What Is Anxiety? Symptoms and Treatment of Anxiety in Cancer

What Is Anxiety?

Anxiety describes intense inner distress, restlessness, unease that is difficult to relieve and worry. These feelings often accompany physical symptoms such as chest tightness, palpitations, breathing difficulty, feeling short of air, dry mouth, fullness in the head, gastrointestinal complaints and tension throughout the body. People may feel distress in their abdomen, chest, throat or head. Thoughts that something bad may happen at any moment or that these distressing emotions and physical symptoms cannot be managed are also common. Statements such as “I cannot stay still, everything is closing in on me, I feel suffocated and distressed” typically describe anxiety.

Why Do Anxiety and Related Physical Changes Occur?

The human nervous system prepares a person for approaching danger to survive or pass through a threat with minimal harm. Facing real danger, it prepares the body to flee or fight. This response, called fight or flight, is initiated and maintained involuntarily by the nervous system. For example, the perceived threat of a dog running toward you or footsteps approaching behind you on a dark road activates this system, creates fear and anxiety and rapidly prepares the body to flee or fight. Muscles need more blood and oxygen to do so. We therefore breathe more frequently, the heart pumps blood faster, muscles tense, pupils dilate to perceive the threat, and attention increases...

However, when this automatic survival system activates without a visible or realistic threat, is intense or persists, the person feels constantly tense, restless and on edge. When constant vigilance and anxious anticipation begin disrupting life, anxiety disorders are considered. Generalized anxiety disorder and panic attacks in panic disorder are among the most common anxiety disorders.

One of the Most Common Findings in Cancer: Anxiety

Cancer involves considerable uncertainty and lack of control regarding its causes, course, treatment choices and possible outcomes, and poses a threat to life. From this perspective, it is unsurprising that anxiety and fear are among its most common symptoms. Anxiety can occur at any disease stage, but severe, prolonged anxiety reduces quality of life and adversely affects treatment.

What Can Trigger Anxiety in Cancer?

• Exposure to large amounts of information and complex medical terminology during diagnosis,
• Uncertainty about the disease, necessary tests, possible treatments and outcomes,
• Difficulty adapting to changing social life and roles, 
• Experiencing inadequately controlled pain, nausea and sleep disturbances,
• Difficulty adjusting to altered body image after surgery (for example, loss of a breast)
• Difficulty adjusting to altered body image after medical treatment (for example, hair loss)
• As a direct adverse effect of medicines (for example, interferon beta treatment or when high-dose steroids are required)
• As a symptom accompanying delirium resulting from disrupted biological balance
• Lack of treatment response,
• Metastases being discovered,
• Learning that the disease has recurred,
• Feeling that the disease may return at any moment, even after full recovery,
• Immediately before regular doctor visits or tests, anxiety may become more pronounced and associated physical complaints may increase.

What Might an Anxious Patient Experience?

• Inner distress and restlessness
• Inability to relax, constant tension, worry and feeling on edge
• Intermittent episodes of intense anxiety (panic attacks)
• Constantly thinking about disease-related issues (mental preoccupation)
• Difficulty deciding and solving problems, even minor ones, alongside attention and concentration difficulties
• An intense need to research the disease and treatment online
• Difficulty falling and staying asleep, loss of appetite and fatigue
• Intense worry over a simple symptom
• Requesting doctor appointments more often than recommended
• Having tests outside medical recommendations and requesting additional procedures,
• Nausea becoming pronounced even before chemotherapy or when approaching the hospital
• Experiencing nausea, headaches and other physical complaints more intensely than expected
• Not wanting to leave the hospital or doctors

If these complaints disrupt treatment and functioning, this may indicate that anxiety is out of control and professional help is needed.

What Can Patients and Loved Ones Do?

• First, patients and relatives should receive all necessary information clearly and fully from their doctors and treatment team. Patients who are adequately informed, particularly by their doctor, and feel they are in the right place and safe hands are known to tolerate uncertainty more easily. Adequately informed patients also have shorter hospital stays, fewer repeated doctor visits and greater success managing adverse effects.
• Feeling anxious, frightened, sad, angry or overwhelmed is normal. Sharing and expressing these emotions with loved ones may help, but it is not always easy. Many relatives make extraordinary efforts to support patients and ease their lives, trying to protect them from all sadness and distress. These well-intentioned, admirable but unrealistic efforts may increase distress by making patients feel that “nobody hears what I am going through; I am not understood enough.” When patients share grief or anger, saying “Please do not worry about these things, forget them, we will handle it” will not help. Those feelings need to be heard and taken seriously.
• Together with loved ones, discuss how to support one another. For example, organize a division of tasks to reduce uncertainty: one person arranges hospital transport, another helps care for children at home, and financial management is planned.
• You can follow trustworthy online support groups.
• Breathing and relaxation exercises can help manage anxiety. Learning them and practicing several times daily is beneficial. Similarly, light exercise permitted by your doctor, yoga, meditation or activities such as playing an instrument, painting or crafts will shift attention away from the uncertain, uncontrollable future and current physical complaints, helping manage anxiety.
• A balanced diet, regular physical activity, adequate social support, mindfulness exercises and avoiding cigarettes, coffee, stimulant drinks and heavy alcohol use support anxiety control.
• Tell your doctor that you would like to consult a psychiatrist to distinguish whether anxiety is an emotional response to disease, a direct biological effect of cancer or an adverse effect of medication. Psychotherapy and medicines can relieve anxiety and anxiety disorders, improve the disease experience and increase quality of life.

Written by: Psychiatrist Güneş Berk of the OncoTrust team