Some people 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 disorder, such as major depression.
This summary describes the milder levels of distress in adults with cancer, including:
Nearly half of people with cancer report having a lot of distress. In general, the type of cancer does not make a difference in the amount of distress reported. Factors that increase the risk of anxiety and distress are not always related to the cancer.
Risk factors for high levels of distress in people with cancer include:
People who have a high level of distress when they are diagnosed with cancer are more likely to have continued high levels of distress after their diagnosis.
Screening is usually done by asking about how you feel, your energy level, relationships, work, and finances. Your doctor may refer you to a social worker, mental health professional, palliative care specialist, or pastoral counselor for further evaluation and therapy.
For information on depression and post-traumatic stress related to cancer, visit:
The way people with cancer cope is usually linked to their personality traits (such as whether they usually expect the best versus the worst, or if they are shy versus outgoing).
You may find it easier to adjust if you carry on with your usual routine and work, and keep doing activities that matter to you. People who adjust well to coping with cancer continue to find meaning and importance in their lives. People who do not adjust well may withdraw from relationships or situations and feel hopeless.
If you are having trouble coping with cancer you may find it helpful to talk with a professional about your concerns and worries. These specialists include:
Distress can occur when you feel you are unable to manage or control changes caused by cancer. People with the same diagnosis or treatment can have different levels of distress. People have less distress when they feel the demands of the diagnosis and treatment are low or the amount of support they get is high. For example, a health care professional can help the person adjust to the side effects of chemotherapy by giving medicine for nausea.
Living with a diagnosis of cancer involves many life adjustments. Normal adjustment involves learning to cope with emotional distress and solve problems caused by having cancer.
The coping skills needed will change at different points in your cancer journey, such as when you:
The process of adjusting to cancer begins before people hear the diagnosis. You may feel worried and afraid when you have unexplained symptoms or are having tests done to find out if you have cancer.
A diagnosis of cancer can cause people to have more distress when their fears become true. It may be difficult for people to understand what the doctors are telling them during this time. For more information, see Communication in Cancer Care.
Additional help from health professionals for problems such as fatigue, trouble sleeping, and depression may be needed during this time.
As people go through cancer treatment, they use coping skills (also known as coping strategies) to adjust to the stress of treatment.
Adjusting to cancer treatment might involve coping skills that help the person change their thoughts or behaviors. For example, changing a daily routine or work schedule to manage the side effects of cancer treatment is a coping skill.
People will be glad when treatment has ended but may feel increased anxiety as they see their treatment team less often. Other concerns include returning to work and family life and being worried about any change in their health.
During remission, people may become distressed before follow-up medical visits because they worry that the cancer has come back. Waiting for test results can be very stressful.
Cancer that comes back after treatment may cause an increase in distress from having:
A person's quality of life may be improved if they are able to manage their cancer and have support from friends and family.
Sometimes cancer comes back or does not get better with treatment. The treatment plan then changes from one that is meant to cure the cancer to one that gives comfort and relieves symptoms. This may cause the person to have an increase in anxiety or depression. For more information, visit Depression and Cancer-Related Post-Traumatic Stress.
People who adjust to the return of cancer often keep up hope in meaningful life activities. Some people look to spirituality or religious beliefs to help keep up their quality of life. For more information, visit Spirituality in Cancer Care.
People adjust to finishing cancer treatment and being long-term cancer survivors over many years. Some common problems reported by cancer survivors as they face the future include:
Regular exercise and individual or group counseling may help improve these problems and the person's quality of life.
Most people adjust well and some even say that surviving cancer has given them a greater appreciation for life, a better understanding of what is most important in their life, and stronger spiritual or religious beliefs.
Some people may have more trouble adjusting because of medical problems, fewer friends and family members who give support, money problems, or mental health problems not related to the cancer.
Almost all people living with cancer have feelings of distress. Feelings of distress range from sadness and fears to more serious problems such as depression, anxiety, panic, feeling uncertain about spiritual beliefs, or feeling alone or separate from friends and family.
People who are in distress during any phase of cancer need treatment and support. People are more likely to need to be checked and treated for distress:
Studies have shown that people who are having trouble adjusting to cancer are helped by treatments that give them emotional and social support, including:
Benefits from these therapies include having lower levels of depression, anxiety, and cancer- and treatment-related symptoms, as well as feeling more hopeful.
An adjustment disorder occurs when a person's reaction to a stressful event:
Stressful events for people with cancer include diagnosis, treatment, cancer recurrence, and when side effects occur. People who have trouble coping with these events may develop an adjustment disorder. An adjustment disorder usually begins within 3 months of a stressful event.
Individual (one-to-one) and group counseling have been shown to help people with cancer who have adjustment disorders. Counseling may include treatment that focuses on the person's thoughts, feelings, and behaviors.
Other activities that may help people cope include:
People who are having trouble adjusting to cancer should try counseling before medicine. Counseling may not help everyone, and some people may have a mental health disorder, such as severe anxiety or major depression. These people may need antianxiety or antidepressant medicine along with counseling. Learn more about Depression.
Studies show that almost half of all people with cancer say they feel some anxiety and about one-fourth of all people with cancer say they feel a great deal of anxiety. A person may become more anxious as cancer spreads or treatment becomes more aggressive.
For some people, anxiety may feel like it is more than they can handle and this may affect their cancer treatment.
Symptoms of anxiety disorders include:
People are more likely to have anxiety disorders during cancer treatment if they have:
An anxiety disorder diagnosis is based on how symptoms of anxiety affect the person'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 can affect day-to-day life in many ways, such as:
In addition to anxiety caused by a cancer diagnosis, other causes of anxiety disorder in people with cancer may include:
Anxiety from these causes is usually managed by treating the cause of the anxiety.
People who have intense fear, have trouble understanding information about their cancer, or are unable to cooperate with medical tests should be screened for the following types of anxiety disorders:
People with cancer who have OCD may be unable to follow through with treatment because of persistent thoughts and behaviors. They may also have obsessive thoughts about their cancer coming back. OCD is rare in people with cancer who did not have an anxiety disorder before being diagnosed with cancer.
People with anxiety disorders need information and support to understand their cancer and treatment choices. Some helpful psychological treatments may include:
Using different methods together may be helpful for some people. For more information, visit the Psychological and Social Distress section.
Antianxiety medicines may be used alone or combined with other psychological therapies. These medicines relieve symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle tightness. They may relieve daytime distress and lessen trouble sleeping.
Studies show that antidepressants are useful in treating anxiety disorders. Children and teenagers being treated with antidepressants have an increased risk of thinking about suicide and must be watched closely. For more information, visit the Treatment section in Depression.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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This PDQ cancer information summary has current information about normal adjustment issues, and the pathophysiology and treatment of psychosocial distress and the adjustment disorders. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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PDQ® Supportive and Palliative Care Editorial Board. PDQ Adjustment to Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389325]
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