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Adjustment to Cancer: Anxiety and Distress

Anxiety Disorders

Anxiety disorders are very strong fears that may be caused by physical or psychological stress.

Studies show that almost half of all patients with cancer say they feel some anxiety and about one-fourth of all patients with cancer say they feel a great deal of anxiety. Patients living with cancer find that they feel more or less anxiety at different times. A patient may become more anxious as cancer spreads or treatment becomes more intense.

For some patients feelings of anxiety may become overwhelming and affect cancer treatment. This is especially true for patients who had periods of intense anxiety before their cancer diagnosis. Most patients who did not have an anxiety condition before their cancer diagnosis will not develop an anxiety disorder related to the cancer.

Patients are more likely to have anxiety disorders during cancer treatment if they have any of the following:

Anxiety disorders may be hard to diagnose.

It may be hard to tell the difference between normal fears related to cancer and abnormally severe fears that can be described as an anxiety disorder. The diagnosis is based on how symptoms of anxiety affect the patient's quality of life, what kinds of symptoms have developed since the cancer diagnosis or treatment, when the symptoms occur, and how long they last.

Anxiety disorders cause serious symptoms that affect day-to-day life, including:

There are different causes of anxiety disorders in cancer patients.

In addition to anxiety caused by a cancer diagnosis, the following may cause anxiety in patients with cancer:

Anxiety from these causes is usually managed by treating the cause itself.

A cancer diagnosis may cause anxiety disorders to come back in patients with a history of them.

When patients who had an anxiety disorder in the past are diagnosed with cancer, then the anxiety disorder may come back. These patients may feel extreme fear, be unable to remember information given to them by caregivers, or be unable to follow through with medical tests and procedures. They may have symptoms including:

Patients with cancer may have the following types of anxiety disorders:

Phobia

Phobias are fears about a situation or an object that lasts over time. People with phobias usually feel intense anxiety and avoid the situation or object they are afraid of. For example, patients with a phobia of small spaces may avoid having tests in small spaces, such as magnetic resonance imaging (MRI) scans.

Phobias may make it hard for patients to follow through with tests and procedures or treatment. Phobias are treated by professionals and include different kinds of therapy.

Panic disorder

Patients with panic disorder feel sudden intense anxiety, known as panic attacks. Symptoms of panic disorder include the following:

A panic attack may last for several minutes or longer. There may be feelings of discomfort afterwards that last for several hours. Panic attacks are treated with medicine and talk therapy.

Obsessive-compulsive disorder

Obsessive-compulsive disorder is rare in patients with cancer who did not have the disorder before being diagnosed with cancer.

Obsessive-compulsive disorder is diagnosed when a person uses persistent (obsessive) thoughts, ideas, or images and compulsions (repetitive behaviors) to manage feelings of distress. The obsessions and compulsions affect the person's ability to work, go to school, or be in social situations. Examples of compulsions include frequent hand washing or constantly checking to make sure a door is locked. Patients with obsessive-compulsive disorder may be unable to follow through with cancer treatment because of these thoughts and behaviors. Obsessive-compulsive disorder is treated with medicine and individual (one-to-one) counseling.

Post-traumatic stress disorder

See the PDQ summary on Post-traumatic Stress Disorder for information about this condition.

Generalized anxiety disorder

Patients with generalized anxiety disorder may feel extreme and constant anxiety or worry. For example, patients with supportive family and friends may fear that no one will care for them. Patients may worry that they cannot pay for their treatment, even though they have enough money and insurance.

A person who has generalized anxiety may feel irritable, restless, or dizzy, have tense muscles, shortness of breath, fast heart beat, sweating, or get tired quickly. Generalized anxiety disorder sometimes develops after a patient has been very depressed.

There are different kinds of treatment for anxiety disorders.

There are different types of treatment for patients with anxiety disorders, including methods to manage stress. Ways to manage stress include the following:

Patients with anxiety disorders need information and support to understand their cancer and treatment choices. Psychological treatments for anxiety can also be helpful. These include:

Other treatments used to lessen the symptoms of anxiety include:

Using different methods together may be helpful for some patients. (See the Psychological and Social Distress section of this summary for more information.)

Medicine may be used alone or combined with other types of treatment for anxiety disorders.

Antianxiety medicines may be used if the patient doesn’t want counseling or if it’s not available. These medicines relieve symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle tightness. They may relieve daytime distress and reduce insomnia. These medicines may be used alone or combined with other therapies.

Although some patients are afraid they may become addicted to antianxiety medicines, this is not a common problem in cancer patients. Enough medicine is given to relieve symptoms and then the dose is slowly lowered as symptoms begin to get better.

Studies show that antidepressants are useful in treating anxiety disorders. Children and teenagers being treated with antidepressants have an increased risk of suicidal thinking and behavior and must be watched closely. (See the Treatment section of the PDQ summary on Depression for more information.)