Anxiety is often manifested in individuals at various times during cancer screening, diagnosis, treatment, or recurrence. It can sometimes affect a person’s behavior regarding his or her health, contributing to a delay in or neglect of measures that might prevent cancer.[1-3] For example, when women with high levels of anxiety learn that they have a genetically lower level of risk of breast cancer than they had previously believed, they might perform breast self-examination more frequently.[4] Patients can experience moderate-to-severe anxiety while waiting for the results of diagnostic procedures.[5] For patients undergoing treatment, anxiety can also heighten the expectancy of pain,[6-8] other symptoms of distress and sleep disturbances, and can be a major factor in anticipatory nausea and vomiting. It has been shown that anxiety can lead to early death if untreated.[9] Anxiety, regardless of its degree, can substantially interfere with the quality of life of patients with cancer and of their families and should be evaluated and treated.[10-12]

Anxiety occurs to varying degrees in patients with cancer and may heighten as the disease progresses or as treatment becomes more aggressive.[13] Investigators have found that 44% of patients with cancer reported some anxiety; 23% reported significant anxiety.[14,15] Anxiety can be part of normal adaptation to cancer. In most cases, the reactions are time limited and may motivate patients and families to take steps to reduce anxiety (e.g., gain information), which may assist in adjusting to the illness. Anxiety reactions that are prolonged or unusually intense, however, are classified as adjustment disorders. These disorders can negatively affect quality of life and interfere with a cancer patient’s ability to function socially and emotionally. These anxiety reactions require intervention.[16] (Refer to the PDQ summary on Normal Adjustment, Psychosocial Distress, and the Adjustment Disorders for more information.) Other specific anxiety disorders such as generalized anxiety, phobia, or panic disorder are not as common among these patients and usually predate the cancer diagnosis. The stress caused by a diagnosis of cancer and its treatment may precipitate a relapse of pre-existing anxiety disorders. These disorders can be disabling and can interfere with treatment. They require prompt diagnosis and effective management.[17]

Factors that can increase the likelihood of developing anxiety disorders during cancer treatment include a history of anxiety disorders, severe pain, anxiety at time of diagnosis,[18] functional limitations, lack of social support,[14] advancing disease, and history of trauma.[13,19] Many medical conditions and interventions can cause anxiety disorders, including central nervous system metastases, lung cancer, and treatment with corticosteroids and other medications. A patient’s experience with cancer or other illnesses may reactivate associations and memories of previous illness and contribute to acute anxiety. Certain demographic factors, such as being female and developing cancer at a young age, are associated with increased anxiety in medical situations.[14,20] Patients who have problems communicating with their families, friends, and physicians are also more at risk of developing anxiety.[20]

In the patient with advanced disease, anxiety is often not caused by the fear of death but by the issues of uncontrolled pain, isolation, abandonment, and dependency.[21] Many of these factors can be managed when adequately assessed and properly treated.

References

1. Lauver D, Ho CH: Explaining delay in care seeking for breast cancer symptoms. J Appl Soc Psychol 23 (21): 1806-25, 1993. 
   
   
2. MacFarlane ME, Sony SD: Women, breast lump discovery, and associated stress. Health Care Women Int 13 (1): 23-32, 1992 Jan-Mar.  [PUBMED Abstract]
   
   
3. Gram IT, Slenker SE: Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited. Am J Public Health 82 (2): 249-51, 1992.  [PUBMED Abstract]
   
   
4. Lerman C, Kash K, Stefanek M: Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. J Natl Cancer Inst Monogr (16): 171-6, 1994.  [PUBMED Abstract]
   
   
5. Jenkins PL, May VE, Hughes LE: Psychological morbidity associated with local recurrence of breast cancer. Int J Psychiatry Med 21 (2): 149-55, 1991.  [PUBMED Abstract]
   
   
6. Velikova G, Selby PJ, Snaith PR, et al.: The relationship of cancer pain to anxiety. Psychother Psychosom 63 (3-4): 181-4, 1995.  [PUBMED Abstract]
   
   
7. Glover J, Dibble SL, Dodd MJ, et al.: Mood states of oncology outpatients: does pain make a difference? J Pain Symptom Manage 10 (2): 120-8, 1995.  [PUBMED Abstract]
   
   
8. Ferrell-Torry AT, Glick OJ: The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs 16 (2): 93-101, 1993.  [PUBMED Abstract]
   
   
9. Sirois F: Psychosis as a mode of exitus in a cancer patient. J Palliat Care 9 (4): 16-8, 1993 Winter.  [PUBMED Abstract]
   
   
10. Davis-Ali SH, Chesler MA, Chesney BK: Recognizing cancer as a family disease: worries and support reported by patients and spouses. Soc Work Health Care 19 (2): 45-65, 1993.  [PUBMED Abstract]
    
    
11. Dahlquist LM, Czyzewski DI, Copeland KG, et al.: Parents of children newly diagnosed with cancer: anxiety, coping, and marital distress. J Pediatr Psychol 18 (3): 365-76, 1993.  [PUBMED Abstract]
    
    
12. Payne SA: A study of quality of life in cancer patients receiving palliative chemotherapy. Soc Sci Med 35 (12): 1505-9, 1992.  [PUBMED Abstract]
    
    
13. Breitbart W: Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 3 (1): 45-60, 1995.  [PUBMED Abstract]
    
    
14. Stark D, Kiely M, Smith A, et al.: Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 20 (14): 3137-48, 2002.  [PUBMED Abstract]
    
    
15. Schag CA, Heinrich RL: Anxiety in medical situations: adult cancer patients. J Clin Psychol 45 (1): 20-7, 1989.  [PUBMED Abstract]
    
    
16. Razavi D, Stiefel F: Common psychiatric disorders in cancer patients. I. Adjustment disorders and depressive disorders. Support Care Cancer 2 (4): 223-32, 1994.  [PUBMED Abstract]
    
    
17. Maguire P, Faulkner A, Regnard C: Managing the anxious patient with advancing disease--a flow diagram. Palliat Med 7 (3): 239-44, 1993.  [PUBMED Abstract]
    
    
18. Nordin K, Glimelius B: Predicting delayed anxiety and depression in patients with gastrointestinal cancer. Br J Cancer 79 (3-4): 525-9, 1999.  [PUBMED Abstract]
    
    
19. Green BL, Krupnick JL, Rowland JH, et al.: Trauma history as a predictor of psychologic symptoms in women with breast cancer. J Clin Oncol 18 (5): 1084-93, 2000.  [PUBMED Abstract]
    
    
20. Friedman LC, Lehane D, Webb JA, et al.: Anxiety in medical situations and chemotherapy-related problems among cancer patients. J Cancer Educ 9 (1): 37-41, 1994.  [PUBMED Abstract]
    
    
21. Hackett TP, Cassem NH: Massachusetts General Hospital Handbook of General Hospital Psychiatry. 2nd ed. Littleton, Mass: PSG, 1987. 
    
    

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