My Sanford Chart allows you secure online access to your personal health information and your child's health information. It's available anywhere you have internet access. There is no cost to you and registering is quick and simple.
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Anxiety and distress can affect the quality of life of patients with cancer and their families.
Patients living with cancer feel many different emotions, including anxiety and distress.
Anxiety and distress may affect a patient's ability to cope with a cancer diagnosis or treatment.
Patients may have anxiety while being screened for a possible cancer, waiting for the results of tests for cancer, receiving a cancer diagnosis, being treated for cancer, or worrying that cancer will recur (come back). It may cause patients to miss check-ups or delay treatment. Anxiety may increase pain, affect sleep, and cause nausea and vomiting. Even mild anxiety can affect the quality of life of patients with cancer and their families and may need to be treated.
Patients living with cancer can feel different levels of distress.
Some patients living with cancer have a low level of distress and others have higher levels of distress. The level of distress ranges from being able to adjust to living with cancer to having a serious mental health problem, such as major depression. However, most patients with cancer do not have signs or symptoms of any specific mental health problem. This summary describes the less severe levels of distress in patients living with cancer, including:
This summary is about adjustment to cancer, anxiety, and distress in adults with cancer.
See the following PDQ summaries for information on these mental health problems:
Patients living with cancer need to make adjustments in their lives to cope with the disease and changes in treatment.
Living with a diagnosis of cancer involves many life adjustments. Normal adjustment involves learning to cope with emotional distress and solve problems caused by having cancer. Patients with cancer do not make these adjustments all at once, but over a period of time as their disease and treatment change. Patients may need to make adjustments when they:
Coping methods help patients adjust.
Patients find it easier to adjust if they can carry on with their usual routines and work, keep doing activities that matter to them, and cope with the stress in their lives.
Coping is the use of thoughts and behaviors to adjust to life situations. The way people cope is usually linked to their personality traits (such as whether they usually expect the best or worst, or are shy or outgoing).
Coping methods include the use of thoughts and behaviors in special situations. For example, changing a daily routine or work schedule to manage the side effects of cancer treatment is a coping method. Using coping methods can help a patient deal with certain problems, emotional distress, and cancer in his or her daily life.
Patients who adjust well are usually very involved in coping with cancer. They also continue to find meaning and importance in their lives. Patients who do not adjust well may withdraw from relationships or situations and feel hopeless. Studies are being done to find out how different types of coping methods affect the quality of life for cancer survivors.
Patients who are adjusting to the changes caused by cancer may have distress.
Distress can occur when patients feel they are unable to manage or control changes caused by cancer. Patients with the same diagnosis or treatment can have very different levels of distress. Patients have less distress when they feel the demands of the diagnosis and treatment are low or the amount of support they get is high. For example, a health care professional can help the patient adjust to the side effects of chemotherapy by giving medicine for nausea.
The way each patient copes with cancer depends on many physical and emotional factors.
The following factors affect how a patient copes with the stress of cancer:
Cancer patients need different coping skills at different points in time.
The coping skills needed will change at important points in time. These include the following:
Learning the diagnosis
The process of adjusting to cancer begins before learning the diagnosis. Patients may feel worried and afraid when they have unexplained symptoms or are having tests done to find out if they have cancer.
A diagnosis of cancer can cause expected and normal emotional distress. Some patients may not believe it and ask, "Are you sure you have the right test results?" They may feel numb or in shock, or as if "This can't be happening to me". Many patients wonder, "Could I die from this?"
Many patients feel they are not able to think clearly and may not understand or remember important information that the doctor gives them about the diagnosis and treatment options. Patients should have a way to go over this information later. It helps to have someone with them at appointments, bring a tape recorder, or make a second appointment to ask the doctor questions and go over the treatment plan. See Talking with the Health Care Team in the PDQ summary on Communication in Cancer Care for more information.
As patients accept the diagnosis, they begin to feel symptoms of distress, including:
When patients receive and understand information about cancer and their treatment options, they may begin to feel more hopeful. Over time, by using ways to cope that have worked in the past and learning new ways to cope, patients usually adjust to having cancer. Extra professional help to deal with problems such as fatigue, trouble sleeping, and depression can be helpful during this time.
Being treated for cancer
As patients go through treatment for cancer, they use coping strategies to adjust to the stress of treatment. Patients may have anxiety or fears about:
Patients usually adjust well when they can compare short-term discomfort to long-term benefit (for example living longer) and decide, "It's worth it". Questions that patients may ask during treatment include, "Will I survive this?"; "Will they be able to remove all the cancer?"; or "What side effects will I have?". Finding ways to cope with problems caused by cancer such as feeling tired, getting to and from treatment, and changes in work schedule is helpful.
