Why treatment can bring so much worry
Treatment asks a lot of you at once. There are new routines, unfamiliar procedures, side effects that are hard to predict, and decisions that feel enormous. Ordinary responsibilities do not stop either: bills, work, children, aging parents. Feeling anxious in the middle of all that is not a sign of weakness. It is a mind responding to real uncertainty.
The American Cancer Society (ACS) notes that people who have or had cancer are at greater risk of anxiety, and that it tends to come and go with particular events. During treatment, those often include:
- Starting a new treatment or changing to a different one
- Experiencing side effects
- Getting tests or waiting on results
- Discussing prognosis or making treatment decisions
- Noticing any symptom of illness, whether or not it turns out to be related to cancer
- Finishing treatment and moving into follow-up care
The National Cancer Institute (NCI) points out that the coping skills people need change at different points, and that adjusting to treatment often means changing thoughts or routines, such as reshaping a work schedule around side effects. What steadied you at diagnosis may need updating a few months in.
What anxiety can feel like
Anxiety shows up in the mind and in the body. The ACS lists signs such as:
- Feeling nervous, anxious or on edge
- Not being able to stop or control worrying
- Worrying too much about many different things
- Trouble relaxing, or restlessness that makes it hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid, as if something awful might happen
NCI adds physical signs such as a fast heartbeat, dry mouth, shaky hands and feeling unable to "turn off" your thoughts. During treatment, worries often attach to specific things: side effects, not knowing what to expect (or knowing too much), family and work, the cancer getting worse, or death. Having some of these signs does not mean you have an anxiety problem. Many people learn to manage them with support and practice.
When anxiety has a physical cause
This is the part people most often miss. NCI explains that in people with cancer, anxiety can sometimes come from physical sources rather than worry alone, including:
- Pain that is not well controlled
- Certain medicines, such as corticosteroids, bronchodilators and antihistamines, which can cause restlessness or agitation
- Withdrawal from alcohol, nicotine, opioids or antidepressants
- Some medical problems and certain tumors that can produce anxiety or panic-like symptoms
When anxiety has one of these causes, NCI notes it is usually managed by treating the cause. So if anxiety appeared suddenly, changed with a new medicine, or arrived with new physical symptoms, tell your oncology team. Do not try to decide on your own whether it is "just nerves."
What helps day to day
There is rarely one fix. The ACS suggests having several coping tools ready, because something that works one day may not work the next. Ideas drawn from ACS and NCI guidance include:
- Stay informed and ask questions. Not knowing is one of the most distressing parts for many people, so write questions down before appointments and ask your team to explain anything unclear.
- Take slow, deep breaths, letting your belly rise. NCI describes slow breathing, tensing and releasing muscle groups, and guided imagery, and notes that even 5 or 10 minutes may help.
- Think about what helped you through hard times before, and try it again.
- Take one moment at a time, and let yourself have bad days. You do not have to stay positive.
- Keep a reliable support system, whether a friend, a relative, a group or even a pet.
- Write in a journal, or record your thoughts, to help sort out what you are going through.
- Connect with people who have been through something similar, in a group or by listening to their stories.
For more practical ideas, see Everyday Coping Strategies During Cancer Treatment. If your anxiety centers on scans and results, Scanxiety covers that wait in detail.
When worry becomes more than everyday anxiety
The ACS suggests it may be time to get help if anxiety makes it hard to do your work, take care of daily tasks or get along with other people. NCI notes that for some people anxiety can feel like more than they can handle and can affect their treatment. A strong fear of needles, for example, can make blood draws and procedures very hard to face, and panic attacks bring sudden, intense fear that NCI says usually lasts 10 to 20 minutes, though dread of the next one can linger.
Only a qualified professional can say whether anxiety has become a disorder, after looking at how it affects your life, when it began and how long it has lasted. Treatment often involves talk therapy, medication, or both. Medication decisions belong with your physicians, who know your full treatment plan.
If your team asks about anxiety, the ACS encourages you to say how you really feel. They may ask how often the feelings come, how intense they are, whether physical symptoms come with them, and how they affect your days. It also helps to know what success looks like. The ACS describes the goal of treatment as bringing anxiety to a manageable level, so it no longer stops you from living your life. Some anxiety may still come and go, and that does not mean help has failed.
A psychologist can offer a place to understand what the fear is about and to build ways of coping that fit your life. Dr. Lehmann is a licensed clinical psychologist in Franklin, Michigan, with an insight-oriented, integrative approach. Read about anxiety therapy and cancer-related emotional support, and contact the practice to ask whether she can help with your situation. Telehealth is available for clients physically located in Michigan at the time of the session, which can be easier on treatment weeks.