Anxiety, ASCO's curriculum


This section has been reviewed and approved by the PLWC Editorial Board, 05/05

Up to 30% of people with cancer experience anxiety, defined as intense feelings of worry, fear, and dread. Anxiety can be acute (occur in short episodes that end quickly) or chronic (remain over time). Sometimes anxiety is caused by a physical condition, such as a hormone-producing tumor or uncontrolled pain. Often, though, the following fears cause anxiety:

  • Death or the process of dying
  • Cancer recurrence (return) or metastasis (spread)
  • Pain
  • Loss of control
  • Dependency or abandonment
  • Changes to the body
  • Procedures, needles, tests, or ceratin treatments, such as chemotherapy

Feeling anxious about test results is common for many people with cancer. However, if anxiety and fear disrupt your life for more than a few weeks, you may want to seek treatment.

Symptoms of acute anxiety

Anxiety that occurs in short episodes is often called an anxiety attack. The symptoms of an anxiety attack include the following:

  • Heart palpitations or a rapid heartbeat
  • High blood pressure
  • Chest pain
  • Shortness of breath
  • Feeling of suffocation
  • Sweating, chills, or hot flashes
  • Dizziness and lightheadedness
  • Trembling
  • An itching or burning sensation on the skin
  • Nausea

  • Abdominal pain
  • Heartburn
  • Diarrhea
  • Feelings of fear or dread
  • A feeling of detachment from yourself or your surroundings

Symptoms of chronic anxiety

The symptoms of chronic anxiety, which occur for a much longer time, may include one or more of the following:

  • Excessive worrying
  • Restlessness
  • Muscle tension
  • Insomnia (sleeping problems)
  • Irritability
  • Fatigue (extreme tiredness)
  • Trouble concentrating
  • Trouble making decisions


To help diagnose anxiety, the doctor may ask about the following:

  • The presence of an anxiety disorder before the diagnosis of cancer
  • A new diagnosis of post-traumatic stress disorder (PTSD), panic, or generalized anxiety disorder (GAD)
  • Any new phobias (fears) of needles, biopsies, transfusions, or certain treatments, such as chemotherapy
  • A history of depression or substance abuse problems

The doctor also may look for the following physical causes of anxiety:

  • Hormone-producing tumors
  • Uncontrolled pain
  • Shortness of breath (dyspnea)
  • Imbalances of blood sugar, calcium, or magnesium
  • Hyperthyroidism (an excess of thyroid hormone)
  • Infection
  • Cancer that started in the brain or spread to the brain
  • Medications, such as antidepressants or antinausea drugs

Managing anxiety

Often the best treatments for anxiety involve techniques to reduce the body's reaction to stress. If these behavioral techniques to reduce anxiety do not resolve the anxiety syptoms, there are medications available to treat anxiety, especially if the anxiety is severe. Behavioral approaches to manage anxiety include the following:

Try to recognize your fear. Sometimes people with anxiety feel a sense of dread or fear that they cannot identify. It helps to articulate your fears as specifically as possible, even if the fears have no "solution," such as a fear of a necessary procedure.

Talk with your doctor. Try to express your feelings and your fears as clearly as possible. If you feel anxious before a certain test, procedure, or treatment, your doctor may help prepare you by explaining the procedure and addressing your concerns. Your doctor can help you by listening to your concerns, providing realistic reassurance, and making sure you have all the necessary information.

Minimize anxiety. Avoid behaviors that make anxiety worse. Getting enough sleep, controlling pain adequately, avoiding caffeinated beverages, and avoiding nicotine withdrawal symptoms can help reduce the symptoms of anxiety.

Practice relaxation. The following relaxation techniques may help reduce anxiety:

  • Focused breathing
  • Muscle relaxation
  • Guided imagery
  • Meditation
  • Hypnosis
  • Biofeedback
  • Yoga

Ask your doctor for a referral or list of providers.

Talk with a counselor. Mental health-care professionals are trained to help people cope with anxiety, and some specialize in working with people with cancer.

Stay involved. Becoming involved with a religious organization, support group, or a cancer organization may help you cope with anxiety.

Medication. People who experience severe acute anxiety may need medication before trying any of the techniques listed above. However, most people try medication only if no other behavorial techniques have worked. Some medications reduce anxiety very quickly, in a matter of hours. If anxiety is still a serious problem after a few weeks, your doctor may offer other types of medications that are more appropriate for chronic anxiety.

More Information

Mental Health and Cancer

PLWC: Managing Side Effects

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