Anxiety in cancer patients

Authors: Dr. Vanja Putarek, MA in Psychology; Antonija Vrdoljak, MA in Psychology

Anxiety is an unpleasant feeling accompanied by worry, nervousness and physical symptoms such as increased blood pressure and pulse, chest pain, rapid breathing, sweating, muscle tension. It usually occurs in situations that are uncertain, new and that the person assesses as dangerous. Since there are many such situations, everyone or at least most people have encountered anxiety during their lives. However, if anxiety occurs when there is no real danger or threat, if it lasts much longer or is stronger than is appropriate for the situation and if it interferes with daily functioning, it becomes a problem for the individual.

When it comes to anxiety related to cancer, it is difficult to apply the usual criteria for determining whether it is excessive. The diagnosis regularly associates a real threat to the person's life with it, and it is thankless to assess how much anxiety is "too much". A person can experience unpleasant feelings during the first examinations, waiting for test results, receiving a diagnosis, going through treatment and after recovery, when the person fears the disease will return. In the period after diagnosis (especially in the first seven to 10 days), increased anxiety is common, but its level usually changes according to the course of the disease. For example, pronounced anxiety is not common after a long period of remission.

In oncology patients, increased anxiety is a significant symptom that is important to pay attention to, and its severity sometimes does not return to normal levels even after recovery. In patients, it can lead to more pronounced problems with appetite, nausea, insomnia, and increased pain perception, which can adversely affect treatment and reduce quality of life. In addition, in oncology patients, excessive anxiety can lead to treatment delays, refusal of some forms of treatment, and missed examinations due to concerns about receiving bad news. Therefore, in the context of cancer treatment, it is necessary to conduct triage procedures (short assessments of the patient's condition according to which the further course of treatment is determined), to check the level of anxiety of oncology patients and its impact on their daily functioning and on the treatment of the disease. When anxiety becomes very pronounced, it is necessary to act on it to reduce it, thereby increasing the quality of life of oncology patients.

One way to reduce anxiety is to use relaxation techniques, such as abdominal (deep, “from the belly”) breathing. By breathing, a person supplies the body with oxygen (when inhaling) and removes carbon dioxide from the body (when exhaling). When thinking about the disease and treatments, a person may feel increased anxiety and breathe rapidly and shallowly (with the upper part of the body, “from the chest”). Rapid and shallow breathing can lead to an imbalance in the level of oxygen and carbon dioxide. More precisely, an increased amount of carbon dioxide is removed from the body, which lowers its level below optimal levels. Due to this rapid and shallow breathing, a person may feel dizzy, headache, lightheadedness, and may also experience blurred vision, tingling, and loss of sensation in the hands and/or feet. These symptoms are usually not life-threatening, but they are unpleasant and increase concern for one’s own life. Abdominal breathing leads to a balance of oxygen and carbon dioxide levels, slows down the heart rate, and makes a person feel more relaxed. In addition, during abdominal breathing, a person concentrates on breathing properly and does not have time to think about the sources of worries. Abdominal breathing is performed in the following way: a person inhales deeply through the nose for four seconds, then holds the air for two seconds and exhales for six seconds. It is important that the person relaxes the jaw (does not keep the teeth clenched tightly), that the exhalations last longer than the inhalations, and, if possible, that the person sits down and makes himself as comfortable as possible. To make it easier to follow the breathing “from the belly”, a person can place one hand on the stomach and the other on the chest.

Another relaxation technique that can be used to reduce anxiety is the visualization (imagination) of a scene in which the person feels calm, relaxed and pleasant (for example, a person can imagine a sunset on the beach during the summer, with the sound of the sea and the sun shimmering on the gentle waves). It is important for the person to imagine the scene in as much detail as possible and to try to concentrate on as many different parts of the scene as possible - whether they hear certain sounds, smell certain smells, what kind of ground they are walking on, whether they see certain animals in the distance, etc.

In order for a person to learn to deal with anxiety and for anxiety reduction to be effective in the long term, it is important to seek professional help. As part of counseling or psychotherapy, depending on the needs and characteristics of the person, beliefs and biases in thinking that can make coping with the disease more difficult can be worked on. In addition, specific beliefs about the disease, approach to the disease and interpretations of the symptoms of the disease can be worked on. The emphasis can also be on working on emotions, changing habits, dealing with fears, accepting certain phenomena that are beyond the individual's control, but also on other processes, depending on the individual. It is important that oncology patients and the professional staff who work with them do not ignore anxiety symptoms because they can greatly impair the quality of life of oncology patients and make coping with cancer more difficult. With timely and professional help, anxiety is not an unsolvable problem, and working on anxiety can increase satisfaction with yourself and life in the long run.

References

1. Leahy, R. L., Holland, S. J. i McGinn, L. K. (2014). Planovi tretmana i intervencije za depresiju i anksiozne poremećaje. Jastrebarsko: Naklada Slap.

2. Stark, D. P. H. i House, A. (2000). Anxiety in cancer patients. British Journal of Cancer, 83(10), 1261–1267. doi: 10.1054/ bjoc.2000.1405

3. https://www.cancer.net/coping-with-cancer/managing-emotions/anxiety

4. https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq

5. https://www.webmd.com/anxiety-panic/anxiety-in-cancer-patients#1

Continue reading: Depression in cancer patients

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