Effective management of anxiety disorders begins with a thorough and comprehensive assessment and an accurate diagnosis. The normal fears and uncertainties associated with cancer are often intense. Often, there is not a clear distinction between normal fears and fears that are more severe and finally reach the criteria for an anxiety disorder.[1] Treatment should be initiated that is not based solely on the definition of the disorder but on consideration for the patient’s quality of life. To assess the severity of the anxiety, it is important to understand to what extent the symptoms of anxiety are interfering with the activities of daily living. Screening for anxiety could include a brief self-report questionnaire that, if a defined cutoff score is exceeded, could then be followed by a more thorough clinical interview. A variety of general screening questionnaires have been used for identification of distress. Other anxiety-specific self-report questionnaires (e.g., State-Trait Anxiety Inventory) have also been used and a questionnaire for the assessment of prostate cancer–related anxiety has been developed and validated.[2-4]

The following is a list of questions that may be used in dialogue with patients to explore their symptoms of anxiety and other disorders. Referral to appropriate specialists may be indicated based on patient response.

• Have you had any of the following symptoms since your cancer diagnosis or treatment? When do these symptoms occur (e.g., how many days before 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?
• Have you been confused or disoriented lately?

References

1. Massie MJ: Anxiety, panic, and phobias. In: Holland JC, Rowland JH, eds.: Handbook of Psychooncology: Psychological Care of the Patient With Cancer. New York, NY: Oxford University Press, 1989, pp 300-9. 
   
   
2. Roth AJ, Rosenfeld B, Kornblith AB, et al.: The memorial anxiety scale for prostate cancer: validation of a new scale to measure anxiety in men with prostate cancer. Cancer 97 (11): 2910-8, 2003.  [PUBMED Abstract]
   
   
3. Stark D, Kiely M, Smith A, et al.: Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 20 (14): 3137-48, 2002.  [PUBMED Abstract]
   
   
4. Roth A, Nelson CJ, Rosenfeld B, et al.: Assessing anxiety in men with prostate cancer: further data on the reliability and validity of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). Psychosomatics 47 (4): 340-7, 2006 Jul-Aug.  [PUBMED Abstract]
   
   

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