Anxiety and Distress During Cancer

Almost all people living with cancer feel some distress. Distress is emotional suffering. It ranges widely. At one end are normal feelings of sadness and fear. At the other are more serious problems: depression, anxiety, panic, or feeling alone and cut off from friends and family.

People with cancer feel distress at different levels. Some have a low level and can adjust to living with cancer. Others have higher levels. Nearly half of people with cancer report a lot of distress. In general, the type of cancer does not change how much distress a person feels.

Distress can come on when you feel unable to manage or control the changes cancer brings. People tend to have less distress when the demands feel manageable. Strong support helps too.

Living with a cancer diagnosis means making many adjustments. Normal adjustment means learning to cope with emotional distress. It also means solving the problems cancer causes. The coping skills you need can change at different points, such as when you:

• hear the diagnosis
• receive cancer treatment
• finish cancer treatment
• learn the cancer is in remission
• learn the cancer has come back
• become a long-term cancer survivor

Each of these moments can bring different worries. When treatment ends, for example, people are often glad. But they may feel more anxious as they see their treatment team less often. During remission, people may feel distressed before follow-up visits, because they worry the cancer has come back. Waiting for test results can be very stressful.

Most people adjust well over time. Some even say that surviving cancer gave them a greater appreciation for life, and a better sense of what matters most.

Studies show that almost half of all people with cancer feel some anxiety. About one-fourth say they feel a great deal of it. Signs of anxiety can include shortness of breath, a fast heartbeat, sweating, restlessness, tight muscles, dizziness, nausea, and irritability.

Anxiety can have many causes beyond the diagnosis itself. Uncontrolled pain can cause it. So can other medical problems, certain tumors, some medicines, and withdrawal from habit-forming substances. That is why it is important to tell your doctor about anxious feelings. Then they can find the cause and treat it.

Some people have trouble adjusting to cancer. Studies show that treatments giving emotional and social support help them. These include:

• relaxation training
• counseling or talk therapy
• cancer education sessions
• social support in a group setting

The benefits include lower levels of depression, anxiety and symptoms. People also feel more hopeful. Other things that may help include cognitive behavior therapy, problem-solving, support from friends and family, meditation, yoga, guided imagery, and breathing exercises.

Your doctor will usually screen you to see whether you need help adjusting to cancer. Screening is often just questions. They ask how you feel, and about your energy level, your relationships, your work and your finances. Your doctor may refer you on for further assessment and support. That could be to a social worker, a mental health professional, a palliative care specialist, or a counselor.

People who are struggling to adjust are usually encouraged to try counseling before medicine. Counseling does not help everyone, though. Some people have severe anxiety that needs anti-anxiety or antidepressant medicine alongside counseling. The right approach is a personal decision, made with your health care provider.

Feelings of distress are a normal part of living with cancer, and support is always available. You do not have to manage these feelings on your own.

• Call 911 or go to an emergency department if you are thinking about ending your life, or you have started to plan or act on it. In the United States you can also call or text 988, the Suicide & Crisis Lifeline, at any hour (NIMH).
• Call your care team the same day if panic comes on suddenly with a pounding heart and breathlessness and you cannot tell whether it is anxiety or something physical. Chest symptoms in someone on cancer treatment deserve a check, not a guess.
• Call your care team the same day if worry has reached the point where you cannot sleep, eat, or keep to your treatment appointments.
• Call your care team within a day or two if a new medicine, a change in dose, or stopping a drug seems to have brought the anxiety on. Anxiety with a treatable medical cause is common, and finding the cause changes what helps.

• NCI — Adjustment to Cancer: Anxiety and Distress (PDQ®), Patient Version
• NIMH — Suicide Prevention
• 988 Suicide & Crisis Lifeline