Coping With Anxiety, Worries and Fears As A Family

What is anxiety?

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, and follow-up plan, change in roles, fear and uncertainty about the future, and financial concerns. Anxiety not only occurs in the cancer patient but also in supporting family members and caregivers who are going through the experience with their loved ones.

Feeling anxious is the body's response to dangerous or stressful situations. Anxiety is a defense 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.

Anxiety Symptoms

Anxiety symptoms can impact our emotions, our behavior, and our physical well-being.

• 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, tremors, muscle tightness, restlessness, abdominal discomfort, loss of appetite, nausea, vomiting, diarrhea, sweating, shivering, feeling itchy, hot, or cold.

Children with cancer may also experience anxiety related to medical procedures and separation from family and friends while hospitalized. It is important to work with your care team to identify strategies to help your child cope with their anxiety. Your care team can help educate your child about what will happen during a procedure as well as provide distraction techniques and activities.

Anxiety is a problem when it does not go away, interferes with daily activities, or does not respond to behavior modification techniques.

Management of Anxiety

Anxiety is treated through a combination of behavioral and medical interventions. Understanding your child’s cancer diagnosis, treatment, and expected side effects can be helpful in reducing anxiety amongst all family members.

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 and your child know what to expect.
• Ask for written materials or referrals to trusted websites about the diagnosis, treatment, and potential side effects.
• Connect with other parents whose children have experienced a similar diagnosis and learn what helped them through treatment.
• Encourage your child to connect with peers at their treatment sites. Child life specialists, recreation therapists, and other ancillary staff can help facilitate peer connections through common activities at the cancer treatment center or through online groups.
• Who is your touchstone; the person you can tell anything to with no worry about judgment? Share your experience with that person. Don’t bottle up your worries and fears. Encourage your child to share their worries too.
• Be aware of potential anxiety triggers; for example, your child may have a fear of needles, and the idea of having IVs placed weekly triggers an anxious response. Work closely with the cancer care team to strategize and employ methods to decrease procedure-related anxiety.
• Regular physical activity releases natural pheromones that combat anxious feelings.
• Caregivers should 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 and your child. A psychologist, social worker, or therapist can help teach you some of these techniques and provide more resources to get you started with relaxation and mindfulness.
• 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. Ask your child’s care team if these may be helpful. For parents, talk with your primary care provider about what is happening with your child and your anxiety symptoms.
• It’s important to talk as a family about fears, worries, and anxiety. Include siblings, grandparents, and friends. A child with cancer may be most anxious about staying alone overnight in the hospital, whereas their sibling is anxious that their parents won’t be able to come to their softball game because they are at the hospital. All of these different experiences of anxiety are valid and impact the family constellation.
• Pay special attention to your child’s experiences at school and with peers. Multiple absences from school, struggling with school work as a result of treatment side effects, being bald or having other obvious physical signs of illness, and returning to school after a prolonged absence can all be challenging times for kids coping with cancer. Talk with school counselors, teachers, and other parents and work together to plan the best methods to support your child at school.

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 the 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 More Information

Anxiety, fear, and cancer – The American Cancer Society

Anxiety resources – CancerCare

Anxiety – Cancer.net

American Childhood Cancer Organization Resources for Kids

Preparing Your Child for Medical Procedures/American Society of Clinical Oncology

Children with Cancer: A Guide for Parents

Anxiety Around Medical Procedures/CureSearch