrying that cancer will recur (come back).

Anxiety and distress may affect a patient's ability to cope with a cancer diagnosis or treatment. It may cause patients to miss check-ups or delay treatment. Anxiety may increase pain, affect sleep, and cause nausea and vomiting. Even mild anxiety can affect the quality of life for cancer patients and their families and may need to be treated.

Patients living with cancer can feel different levels of distress.

Some patients living with cancer have a low level of distress and others have higher levels of distress. The level of distress ranges from being able to adjust to living with cancer to having a serious mental health problem, such as major depression. However, most patients with cancer do not have signs or symptoms of any specific mental health problem. This summary describes the less severe levels of distress in patients living with cancer, including:

  • Normal adjustment—A condition in which a person makes changes in his or her life to manage a stressful event such as a cancer diagnosis. In normal adjustment, a person learns to cope well with emotional distress and solve problems related to cancer.

  • Psychological and social distress—A condition in which a person has some trouble making changes in their life to manage a stressful event such as a cancer diagnosis. Help from a professional to learn new coping skills may be needed.

  • Adjustment disorder —A condition in which a person has a lot of trouble making changes in his or her life to manage a stressful event such as a cancer diagnosis. Symptoms such as depression, anxiety, or other emotional, social, or behavioral problems occur and worsen the person's quality of life. Medicine and help from a professional to make these changes may be needed.

  • Anxiety disorder—A condition in which a person has extreme anxiety. It may be because of a stressful event like a cancer diagnosis or for no known reason. Symptoms of anxiety disorder include worry, fear, and dread. When the symptoms are severe, it affects a person's ability to lead a normal life. There are many types of anxiety disorders:

There are certain risk factors for serious distress in people with cancer.

Nearly half of cancer patients report having a lot of distress. Patients with lung, pancreatic, and brain cancers may be more likely to report distress, but in general, the type of cancer does not make a difference. Factors that increase the risk of anxiety and distress are not always related to the cancer. The following may be risk factors for high levels of distress in patients with cancer:

  • Trouble doing the usual activities of daily living.
  • Physical symptoms and side effects (such as fatigue, nausea, or pain).
  • Problems at home.
  • Depression or other mental or emotional problems.
  • Being younger, nonwhite, or female.
  • Having a lower level of education.

Screening is done to find out if the patient needs help adjusting to cancer.

Screening is usually done by asking the patient questions, either in an interview or on paper. Patients who show a high level of distress usually find it helpful to talk about their concerns with a social worker, mental health professional, palliative care specialist, or pastoral counselor.

This summary is about adjustment to cancer, anxiety, and distress in adults with cancer.

See the following PDQ summaries for information on depression and post-traumatic stress disorder: