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Adjustment to Cancer: Anxiety and Distress (PDQ®)

Patient Version
Last Modified: 10/04/2013

Anxiety Disorders

Current Clinical Trials



Anxiety disorders are very strong fears that may be caused by physical or psychological stress.

Studies show that almost half of all patients with cancer say they feel some anxiety and about one-fourth of all patients with cancer say they feel a great deal of anxiety. Patients living with cancer find that they feel more or less anxiety at different times. A patient may become more anxious as cancer spreads or treatment becomes more intense.

For some patients feelings of anxiety may become overwhelming and affect cancer treatment. This is especially true for patients who had periods of intense anxiety before their cancer diagnosis. Most patients who did not have an anxiety condition before their cancer diagnosis will not have an anxiety disorder related to the cancer.

Patients are more likely to have anxiety disorders during cancer treatment if they have any of the following:

  • A history of an anxiety disorder.

  • A history of physical or emotional trauma.

  • Anxiety at the time of diagnosis.

  • Few family members or friends to give them emotional support.

  • Pain that is not controlled well.

  • Cancer that is not getting better with treatment.

  • Trouble taking care of their personal needs such as bathing or eating.

Anxiety disorders may be hard to diagnose.

It may be hard to tell the difference between normal fears related to cancer and abnormally severe fears that can be described as an anxiety disorder. The diagnosis is based on how symptoms of anxiety affect the patient's quality of life, what kinds of symptoms began since the cancer diagnosis or treatment, when the symptoms occur, and how long they last.

Anxiety disorders cause serious symptoms that affect day-to-day life, including:

  • Feeling worried all the time.

  • Not being able to focus.

  • Not being able to "turn off thoughts" most of the time.

  • Trouble sleeping most nights.

  • Frequent crying spells.

  • Feeling afraid most of the time.

  • Having symptoms such as fast heart beat, dry mouth, shaky hands, restlessness, or feeling on edge.

  • Anxiety that is not relieved by the usual ways to lessen anxiety such as distraction by staying busy.

There are different causes of anxiety disorders in cancer patients.

In addition to anxiety caused by a cancer diagnosis, the following may cause anxiety in patients with cancer:

Anxiety from these causes is usually managed by treating the cause itself.

A cancer diagnosis may cause anxiety disorders to come back in patients with a history of them.

When patients who had an anxiety disorder in the past are diagnosed with cancer, then the anxiety disorder may come back. These patients may feel extreme fear, be unable to remember information given to them by caregivers, or be unable to follow through with medical tests and procedures. They may have symptoms including:

  • Shortness of breath.

  • Sweating.

  • Feeling faint.

  • Fast heart beat.

Patients with cancer may have the following types of anxiety disorders:

Phobia

Phobias are fears about a situation or an object that lasts over time. People with phobias usually feel intense anxiety and avoid the situation or object they are afraid of. For example, patients with a phobia of small spaces may avoid having tests in small spaces, such as magnetic resonance imaging (MRI) scans.

Phobias may make it hard for patients to follow through with tests and procedures or treatment. Phobias are treated by professionals and include different kinds of therapy.

Panic disorder

Patients with panic disorder feel sudden intense anxiety, known as panic attacks. Symptoms of panic disorder include the following:

  • Shortness of breath.
  • Feeling dizzy.
  • Fast heart beat.
  • Shaking.
  • Heavy sweating.
  • Feeling sick to the stomach.
  • Tingling of the skin.
  • Being afraid they are having a heart attack.
  • Being afraid they are "going crazy."

A panic attack may last for several minutes or longer. There may be feelings of discomfort that last for several hours after the attack. Panic attacks are treated with medicine and talk therapy.

Obsessive-compulsive disorder

Obsessive-compulsive disorder is rare in patients with cancer who did not have the disorder before being diagnosed with cancer.

Obsessive-compulsive disorder is diagnosed when a person uses persistent (obsessive) thoughts, ideas, or images and compulsions (repetitive behaviors) to manage feelings of distress. The obsessions and compulsions affect the person's ability to work, go to school, or be in social situations. Examples of compulsions include frequent hand washing or constantly checking to make sure a door is locked. Patients with obsessive-compulsive disorder may be unable to follow through with cancer treatment because of these thoughts and behaviors. Obsessive-compulsive disorder is treated with medicine and individual (one-to-one) counseling.

Post-traumatic stress disorder

See the PDQ summary on Post-traumatic Stress Disorder for information about this condition.

Generalized anxiety disorder

Patients with generalized anxiety disorder may feel extreme and constant anxiety or worry. For example, patients with supportive family and friends may fear that no one will care for them. Patients may worry that they cannot pay for their treatment, even though they have enough money and insurance.

A person who has generalized anxiety may feel irritable, restless, or dizzy, have tense muscles, shortness of breath, fast heart beat, sweating, or get tired quickly. Generalized anxiety disorder sometimes begins after a patient has been very depressed.

There are different kinds of treatment for anxiety disorders.

There are different types of treatment for patients with anxiety disorders, including methods to manage stress. Ways to manage stress include the following:

  • Deal with the problem directly.
  • See the situation as a problem to solve or a challenge.
  • Get all of the information and support needed to solve the problem.
  • Break big problems or events into smaller problems or tasks.
  • Be flexible. Take situations as they come.

Patients with anxiety disorders need information and support to understand their cancer and treatment choices. Psychological treatments for anxiety can also be helpful. These include the following:

  • Individual (one-to-one) counseling.

  • Couple and family counseling.

  • Crisis counseling.

  • Group therapy.

  • Self-help groups.

Other treatments used to lessen the symptoms of anxiety include the following:

Using different methods together may be helpful for some patients. (See the Psychological and Social Distress section of this summary for more information.)

Medicine may be used alone or combined with other types of treatment for anxiety disorders.

Antianxiety medicines may be used if the patient doesn’t want counseling or if it’s not available. These medicines relieve symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle tightness. They may relieve daytime distress and reduce insomnia. These medicines may be used alone or combined with other therapies.

Although some patients are afraid they may become addicted to antianxiety medicines, this is not a common problem in cancer patients. Enough medicine is given to relieve symptoms and then the dose is slowly lowered as symptoms begin to get better.

Studies show that antidepressants are useful in treating anxiety disorders. Children and teenagers being treated with antidepressants have an increased risk of suicidal thinking and behavior and must be watched closely. (See the Treatment section of the PDQ summary on Depression for more information.)

Current Clinical Trials

Check NCI’s list of cancer clinical trials for U.S. supportive and palliative care trials about anxiety disorder that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.