What is anxiety? Does it cause cancer?

Description of the problem: A key feature of anxiety is
the perception of an imminent or future threat, regardless of the accuracy of the
perception. Although in some cases, anxiety can be brought on by exaggerated or
unrealistic appraisals of threat, in the case of cancer, anxiety is a normal and
expected reaction to a serious and potentially life-threatening disease.

Excessive anxiety that is interfering with an individual's daily life warrants
further evaluation. Vital to the assessment of clinically significant anxiety is
the extent to which anxiety meaningfully impairs the ability to function. For
example, extreme anxiety may prevent an otherwise able patient or loved one from
continuing to work, or it may interfere with medical care when a patient’s fearful
avoidance prevents or delays receipt of tests or treatments.

The American Psychiatric Association’s Diagnostic and Statistical Manual
of Mental Disorders (5th ed., 2013) recognizes several distinct types
of anxiety disorders, including generalized anxiety disorder, panic
disorder, panic
attacks, specific phobias, social anxiety disorder,
separation anxiety disorder, agoraphobia, and selective mutism, as well as
substance- or medication-induced anxiety disorder, anxiety disorder due to another
medical condition, other specified anxiety disorder, and unspecified anxiety
disorder. Anxiety may also be a prominent feature of depression or
an adjustment disorder (a short-term psychological reaction to a stressful event),
both of which are common among cancer patients.

The experience of being a cancer patient can contribute to the development of
anxiety disorders in several ways. For example, a patient may develop a phobia of
particular objects or procedures such as needles or diagnostic tests that were
associated with highly stressful experiences. After cancer care, some patients may
experience symptoms of posttraumatic stress disorder, a
trauma- and stress-related disorder characterized by recurrent intrusive memories
and flashbacks, avoidance of reminders of stressful events, and hyperarousal
symptoms such as sleep difficulties and irritability. Anxiety may have origins in
medical causes such as certain types of tumors or physiological side effects from
some treatments.

Prevalence: Not surprisingly, research suggests that the vast majority of cancer patients experience anxiety at some point during their illness. Far fewer develop clinical anxiety disorders. Although several studies have suggested an increased prevalence of anxiety disorders among cancer patients, others suggest little or no difference in this prevalence when cancer patients are compared with the general population. Reported rates of anxiety disorders are usually lower when assessed using formal diagnostic criteria and range from 10 to 30 percent.

Assessment: In the clinical setting, anxiety is most commonly
assessed face to face by a primary care provider or by a provider with special
expertise in mental health, such as a psychiatrist, psychotherapist, or a clinical
psychologist. The assessment is usually in the form of an interview to establish
the nature, duration, and severity of symptoms according to established criteria,
whether according to the diagnostic standards set out by the American Psychiatric
Association or some other diagnostic system.

Numerous standardized questionnaires are also available to measure anxiety in
clinical and research settings. These questionnaires ask respondents to
self-report the frequency or severity of various symptoms commonly associated with
anxiety. Examples of anxiety assessment questionnaires that have been used with
cancer patients include the Beck Anxiety Inventory, the State-Trait Anxiety
Inventory, and the Hospital Anxiety and Depression Scale.

Treatment and therapy: Anxiety related to medication or disease is usually first treated by managing the underlying condition causing symptoms. However, in many cases, anxiety is treated as a condition in its own right. Effective interventions for anxiety include both medical and psychological treatment options.

Medical management of anxiety usually entails treatment with an anxiolytic
(antianxiety) or antidepressant medication, the latter particularly when signs of
a depressed mood are present. The class of drugs known as benzodiazepines, which includes clonazepam (Klonopin),
alprazolam (Xanax), and diazepam (Valium), are sometimes used for short-term
treatment, although longer-term treatment with benzodiazepines is controversial
due to physical dependence and withdrawal symptoms. Commonly prescribed
antidepressants include selective serotonin reuptake inhibitors (SSRIs) such as
paroxetine and sertraline (Zoloft), serotonin-norepinephrine reuptake inhibitors
(SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta), and to a lesser
extent tricyclic antidepressants such as imipramine (Tofranil) and clomipramine
(Anafranil).

Psychological treatments include individual psychotherapy (talk therapy), group
therapy, family therapy, and certain mind-body interventions. Anxiety is highly
responsive and often easily treated with appropriate therapy. In particular,
research heavily supports the efficacy of cognitive-behavioral therapy, which
encompasses a variety of therapeutic techniques. Broadly speaking, the goals of
cognitive-behavioral therapy for anxiety are to guide patients toward a more
balanced and rational appraisal of their concerns and to encourage behaviors that
reduce or neutralize anxieties rather than exacerbate them. Other frequently used
therapeutic approaches include training in relaxation techniques, mindfulness
meditation, and hypnosis. Biofeedback may also be effective in
helping patients recognize and manage physical symptoms of anxiety by, for
example, reducing muscle tension and cardiovascular reactivity to stress.

American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th ed. Washington: Author, 2013. Print.

Antony, Martin M.,
Susan M. Orsillo, and Lizabeth Roemer, eds. Practitioner’s Guide to
Empirically Based Measures of Anxiety. New York: Kluwer
Academic/Plenum, 2001. Print.

Baum, Andrew, and
Barbara L. Andersen, eds. Psychosocial Interventions for
Cancer. Washington: American Psychological Assoc., 2001.
Print.

Cho, William C. S., ed.
Evidence-Based Non-Pharmacological Therapies for Palliative
Cancer Care. Dordrecht: Springer, 2013. Print.

Ladas, Elena J., and Kara M. Kelly.
Integrative Strategies for Cancer Patients: A Practical Resource
for Managing the Side Effects of Cancer Therapy. Hackensack:
World Scientific, 2012. Print.