Finishing cancer treatment can cause mixed feelings. It may be a time of celebration and relief that treatment has ended. But it may also be a time of worry that the cancer could come back. Many patients are glad that treatment has ended but feel increased anxiety as they see their doctors less often. Other concerns include returning to work and family life and being very worried about any change in their health.
During remission, patients may become stressed before follow-up medical appointments because they worry that the cancer has come back. Waiting for test results can be very stressful.
Patients who are able to express both positive and negative emotions are more likely to adjust well. Patients are more able to cope with the emotional stress of finishing treatment and being in remission when they:
Learning that the cancer has come back
Sometimes cancer comes back and does not get better with treatment. The treatment plan then changes from one that is meant to cure the cancer to one that gives comfort and relieves symptoms. This may cause great anxiety for the patient. The patient may feel shock and be unable to believe it at first. This may be followed by a period of distress such as depression, trouble focusing, and being unable to stop thinking about death. Signs of normal adjustment include:
Patients slowly adjust to the return of cancer. They stop expecting to be cured of cancer and begin a different kind of healing. This healing is a process of becoming whole again by changing one's life in many ways when faced with the possibility of death. It is very important that patients keep up hope while they adjust to the return of cancer. Some patients keep up hope through their spirituality or religious beliefs. (See the PDQ summary on Spirituality in Cancer Care for more information.)
Becoming a cancer survivor
Patients adjust to finishing cancer treatment and being long-term cancer survivors over many years. As treatments for cancer have gotten better, cancer has become a chronic disease for some patients. Some common problems reported by cancer survivors as they face the future include:
Most patients adjust well and some even say that surviving cancer has given them a greater appreciation of life, helped them understand what is most important in their life, and stronger spiritual or religious beliefs.
Some patients may have more trouble adjusting because of medical problems, fewer friends and family members to give support, money problems, or mental health problems not related to the cancer.
Feelings of emotional, social, or spiritual distress can make it hard to cope with cancer treatment.
Almost all patients living with cancer have feelings of distress. Feelings of distress range from sadness and fears to more serious problems such as depression, panic, feeling uncertain about spiritual beliefs, or feeling alone or separate from friends and family.
Patients who are in distress during any phase of cancer need treatment and support for their distress. Patients are more likely to need to be checked and treated for distress during the following periods:
Patients who are having trouble coping with cancer may find it helpful to talk with a professional about their concerns and worries. These specialists include:
Patients who are in distress can be helped by different kinds of emotional and social support.
Studies have shown that patients who are having trouble adjusting to cancer are helped by treatments that give them emotional and social support, including:
These types of treatment may be combined in different ways for one or more sessions. Studies have shown that patients with cancer who receive such therapies receive benefits compared to those who do not receive these therapies. Benefits include having lower levels of depression, anxiety, and disease- and treatment-related symptoms, as well as feeling more optimistic. Patients who have the most distress seem to get the most help from these therapies. However, patients who received these therapies did not live longer than those who did not receive them.
Adjustment disorders may cause serious problems in daily life.
An adjustment disorder occurs when the patient's reaction to a stressful event:
Causes of adjustment disorders in cancer patients include the following:
An adjustment disorder usually begins within three months of a stressful event and lasts no longer than six months after the event is over. Some patients may have a chronic adjustment disorder because they have many causes of distress, one right after another.
An adjustment disorder may become a more serious mental disorder such as major depression. This is more common in children and adolescents than in adults. (See the PDQ summary on Pediatric Supportive Care for more information.)
Counseling can help patients with adjustment disorders.
Individual (one-to-one) and group counseling have been shown to help cancer patients with adjustment disorders. Counseling may include treatment that focuses on the patient's thoughts, feelings, and behaviors. The following may help patients cope:
Counseling may be combined with antianxiety medicine or antidepressants.
Counseling should be tried before medicine. Some patients are not helped by counseling or have a more severe mental health problem, such as severe anxiety or depression. These patients may be helped by an antianxiety or antidepressant medicine along with counseling. (See the PDQ summary on Depression for more information.)
Current Clinical Trials
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about adjustment disorder that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Anxiety disorders are very strong fears that may be caused by physical or psychological stress.
Studies show that almost half of all patients with cancer say they feel some anxiety and about one-fourth of all patients with cancer say they feel a great deal of anxiety. Patients living with cancer find that they feel more or less anxiety at different times. A patient may become more anxious as cancer spreads or treatment becomes more intense.
