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 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.

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 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.

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.

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.

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.

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:

• Normal Adjustment and Distress
• Post-Traumatic Stress Disorder

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