Anxiety Disorders
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 develop 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 have developed 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:
- Pain: Patients whose pain is not well controlled with medicine feel anxious, and anxiety can increase pain.
- Other medical problems: Anxiety may be a warning sign of a change in metabolism (such as low blood sugar), a heart attack, severe infection, pneumonia, or a blood clot in the lung. Sepsis and electrolyte imbalances can also cause anxiety.
- Certain types of tumors: Certain hormone -releasing tumors can cause symptoms of anxiety and panic attacks. Tumors that have spread to the brain and spinal cord and tumors in the lungs can cause other health problems with symptoms of anxiety.
- Taking certain drugs: Certain types of drugs, including corticosteroids, thyroxine, bronchodilators, and antihistamines, can cause restlessness, agitation, or anxiety.
- Withdrawing from habit-forming drugs: Withdrawal from alcohol, nicotine, opioids, or antidepressant medicine can cause agitation or anxiety.
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:
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.
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 afterwards that last for several hours. Panic attacks are treated with medicine and talk therapy.
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 1 for information about this condition.
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 develops 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:
- 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:
- Hypnosis.
- Meditation.
- Relaxation training.
- Guided imagery.
- Biofeedback.
Using different methods together may be helpful for some patients. (See the Psychological and Social Distress 2 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 3 section of the PDQ summary on Depression 4 for more information.)
Glossary Termsabnormal (ab-NOR-mul)Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).agitation (A-jih-TAY-shun) A condition in which a person is unable to relax and be still. The person may be very tense and irritable, and become easily annoyed by small things. He or she may be eager to have an argument, and be unwilling to work with caregivers to make the situation better.alcohol (AL-kuh-hol) A chemical substance found in beer, wine, and liquor, and some medicines, mouthwashes, household products, and essential oils (scented liquid taken from plants). Alcohol contains a carbon atom attached to a hydroxyl group (a molecule made of an oxygen atom and a hydrogen atom).antianxiety agent (AN-tee-ang-ZY-eh-tee AY-jent) A drug used to treat symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle tightness, that may occur as a reaction to stress. Most antianxiety agents block the action of certain chemicals in the nervous system. Also called anxiolytic and anxiolytic agent.antidepressant (AN-tee-dee-PREH-sunt) A drug used to treat depression.antihistamine (AN-tee-HIS-tuh-meen) A type of drug that blocks the action of histamines, which can cause fever, itching, sneezing, a runny nose, and watery eyes. Antihistamines are used to prevent fevers in patients receiving blood transfusions and to treat allergies, coughs, and colds.anxiety (ang-ZY-eh-tee) Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.biofeedback (BY-oh-FEED-bak) A method of learning to voluntarily control certain body functions such as heartbeat, blood pressure, and muscle tension with the help of a special machine. This method can help control pain.blood clot (blud klot) A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.blood sugar (blud SHUH-ger) Glucose (a type of sugar) found in the blood. Also called glycemia.bronchodilator (BRON-koh-DY-lay-ter) A type of drug that causes small airways in the lungs to open up. Bronchodilators are inhaled and are used to treat breathing disorders, such as asthma or emphysema.cancer (KAN-ser) A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.caregiver (KAYR-gih-ver) A person who gives care to people who need help taking care of themselves. Examples include children, the elderly, or patients who have chronic illnesses or are disabled. Caregivers may be health professionals, family members, friends, social workers, or members of the clergy. They may give care at home or in a hospital or other health care setting.compulsion (kum-PUL-zhun) An uncontrollable urge to say or do something without an obvious reason. A person may repeat a behavior, such as hand-washing, over and over.condition (kun-DIH-shun) In medicine, a health problem with certain characteristics or symptoms.corticosteroid (KOR-tih-koh-STAYR-oyd) Any steroid hormone made in the adrenal cortex (the outer part of the adrenal gland). They are also made in the laboratory. Corticosteroids have many different effects in the body, and are used to treat many different conditions. They may be used as hormone replacement, to suppress the immune system, and to treat some side effects of cancer and its treatment. Corticosteroids are also used to treat certain lymphomas and lymphoid leukemias.counseling (KOWN-suh-ling) The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.depression (dee-PREH-shun) A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.diagnosis (DY-ug-NOH-sis) The process of identifying a disease, such as cancer, from its signs and symptoms.disorder (dis-OR-der) In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.distraction (dis-TRAK-shun) In medicine, a pain relief method that takes the patient's attention away from