Description and Cause
Adjustment Disorder
Panic Disorder
Phobias
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Generalized Anxiety Disorder
Anxiety Disorder Caused by Other General Medical Conditions
Some persons may have already experienced intense anxiety in their life because
of situations unrelated to their cancer. These anxiety conditions may recur or
become aggravated by the stress of a cancer diagnosis. Patients may experience
extreme fear, be unable to absorb information given to them by caregivers, or
be unable to follow through with treatment. In order to plan treatment for a
patient's anxiety, a doctor may ask the following questions about the patient's symptoms:
- Have you had any of the following symptoms since your cancer diagnosis or
treatment? When do these symptoms occur (i.e., how many days prior to
treatment, at night, or at no specific time) and how long do they last?
- Do you feel shaky, jittery, or nervous?
- Have you felt tense, fearful, or apprehensive?
- Have you had to avoid certain places or activities because of fear?
- Have you felt your heart pounding or racing?
- Have you had trouble catching your breath when nervous?
- Have you had any unjustified sweating or trembling?
- Have you felt a knot in your stomach?
- Have you felt like you have a lump in your throat?
- Do you find yourself pacing?
- Are you afraid to close your eyes at night for fear that you may die in
your sleep?
- Do you worry about the next diagnostic test, or the results of it, weeks in
advance?
- Have you suddenly had a fear of losing control or going crazy?
- Have you suddenly had a fear of dying?
- Do you often worry about when your pain will return and how bad it will
get?
- Do you worry about whether you will be able to get your next dose of pain medication on time?
- Do you spend more time in bed than you should because you are afraid that
the pain will intensify if you stand up or move about?
- Have you been confused or disoriented lately?
Anxiety disorder includes adjustment disorder, panic disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and anxiety disorder caused by other general medical
conditions. Each of these is explained below.
Adjustment Disorder
Adjustment disorder includes behaviors or moods more extreme than expected in a
reaction to a cancer diagnosis. Symptoms include severe nervousness, worry,
jitteriness, and the inability to go to work, attend school, or be with other
people. Adjustment disorder is more likely to occur in cancer patients during
critical times of the disease. These include being tested for the disease,
learning the diagnosis, and experiencing a relapse of the disease. Many cancer
patients can achieve relief from adjustment disorder in several ways, including
receiving reassurance from caregivers, exercising relaxation techniques, taking
medication, and participating in support and education programs.
Panic Disorder
Patients with panic disorder experience intense anxiety. Patients may suffer
shortness of breath, dizziness, rapid heart beat, trembling, profuse sweating, nausea, tingling sensations, or fears of "going crazy." Attacks may last for
several minutes or several hours and are treated with medication. Symptoms of
panic disorder may be very similar to other medical conditions.
Phobias
Phobias are ongoing fears about or avoidance of a situation or object. People
with phobias usually experience intense anxiety and avoid situations that may
frighten them. Cancer patients may fear needles. They may also fear small
spaces and avoid having tests in confined spaces, such as magnetic resonance
imaging (MRI) scans.
Obsessive-Compulsive Disorder
A person with obsessive-compulsive disorder has persistent thoughts, ideas, or
images (obsessions) that are accompanied by repetitive behaviors (compulsions).
Patients with obsessive-compulsive disorder may be unable to follow through
with cancer treatment because they are disabled by thoughts and behaviors that
interfere with their ability to function normally. Obsessive-compulsive
disorder is treated with medication and psychotherapy. Obsessive-compulsive
disorder is rare in patients with cancer who did not have the disorder before
being diagnosed with cancer.
Post-Traumatic Stress Disorder
The diagnosis of cancer may cause a person who has previously experienced a
life-threatening event to relive the trauma associated with that event.
Patients with cancer who have post-traumatic stress disorder may experience
extreme anxiety before surgery, chemotherapy, painful medical procedures, or
bandage changes. Post-traumatic stress disorder is treated with psychotherapy.
Generalized Anxiety Disorder
Patients with generalized anxiety disorder may experience extreme and constant
anxiety or unrealistic 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, although they have adequate financial resources
and insurance. Generalized anxiety disorder may happen after a patient has
been very depressed. A person who has generalized anxiety may feel irritable
or restless, have tense muscles, shortness of breath, heart palpitations,
sweating, dizziness, and be easily fatigued.
Anxiety Disorder Caused by Other General Medical Conditions
Patients with cancer may experience anxiety that is caused by other medical
conditions. Patients who are experiencing severe pain feel anxious, and
anxiety can increase pain. The sudden appearance of extreme anxiety may be a
symptom of infection, pneumonia, or an imbalance in the body's chemistry. It
may also occur before a heart attack or blood clot in the lung and be
accompanied by chest pain or trouble breathing. A decrease in the amount of oxygen that the blood is able to carry may also make the patient feel as though
he or she is suffocating; this can cause anxiety.
Anxiety is a direct or indirect side effect of some medications. Some
medications can cause anxiety, while others may cause restlessness, agitation, depression, thoughts of suicide, irritability, or trembling.
Certain tumors may cause anxiety or produce symptoms that resemble anxiety and
panic by creating chemical imbalances or shortness of breath.
See the following PDQ summaries for more information:
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