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Anxiety

Introduction

  • Anxiety has been described as vague, uneasy or unpleasant feelings of potential harm or distress, in addition to an arousal that is due to real or perceived threats to physical or mental well-being. It is a highly personal experience that may be affected by past feelings and situations.
  • In addition to depression, anxiety is one of the most commonly identified responses to the cancer experience.
  • Some degree of anxiety is normal for families facing a life threatening illness. However, anxiety that is poorly controlled can interfere with effective coping.
  • Anxiety may be acute or chronic. Acute anxiety may be related to the stress of the cancer and its treatment. Chronic anxiety generally predates the cancer diagnosis but may be exacerbated during the treatment.
  • When patients pass from one phase of their life-threatening disease to another, they can develop anxiety or fear as a normal reaction to this process, as can their caregivers. The individuals must be assessed in order to distinguish normal fear from the anxiety of an adjustment disorder.
  • This distinction can be made based on duration and intensity of symptoms as well as the degree of functional impairment. If levels of anxiety are viewed as intolerable by the individual, or if they persist for several weeks or months, psychiatric treatment may be necessary.

Assessment

  • Signs and symptoms of anxiety can include:
    • verbal expression of anxiety
    • verbal denial of obvious tension or anxiety
    • difficulty solving problems
    • feeling excitable
    • increased muscle tension (appear tense)
    • trembling and shaking
    • headaches
    • getting angry
  • Because anxiety can also be a manifestation of depression, individuals need to be assessed to differentiate between anxiety and depression (see Depression module to assess for depression).
  • Do a pain assessment to assess degree of control of pain and impact of pain on symptoms of anxiety (see Pain module).
  • Review all medications to determine whether anxiety is linked to medications.
  • Assess the degree of impairment caused by the anxiety, including functional ability and self care activities.
  • Assess for hypoxia and fecal impaction as potential souces/contributors to anxiety.

Interventions

  • A calm, reassuring approach when communicating with the individual may help to lessen the sense of anxiety.
  • Various treatment regimens may be used individually or in combination with one another. These include: social support, counseling and psychotherapy, education, cognitive and behavioral techniques, and medications.
  • Identification of support systems and efforts to strengthen those support systems are essential to the treatment of anxiety.
  • Consider referral to social worker, support groups, chaplain or rabbi, or psychological counseling.
  • Cognitive and behavioral techniques include hypnosis, biofeedback, music therapy, mental imagery, distraction, relaxation techniques and meditation.
  • Relief from physical symptoms may relieve anxiety in the physically ill. This includes aggressive symptom management, pain control, and treatment of hypoxia.
  • The most commonly used medications for anxiety in cancer patients are the benzodiazepines. The shorter acting drugs are preferred for individuals receiving other sedating medications.

References

Gobel, BH "Anxiety" in Groenwald, SL, Frogge, MH, Goodman, M, Yarbro, CH (1996) Cancer Symptom Management Boston: Jones and Bartlett.

Depression Awareness, Recognition and Treatment (D/ART) Campaign: National Institute of Mental Health, 1997. (800) 421-4211.





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