Anxiety and Cancer

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Approved by the Cancer.Net Editorial Board, 03/2016
Anxiety may be described as feeling nervous, on edge, or worried. It is a normal emotion that alerts your body to respond to a threat. However, intense and prolonged anxiety is a disorder. And it may interfere with your daily activities and relationships. Acute anxiety occurs in short episodes that end quickly. Chronic anxiety remains over time. Anxiety symptoms may be mild or severe. And some of the symptoms may be similar to those of depression. Often, this is because depression occurs along with anxiety.

Various Emotion Forms
Below is a list of various forms of emotions patients suffer from:
* Coping With Anger
* Coping With Guilt
* Coping With Uncertainty
* Managing Stress
* Enxiety
* Fear Related Side Effects
* Grief And Loss
* Self Image And Cancer

Anxiety and cancer
Many people with cancer experience symptoms of anxiety. A cancer diagnosis may trigger these feelings:
• Fear of treatment or treatment-related side effects
• Fear of cancer returning or spreading after treatment
• Uncertainty
• Worry over losing independence
• Concern about having relationships change
• Fear of death
Anxiety may make it harder to cope with cancer treatment. It may also interfere with your ability to make choices about your care. As a result, identifying and managing anxiety are important parts of cancer treatment.

Acute anxiety symptoms
You may frequently experience short periods of the symptoms listed below. A panic attack is when a person has all of these symptoms at once:
• A feeling of intense fear or dread
• A feeling of detachment from yourself or your surroundings
• Heart palpitations or rapid heartbeat
• High blood pressure
• Chest pain
• Shortness of breath
• A feeling of suffocation
• Sweating
• Chills
• Dizziness or lightheadedness
• Trembling
• Nausea, diarrhea, heartburn, or a change in appetite
• Abdominal pain

Chronic anxiety symptoms
Chronic anxiety may include acute anxiety episodes, along with one or more of the following symptoms. They typically last for a longer time:
• Excessive worrying
• Restlessness
• Muscle tension
• Insomnia, which is the inability to fall asleep or stay asleep.
• Irritability
• Fatigue
• Difficulty concentrating
• Indecision, which means having difficulty making decisions
It is important to tell your doctor or another member of your health care team if you experience any of these symptoms. However, such symptoms are not necessarily related to anxiety. Some may be side effects of the cancer or cancer treatment. For example, fatigue, insomnia, and difficulty concentrating are common side effects of cancer and cancer treatment.

Risk factors for anxiety
People with cancer are more likely to experience anxiety if they have these risk factors:
• Previous diagnosis of anxiety or depression
• Family history of anxiety or depression
• Lack of support of friends or family
• Financial burdens

Screening for anxiety
The American Society of Clinical Oncology (ASCO) recommends screening for anxiety. Screenings should occur when you receive a cancer diagnosis and at regular periods during your treatment and recovery.
Treatment recommendations will depend on how many anxiety symptoms you have and how often you experience them. Although it may be difficult to explain, communicate your experience to your health care team. This will help them address your concerns and create a treatment plan. Make sure to include the following:
• Your feelings
• Specific sources of your fears
• Physical symptoms
• The effect on your daily life

Treatment types
There are a variety of ways to cope with anxiety. Many are used together. Talk with your doctor or a professional counselor to find the best options for you.
• Relaxation techniques: Relaxation techniques may be used alone or to supplement other types of treatment. Some of the following methods may be done with little guidance. Others may require the help of an instructor.
• Deep breathing
• Progressive muscle relaxation: This is a technique that involves tightening and then relaxing muscles. You begin at the toes or the head and progressively relax the muscles across the body.
• Guided imagery.
This is the use of words and sounds to help you imagine positive settings, experiences, and feelings.
• Meditation: This is a practice of focusing attention in one direction to achieve a sense of grounding in the present moment and reduce stress.
• Hypnosis
• Biofeedback. This involves paying attention to and controlling signals from the body, such as heart rate. Signals from the body are measured with painless electrical sensors, called electrodes.
• Yoga. This is the use of breathing and posture exercises to promote relaxation.
• Psychological Treatment
Mental health professionals include licensed counselors, psychologists, and psychiatrists. They provide tools to improve coping skills, develop a support system, and reshape negative thoughts. Options include individual therapy, couples or family therapy, and group therapy. Additionally, psychiatrists are the mental health professionals who can prescribe medications (see below).
• Medication: If your anxiety symptoms are moderate to severe, you may benefit from medication. Different types of medications are available.
Your doctor will select the most appropriate medication based on these factors:
• Your needs
• Potential side effects
• Other medications you take
• Your medical history

Tell your doctor about all cancer-related medications and supplements you take. Some may interfere with types of anti-anxiety medications. Some people experience improvement 2 weeks after starting medication. However, it often takes up to 6 to 8 weeks for the medication to have full effect. Medication may not sufficiently treat anxiety unless it is combined with psychological treatment.

After a referral to a mental health professional, your oncologist will likely want to talk with you about your treatment’s effectiveness and side effects. If anxiety symptoms have not decreased after 8 weeks of treatment:
• Consider other treatment options, such as trying medication or switching to a different type of medication
• Consider adding counseling to your treatment plan, if you haven’t already
You and your doctor can address these options earlier, if necessary.

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