the pain.distress (dih-STRESS) Extreme mental or physical pain or suffering.dose (dose) The amount of medicine taken, or radiation given, at one time.drug (drug) Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.electrolyte (ee-LEK-troh-lite) A substance that breaks up into ions (particles with electrical charges) when it is dissolved in water or body fluids. Some examples of ions are sodium, potassium, calcium, chloride, and phosphate. These ions help move nutrients into cells, help move waste out of cells, and help nerves, muscles, the heart, and the brain work the way they should.generalized anxiety disorder (JEH-neh-ruh-lized ang-ZY-eh-tee dis-OR-der) A condition marked by excessive worry and feelings of fear, dread, and uneasiness that last six months or longer. Other symptoms of generalized anxiety disorder include being restless, being tired or irritable, muscle tension, not being able to concentrate or sleep well, shortness of breath, fast heartbeat, sweating, and dizziness. Also called GAD.guided imagery (GY-did IH-muh-jree) A technique in which a person focuses on positive images in his or her mind. It can help people reach a relaxed, focused state and help reduce stress and give a sense of well-being. Also called imagery.hormone (HOR-mone) One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.hypnosis (hip-NOH-sis) A trance-like state in which a person becomes more aware and focused and is more open to suggestion.infection (in-FEK-shun) Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.insomnia (in-SOM-nee-uh) Difficulty in going to sleep or getting enough sleep.lung (lung) One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.magnetic resonance imaging (mag-NEH-tik REH-zuh-nunts IH-muh-jing) A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. Magnetic resonance imaging makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. Magnetic resonance imaging is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called MRI, NMRI, and nuclear magnetic resonance imaging.medicine (MEH-dih-sin) Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.metabolism (meh-TA-buh-lih-zum) The chemical changes that take place in a cell or an organism. These changes make energy and the materials cells and organisms need to grow, reproduce, and stay healthy. Metabolism also helps get rid of toxic substances.nicotine (NIH-kuh-TEEN) An addictive, poisonous chemical found in tobacco. It can also be made in the laboratory. When it enters the body, nicotine causes an increased heart rate and use of oxygen by the heart, and a sense of well-being and relaxation. It is also used as an insecticide.obsessive-compulsive disorder (ob-SEH-siv-kum-PUL-siv dis-OR-der) An anxiety disorder in which a person has intrusive ideas, thoughts, or images that occur repeatedly, and in which he or she feels driven to perform certain behaviors over and over again. For example, a person may worry all the time about germs and so will wash his or her hands over and over again. Having an obsessive-compulsive disorder may cause a person to have trouble carrying out daily activities.opioid (OH-pee-OYD) A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.panic (PA-nik) Sudden extreme anxiety or fear that may cause irrational thoughts or actions. Panic may include rapid heart rate, flushing (a hot, red face), sweating, and trouble breathing.PDQ PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.phobia (FOH-bee-uh) An extreme, irrational, fear of something that may cause a person to panic. Examples of common phobias include fear of spiders, flying in an airplane, elevators, heights, enclosed rooms, crowded public places, and embarrassing oneself in front of other people.pneumonia (noo-MOH-nyuh) A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.psychological (SY-koh-LAH-jih-kul) Having to do with how the mind works and how thoughts and feelings affect behavior.quality of life (KWAH-lih-tee ... life) The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.relaxation technique (ree-lak-SAY-shun tek-NEEK) A method used to help reduce muscle tension and stress, lower blood pressure, and control pain. Examples of relaxation techniques include tensing and relaxing muscles throughout the body, guided imagery (focusing the mind on positive images), meditation (focusing thoughts), and deep breathing exercises.scan (skan) A picture of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body.sepsis (SEP-sis) The presence of bacteria or their toxins in the blood or tissues.spinal cord (SPY-nul kord) A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.stomach (STUH-muk) An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.stress (stres) The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.suicide (SOO-ih-SIDE) The act of taking one's own life on purpose.symptom (SIMP-tum) An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.talk therapy (...THAYR-uh-pee) Treatment of mental, emotional, personality, and behavioral disorders using methods such as discussion, listening, and counseling. Also called psychotherapy.therapy (THAYR-uh-pee) Treatment.thyroxine (thy-ROK-seen) A hormone that is made by the thyroid gland and contains iodine. Thyroxine increases the rate of chemical reactions in cells and helps control growth and development. Thyroxine can also be made in the laboratory and is used to treat thyroid disorders. Also called L-3,5,5’-tetraiodothyronine, T4, and thyroxin.trauma (TRAW-muh) Injury to the body, or an event that causes long-lasting mental or emotional damage.tumor (TOO-mer) An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm. |