For some patients feelings of anxiety may become overwhelming and affect cancer treatment. This is especially true for patients who had periods of intense anxiety before their cancer diagnosis. Most patients who did not have an anxiety condition before their cancer diagnosis will not have an anxiety disorder related to the cancer.
Patients are more likely to have anxiety disorders during cancer treatment if they have any of the following:
Anxiety disorders may be hard to diagnose.
It may be hard to tell the difference between normal fears related to cancer and abnormally severe fears that can be described as an anxiety disorder. The diagnosis is based on how symptoms of anxiety affect the patient's quality of life, what kinds of symptoms began since the cancer diagnosis or treatment, when the symptoms occur, and how long they last.
Anxiety disorders cause serious symptoms that affect day-to-day life, including:
There are different causes of anxiety disorders in cancer patients.
In addition to anxiety caused by a cancer diagnosis, the following may cause anxiety in patients with cancer:
Anxiety from these causes is usually managed by treating the cause itself.
A cancer diagnosis may cause anxiety disorders to come back in patients with a history of them.
When patients who had an anxiety disorder in the past are diagnosed with cancer, then the anxiety disorder may come back. These patients may feel extreme fear, be unable to remember information given to them by caregivers, or be unable to follow through with medical tests and procedures. They may have symptoms including:
Patients with cancer may have the following types of anxiety disorders:
Phobias are fears about a situation or an object that lasts over time. People with phobias usually feel intense anxiety and avoid the situation or object they are afraid of. For example, patients with a phobia of small spaces may avoid having tests in small spaces, such as magnetic resonance imaging (MRI) scans.
Phobias may make it hard for patients to follow through with tests and procedures or treatment. Phobias are treated by professionals and include different kinds of therapy.
Patients with panic disorder feel sudden intense anxiety, known as panic attacks. Symptoms of panic disorder include the following:
A panic attack may last for several minutes or longer. There may be feelings of discomfort that last for several hours after the attack. Panic attacks are treated with medicine and talk therapy.
Obsessive-compulsive disorder is rare in patients with cancer who did not have the disorder before being diagnosed with cancer.
Obsessive-compulsive disorder is diagnosed when a person uses persistent (obsessive) thoughts, ideas, or images and compulsions (repetitive behaviors) to manage feelings of distress. The obsessions and compulsions affect the person's ability to work, go to school, or be in social situations. Examples of compulsions include frequent hand washing or constantly checking to make sure a door is locked. Patients with obsessive-compulsive disorder may be unable to follow through with cancer treatment because of these thoughts and behaviors. Obsessive-compulsive disorder is treated with medicine and individual (one-to-one) counseling.
Post-traumatic stress disorder
See the PDQ summary on Post-traumatic Stress Disorder for information about this condition.
Generalized anxiety disorder
Patients with generalized anxiety disorder may feel extreme and constant anxiety or worry. For example, patients with supportive family and friends may fear that no one will care for them. Patients may worry that they cannot pay for their treatment, even though they have enough money and insurance.
A person who has generalized anxiety may feel irritable, restless, or dizzy, have tense muscles, shortness of breath, fast heart beat, sweating, or get tired quickly. Generalized anxiety disorder sometimes begins after a patient has been very depressed.
There are different kinds of treatment for anxiety disorders.
There are different types of treatment for patients with anxiety disorders, including methods to manage stress. Ways to manage stress include the following:
Patients with anxiety disorders need information and support to understand their cancer and treatment choices. Psychological treatments for anxiety can also be helpful. These include the following:
Other treatments used to lessen the symptoms of anxiety include the following:
Using different methods together may be helpful for some patients. (See the Psychological and Social Distress section of this summary for more information.)
Medicine may be used alone or combined with other types of treatment for anxiety disorders.
Antianxiety medicines may be used if the patient doesn't want counseling or if it's not available. These medicines relieve symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle tightness. They may relieve daytime distress and reduce insomnia. These medicines may be used alone or combined with other therapies.
Although some patients are afraid they may become addicted to antianxiety medicines, this is not a common problem in cancer patients. Enough medicine is given to relieve symptoms and then the dose is slowly lowered as symptoms begin to get better.
Studies show that antidepressants are useful in treating anxiety disorders. Children and teenagers being treated with antidepressants have an increased risk of suicidal thinking and behavior and must be watched closely. (See the Treatment section of the PDQ summary on Depression for more information.)
Current Clinical Trials
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about anxiety disorder that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. We can respond only to email messages written in English.
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
|NCI Public Inquiries Office|
|6116 Executive Boulevard, MSC8322|
|Bethesda, MD 20892-8322|
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-11-28
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.