Coping with Anxiety

Cancer and its treatment are stressful and worrying for each family. Some anxiety is healthy, but don’t allow anxiety to take over your life. These guidelines can help you regain control over anxiety.

Anxiety is a feeling of fear or anticipated harm accompanied by fearful thoughts about future events. Panic attacks can feel suffocating and amplify your heart rate, causing cold sweats, shaking, and the desire to escape. Intrusive worrying thoughts interfere with daily activities and disrupt sleep. Memory, concentration, and confidence are also affected. 

Suffering from life-threatening and life-limiting illnesses may impose certain stress on the patients. On one hand, the patients would be worried about the progress of their conditions and treatment. On the other hand, they may need to face many changes in life, such as physical discomfort, adjustments to everyday life and financial pressure. Many patients may feel losing control of their lives, helpless, anxious, and fearful. If the patients continue to experience the following problems in a way that affects their daily functioning, they may have anxiety disorders. 

• Cognitive aspect:
  • Uncontrollable, excessive, and persistent worrying about illness situation or issues related to the end of life. For example, the patients may worry about the rapid deterioration of their condition, the inability to control physical symptoms and show signs of impending death.
• Physical aspect:
  • Frequent dizziness, headache, thirst, rapid heartbeat, excessive sweating, breathlessness, muscle tension, fatigue, or insomnia.
• Behavioural aspect: 
  • Seeking assurance from others repeatedly on different things. For example, the patients may constantly ask healthcare professionals about their symptoms or conditions.
  • The patients may avoid facing their condition due to excessive anxiety. For example, they may avoid talking about their illness, or even choose to ignore the scheduled follow-up consultation. 
  • The patients may become very irritable.

Anxiety indicates that we feel threatened.  

• Anxiety energizes the body to escape physical threats.  Cancer, financial problems, or failure are threats you can’t run from. So, anxiety remains. 
• Cancer creates a high level of uncertainty towards significant threats to health, wellbeing, family, and finances. This means people face high coping demand, often exceeding our everyday coping limits, causing stress and anxiety. 
• Longstanding stressful situations can cause anxiety to last for many years. 
• Consuming caffeine (tea, coffee, Red Bull), cigarettes, alcohol, and medical conditions like thyroid disorders can result in feelings that mimic anxiety, triggering true anxiety.  
• Some people may be temperamentally more prone to experience anxiety. 

Risks

Cancer patients who have the following are at higher risk of anxiety: 

• Previous diagnosis of anxiety or depression 
• Family history of anxiety or depression 
• Lack of support of friends or family 
• Financial burdens

Your doctors may prescribe some medications to relieve your anxiety. The commonly used medications include: 

• Benzodiazepines:  
  • These are used intermittently for episodes of anxiety severe enough to interrupt a patient's day-to-day life and that have not responded to relaxation measures.  
  • Examples of benzodiazepines include: lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium).
• Antidepressants (Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitors (SNRI)) 
  • By regulating brain chemistry, antidepressants like fluoxetine, mirtazapine, venlafaxine, can be used when patients have recurrent episodes of anxiety. 
• Beta Blockers  
  • Beta blockers are medications that are typically used to control high blood pressure and treat certain heart problems. For some people, these medications can decrease stress symptoms.

Here are the things patients can do to handle anxiety themselves:

• Regular exercise 
  • Exercise can help relax the mood and regain a sense of control over your life. Patients can exercise with appropriate level of intensity and frequency based on their physical conditions. For example: stretching or walking slowly in the park. 
• Learn to relax yourself in different ways 
  • Try to practise breathing exercises or muscle relaxation trainings.  
• Deal with the ruminative, anxious and helpless thoughts 
  • When you notice that you have a negative thought, such as “my pain is not under control”, you can approach it from different perspectives, for example: 
    • Write down your thoughts on a piece of paper to help you deal with it in a calm and objective way 
    • Tell yourself that “This is just a thought…” and that it may not reflect the reality 
    • Look at the idea from a different perspective and ask yourself, ”If my friend had this thought, what would I say to him/her?”, “Is there any evidence that proves that it’s true?”, “Is the thinking pattern helpful?” 
    • Practise mindfulness to review your thoughts and pay attention to how your body reacts 
• Maintain personal social support 
  • It is helpful to talk with trusted persons about the difficulties and problems you are going through. It also allows you to feel the support from your friends and family. Using different perspectives to understand your condition and approach problems, you may avoid being trapped in negativity. 
• Avoid smoking and drinking 
  • Smoking and alcohol consumption will intensify the symptoms of anxiety. 
• Avoid caffeine consumption 
  • Caffeine may affect your sleep, increase your heart rate and make you more prone to anxiety symptoms. 
• Seek help from professionals 
  • If your anxiety symptoms have brought significant impact on your daily functioning, notify your healthcare professionals as soon as possible. Based on your condition, they will provide suitable treatment and recommendations to manage the symptoms more effectively. 

HKU Med: Jockey Club Institute of Cancer Care: Managing Anxiety During and After Cancer Treatment

Smart Patient Website, Hospital Authority