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CANCERSMART • Wellspring Cancer Support Foundation • March 2011 • Issue 8
CANCER & ANXIETY
By Kimberley Miller, MD, FRCPC, Attending Psychiatrist, Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, DO YOU REMEMBER WHERE YOU WERE, WHEN YOU OR YOUR LOVED ONE FIRST RECEIVED THE DIAGNOSIS OF CANCER? This memory alone may contribute to feelings of duration, frequency, number and intensity of anxiety anxiety, which may be of a physical (e.g., nausea, symptoms are significant enough to interfere with headache, racing heart) or psychological (e.g., worried, scared) nature. Anxiety is a feeling of apprehension or worry, caused by anticipation of danger and Anxiety disorders may present as panic attacks, social uncertainty. It may include irritability, poor anxiety, generalized anxiety, post traumatic stress, concentration, fatigue, sleep disturbance, restlessness, obsessions, compulsions, or phobias. Anxiety may also occur with depression in up to 40% of individuals diagnosed with cancer.2 Anxiety is a normal response to a significant threat, and Anxiety related to cancer maybe related to any of the • Physical symptoms, such as pain, nausea, and shortness of breath, metabolic abnormalities (e.g. (e.g. stemetil, decadron) and fatigue (ritalin), sudden discontinuation of regular alcohol use or Cancer survivors may also experience anxiety, in anti-anxiety medications (e.g. ativan) contemplating returning to the workforce, coping • Anticipating medical appointments, procedures, with ongoing body image concerns and losses, or chemotherapy, and receiving CT or MRI scan such as fertility and sexual functioning, living with results may contribute to anxiety in cancer residual side effects of treatment, as well as coping • Uncertainty about the future, loss of control and with changes in physical, cognitive and emotional independence, changes in relationships, roles, physical appearance and life plans, and fear of future suffering and dying may add to anxiety • Personal coping style and meaning attached to cancer, history of anxiety, temperament, level Most anxiety improves over time with support and of social supports, stage of life, interpersonal clarification of a treatment plan that offers hope relationships, and spiritual beliefs are also and/or symptomatic relief. Anxiety that becomes important factors impacting the degree of anxiety persistent or present “more often than not,” or is intrusive and/or uncontrollable is much less common in cancer, occurring in 10-30% of people diagnosed with cancer.1 An anxiety disorder develops when the Copyright 2011 • All information in this newsletter is owned by or licensed to Wellspring and all rights are reserved.
Charitable Registration # 89272 8940 RR0001 • www.wellspring.ca CANCERSMART • Wellspring Cancer Support Foundation • March 2011 • Issue 8
CANCER & ANXIETY CONT’D
By Kimberley Miller, MD, FRCPC, Attending Psychiatrist, Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Panic Disorder
When asked about coping, individuals with cancer • Can often manifest as recurrent “panic attacks”, that may report that “religion and prayer, living in the have initially been triggered by an event such as having a present, focusing on or strengthening relationships, seizure, but then take on a life of their own and suddenly controlling symptoms, controlling situations… and focusing on positive memories”3 are strategies that are used. Improved coping may occur through Post-traumatic Stress Disorder
setting meaningful and realistic goals, emphasizing • Symptoms can often include intrusive flashbacks or your personal strengths and reinforcing your sense nightmares about initial cancer diagnosis or treatment, of personal control. Relaxation strategies such as progressive muscle relaxation, deep breathing exercises, guided imagery, hypnosis, biofeedback, meditation and mindfulness-based stress reduction Social Anxiety
can also alleviate anxiety. Expressing and processing • Can be experienced as a fear of social situations; social emotions about the illness experience can occur anxiety in many cancer patients may occur due to change in body image from chemotherapy through journaling, art or music therapy, yoga or other forms of aerobic and anaerobic exercise. If the above is not enough, or if personal supports Obsessive-Compulsive Disorder
are inadequate or unavailable, or anxiety is more • An example for some cancer patients could be that long after treatment has ended, constant thoughts about severe, professional psychosocial support may be infection risk, washing hands in ritualized way multiple needed. This will involve supporting you and your family, while exploring and understanding the cause of your specific anxiety problem, correcting any misperceptions about your cancer or its treatment, if • Can be experienced for instance, as a persistent fear present, educating you about psychological symptoms of specific object or situation (e.g., needles, radiation, and cancer and advocating by communicating with your oncology professionals. Individual or (group psychotherapy) can help you adjust to various aspects Generalized Anxiety Disorder
of your illness experience, through exploring your • May be exemplified as uncontrollable excessive worry relationship and thinking patterns, coping styles and about many things (e.g. finances, safety of family), in sense of personal meaning and purpose. Informing your oncologist or nurse about any emotional distress that you are experiencing can facilitate a referral to a social worker, psychologist or psychiatrist, as needed. Medications may also be recommended which are Finding a trusted confidante may be the best place to start. For those in the supportive or care giving role, bearing witness to, validating and normalizing distress can be very powerful and help to relieve anxiety and the Stark DP, House A: Anxiety in cancer patients. Br J Cancer 2000; 83:1261-1267. related feelings of isolation. This may also occur more Stark D, Kiely M, Smith A, et al. Anxiety disorders in cancer patients: their formally through organized support groups. nature, associations, and relation to quality of life. J Clin Oncol 2002; 20:3137-3148. Chi GC. The role of hope in patients with cancer. Oncol Nurs Forum 2007; 34:415-424. Copyright 2011 • All information in this newsletter is owned by or licensed to Wellspring and all rights are reserved.
Charitable Registration # 89272 8940 RR0001 • www.wellspring.ca

Source: http://www.wellspring.ca/Wellspring_Staging/media/national/documents/CancerSmart/individual_article/CancerSmart_March2011_CancerAnxiety.pdf