Anxiety and cancer

Patients living with cancer often feel many different emotions, including anxiety and distress.

• Anxiety is fear, dread and uneasiness caused by stress.
• Distress is emotional, mental, social or spiritual suffering. Patients who are distressed may have a range of feelings from vulnerability and sadness to depression, anxiety, panic and isolation.

It's not uncommon for patients to experience feelings of anxiety and distress before, during and after treatment, including: while being screened for cancer, waiting for the results of tests, receiving a cancer diagnosis, being treated for cancer or worrying that cancer will recur (come back.)

Anxiety and distress may affect your ability to cope with a cancer diagnosis or treatment. This may cause you to miss check-ups or delay treatment. Anxiety may increase pain, affect sleep, and cause nausea and vomiting. Even mild anxiety can affect your quality of life and may need to be treated.

Some patients living with cancer have a low level of distress and others have higher levels of distress. The level of distress ranges from being able to adjust to living with cancer to having a serious mental health problem, such as major depression. However, most patients with cancer do not have signs or symptoms of any specific mental health problem.

Less severe levels of distress in patients living with cancer often include:

Normal adjustment: A condition in which a person makes changes in his or her life to manage a stressful event such as a cancer diagnosis. In normal adjustment, a person learns to cope well with emotional distress and solve problems related to cancer.

Psychological and social distress: A condition in which a person has some trouble making changes in their life to manage a stressful event such as a cancer diagnosis. Help from a professional to learn new coping skills may be needed.

Adjustment disorder: A condition in which a person has a lot of trouble making changes in his or her life to manage a stressful event such as a cancer diagnosis. Symptoms such as depression, anxiety, or other emotional, social, or behavioral problems occur and worsen the person's quality of life. Medicine and help from a professional to make these changes may be needed.

Anxiety disorder: A condition in which a person has extreme anxiety. It may be because of a stressful event like a cancer diagnosis or for no known reason. Symptoms of anxiety disorder include worry, fear and dread. When the symptoms are severe, it affects a person's ability to lead a normal life. There are many types of anxiety disorders:

• Generalized anxiety disorder.
• Panic disorder (a condition that causes sudden feelings of panic).
• Agoraphobia (fear of open places or situations in which it might be hard to get help if needed). 
• Social anxiety disorder (fear of social situations).
• Specific phobia (fear of a specific object or situation).
• Obsessive-compulsive disorder.
• Post-traumatic stress disorder.

Risk factors for serious distress

Nearly half of cancer patients report having a lot of distress, though factors that increase the risk of anxiety and distress are not always related to the cancer. The following may be risk factors for high levels of distress in patients with cancer:

• Trouble doing the usual activities of daily living.
• Physical symptoms and side effects (such as fatigue, nausea or pain).
• Problems at home.
• Depression or other mental or emotional problems.
• Being younger, nonwhite or female.
• Having a lower level of education.

Screening

When you're diagnosed with cancer, you may be screened for anxiety and distress. This often includes answering a series of questions either in an interview or on paper. Patients who show a high level of distress usually find it helpful to talk about their concerns with a social worker, mental health professional, palliative care specialist or pastoral counselor.

*Article adapted from the National Cancer Institute.