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Anxiety and cancer

Anxiety is common. Many people have it at some point in their lives. But you are at greater risk of anxiety if you have, or had, cancer.  Anxiety that continues untreated can lead to other health problems. It can also make your cancer treatment and recovery more difficult.

What happens if my anxiety is left untreated?

Anxiety that continues and isn’t treated can lead to many other problems: a weakened immune system; digestive problems; worse treatment side effects; slower physical recovery; poorer quality of life; and decreased survival.

When does anxiety happen during cancer treatment?

Anxiety can come and go during your cancer journey. This is especially true for certain events and milestones, such as when you:

• Are first diagnosed
• Start a new cancer treatment
• Experience side effects
• Get tests or scans, or have to wait on results
• Discuss prognosis or treatment decisions
• Go to follow-up appointments
• Have any symptoms of illness (that may or may not be related to cancer)
• Finish treatment and move to survivorship care

It’s completely normal for caregivers or family members to have anxiety at these times as well. Many of the coping tips that work for people going through cancer can also work for caregivers who experience anxiety.

What else increases my risk of anxiety?

Some people with cancer have an even higher risk of anxiety. Things known to increase the risk of anxiety include:

• Living alone
• Younger age at diagnosis
• Advanced disease
• History of mental health treatment
• Other health conditions
• Social isolation

Screening

Many experts recommend screening everyone with cancer for anxiety and depression. If your health care team asks you about your anxiety, share how you’re really feeling. This will give them important information, so they can get you the support and resources you need.

They might ask questions to learn more about:

• Thoughts or feelings you are having
• How often you have those feelings, and how intense they are
• Physical symptoms that might be connected to your anxiety
• How these symptoms affect your day-to-day life
• If you’re thinking of hurting yourself or anyone else

If it seems like you have anxiety, your care team might also screen you for other health problems. This is because certain health problems could be making your anxiety worse.

Treatments

There are treatments available to help you manage your anxiety. Treatment often includes talk therapy, medication, or a combination of both. Sometimes, other activities like yoga, reflexology, and acupuncture are also combined with these standard medical treatments.

Psychotherapy (talk therapy)

There are many types of psychotherapy (talk therapy). The most common types used to treat anxiety include: 

• Cognitive behavioral therapy (CBT). CBT helps you recognize and process your feelings. You’ll learn relaxation techniques, coping strategies, and ways to manage negative thoughts.  
• Acceptance and commitment therapy (ACT): ACT is a sub-set of CBT. You’ll use mindfulness practices to notice and acknowledge your negative thoughts without trying to change or get rid of them.
• Interpersonal therapy (IPT): IPT focuses on the connection between your anxiety and your relationships with others.
• Eye movement desensitization and reprocessing (EMDR): EMDR therapy uses directed eye movements along with talk therapy to help your brain heal from past life experiences.

Learn more about coping with distress.

Medicines

If your anxiety is affecting your everyday life, your health care team might suggest adding an antianxiety medicine. (These are also known as anxiolytics). The most common types are antidepressants and benzodiazepines.

Antidepressants

Antidepressants can help with more than depression. They also help with anxiety, pain, and sleep problems. Antidepressants work by affecting the levels of certain chemicals in the brain, such as serotonin and norepinephrine.

Most take a few weeks to start working, so give them time. There are also several different types of antidepressants. Don’t get discouraged if the first one doesn’t work for you.

Learn more about antidepressants.

Benzodiazepines

Benzodiazepines work much faster than antidepressants. They can be helpful if you are feeling overwhelmed, nervous about a procedure, or can’t stop worrying. Benzodiazepines are controlled substances and can be habit-forming.

Talk to your health care team about the risks and benefits of any new medicine.

Other medicines used to treat anxiety

• Buspirone (Buspar) increases serotonin and dopamine.
• Hydroxyzine (Atarax, Vistaril) is an antihistamine that also increases serotonin.
• Certain beta blockers such as propranolol (Inderal) are used off-label for performance anxiety.

Medicines work best when they are combined with other things like therapy, lifestyle changes, and support from friends and family. Having more than one tool in your toolbox gives you the best chance of managing your anxiety.

Not every treatment works for every person. Don’t give up or blame yourself if something isn’t working. Be honest with yourself and your care team about how you’re feeling. The more honest you are, the better chance you have of figuring out what does work for you.

Complementary therapies

Activities like yoga, reflexology, and acupuncture can also improve anxiety during and after cancer treatment. Studies show that these complementary therapies improve anxiety symptoms and quality of life. Complementary therapies are often used alongside conventional (regular) medical treatments, like medicine and psychotherapy.

During cancer treatment:

• Mindfulness-based activities
• Yoga
• Relaxation therapies
• Music therapy or music-based activities
• Reflexology

For anxiety related to tests or procedures:

• Hypnosis
• Inhaling lavender essential oil

After cancer treatment:

• Mindfulness-based activities
• Acupuncture
• Reflexology
• Yoga (for people with breast cancer)
• Tai chi or qigong (for people with breast cancer)

Cannabis (marijuana):

• C?annabis is being studied for its possible benefits in helping to manage stress and anxiety from cancer and its treatment.
• Cannabis has risks and can be harmful in certain situations, forms, and doses.

Learn more about complementary therapies.

Mindfulness-based activities

Studies show that certain mindfulness-based activities can improve symptoms of anxiety.

Mindfulness is about noticing and being present with your thoughts, emotions, body, and the world around you.

Our minds distract us from the present moment all the time, so it’s easy to get caught up in thoughts and worries about the past or future. Mindfulness can help you stay connected to the present moment.

Learn more about practicing mindfulness and relaxation.

Tips for coping with anxiety

• Reflect. Think about what helped you in the past during distressing situations. If something worked, try it the next time you’re anxious.  
• Take one moment at a time. Also, it’s okay if you don’t always feel positive. An important part of healing is letting yourself feel all your feelings, good and bad.
• Stay informed and ask questions. One of the most distressing things for many people is the unknown.
• Have a reliable support system. This might be a friend, family member, group, or even a pet.
• Find someone you can talk to. A therapist can help you identify and reframe negative thoughts and behaviors and learn new coping skills.
• Take deep, slow breaths. This tells your nervous system you’re safe and can relax. Doing this over time can help change your physical reactions to anxiety.
• Use a journal. Writing down or recording your thoughts and feelings can help you process what you’re going through.
• Connect with people who’ve gone through similar experiences. If you aren’t ready to talk in a group, listening to a podcast where other people talk about these experiences is another great option.

It’s important to know that you might still have anxiety sometimes, even if you’re being treated for it. This doesn’t mean it’s not working for you. The goal is to get your anxiety to a manageable level, so it doesn’t stop you from living your life and finding joy in the activities and people you love.

Often, there isn’t one single fix. Something might even work one day but not the next. The more coping methods you have ready, the better prepared you’ll be when you need them. 

Talking to your health care team

It can be difficult to talk about mental health. It might help to write down some of the symptoms you’re having or questions you want to ask. Here are a few ideas:

• Can my symptoms be managed?
• What types of treatments do you recommend?
• Would medication help?
• Can I talk with a therapist or specialist about my symptoms?
• Can you recommend a support group for me?

What caregivers, friends, and family can do

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