Anxiety, Worries and Fears
Anxiety in cancer is common and occurs at various points across the cancer journey. Anxiety in cancer patients can be associated with the stress related to the diagnosis, treatment plan, change in roles, fear and uncertainty about the future, fear of death, lifestyle changes, body changes, fear of recurrence, "scanxiety" or anxiety related to routine cancer screening tests, and financial concerns.
Anxiety is the body's natural response to real or perceived threat. Feeling anxious is the body's response to dangerous or stressful situations. Anxiety is a defensive mechanism that manages our fight or flight reaction. Anxiety can help the individual to process threats and cope or avoid real or perceived dangers. Anxiety can also be challenging, manifesting as obsessive thoughts, worry, rumination, avoidance, fear, hypervigilance and panic. Anxiety impacts the body systemically. It can cause "symptoms," impacting your:
- Cognition: Feeling like the walls are closing in or that you are trapped, or that going outside or your home is unsafe; cannot focus on anything other than the threat.
- Affect: Feeling emotions such as worry, nervousness, terror, or fear.
- Behavior: Avoidant, immobility, inability to speak, crying, or screaming.
- Physical well-being: Palpitations, fainting, shortness of breath, tremor, muscle tightness, restless, abdominal discomfort, loss of appetite, nausea, vomiting, diarrhea, sweating, shivering, feeling itchy, hot, or cold.
Anxiety is a problem when it does not go away, interferes with daily activities, or does not respond to behavior modifications techniques.
Anxiety is treated through a combination of behavioral and medical interventions. Understanding your cancer diagnosis, treatment, and expected side effects can be helpful in reducing anxiety.
The following tips can also help reduce your anxiety, especially when your anxiety is associated with "a fear of the unknown:"
- Ask questions about procedures so you know what to expect.
- Ask for written materials about your diagnosis, treatment and potential side effects.
- Connect with peers who have experienced a similar diagnosis and learn what helped them through treatment.
- Talk to your support network about your worries, concerns, fears and hopes.
- Be aware of potential anxiety triggers; for example, you may have a fear of needles and the idea of having IV’s placed weekly triggers an anxious response.
- Regular physical activity releases natural pheromones that combat anxious feelings.
- Reduce alcohol, caffeine and nicotine intake. Don’t rely on substances to help manage your symptoms.
- Use relaxation techniques when facing anxiety-provoking situations. These may include meditation, deep breathing, listening to your favorite music, prayer, etc. Find what works best for you.
- Consider a referral to a cognitive-behavioral therapist who specializes in the treatment of anxiety and adjustment disorders. These therapists focus on reframing thoughts, deep breathing, guided imagery, hypnosis, relaxation and meditation to help manage anxiety.
- Prescription anti-anxiety medications can be very helpful in the management of situational and adjustment related anxiety.
When to contact your care team
If you are having anxiety that is limiting your ability to perform or enjoy normal activities or is interfering with your sleep, concentration or appetite, talk to your care team.
Severe anxiety can result in a panic attack. Symptoms associated with a panic attack mimic symptoms associated with a heart attack including heart palpitations (racing heartbeats that you can feel), shortness of breath and sweating. If you think you are having a panic attack, contact your care team.
Resources for further reading:
Anxiety, fear and cancer – The American Cancer Society
Anxiety resources – CancerCare
Anxiety – Cancer.net
Levin TT, Alici Y. Anxiety Disorders. In Holland J et. al. editors. Psycho-oncology. 2nd edition, New York: Oxford; 2010.
Linden W, Vodermaier A, MacKenzie R, Greig D. (2012). Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age. Journal of Affective Disorders. 2012; 141(2): 343-351.