Anxiety

Anxiety

Anxiety can be a normal part of life and a normal reaction to have about a breast cancer diagnosis and breast cancer treatment.
 

Anxiety can be a normal part of life. People can feel anxious about any number of things, including a change in living arrangements, an upcoming deadline, or public speaking. Anxiety also can be a normal reaction to have about a breast cancer diagnosis and breast cancer treatment. 

With breast cancer, anxiety can be triggered at different points in time: 

  • after initial diagnosis (receiving the news, going for additional tests and imaging, telling family and friends, and putting together a treatment plan)

  • during treatment (wondering how well or fast treatments may work, and worried about any side effects)

  • after treatment (worrying about possible recurrence, feeling uncomfortable that you’re not being followed as closely by your cancer care team, and feeling nervous about follow-up imaging)

With metastatic breast cancer or with breast cancer that has returned (recurrence), anxiety can be triggered by worries about needing ongoing treatment and nervousness about how long treatment might keep the cancer under control.

Feelings of anxiety typically ease up after the trigger goes away. But sometimes anxiety can become intense and begin to interfere with a person’s quality of life. When anxiety does not go away, it’s considered to be an anxiety disorder. 

Symptoms of an anxiety disorder can include:

  • trouble falling asleep and staying asleep (insomnia)

  • very low energy

  • loss of appetite

  • an inability to concentrate

  • lack of interest in normal everyday activities

  • feeling worried, on edge, or unable to turn off your thoughts most of the time

Anxiety can also cause physical symptoms such as:

  • sweating

  • nausea

  • chest pain

  • increased heart rate (palpitations)

  • shortness of breath

  • stomach pain or diarrhea

  • headaches

  • dry mouth

  • shaking or trembling

  • faintness or dizziness

  • tense or arching muscles

  • panic attacks (sudden, incapacitating feelings of anxiety)

Certain cancer treatments, such as chemotherapy, pain medicines, steroids, and hormonal therapies, can trigger ongoing anxiety — either directly or indirectly because of the following side effects:

  • fatigue

  • trouble sleeping

  • joint pain

  • nerve pain

  • hormonal changes

There are also some factors that can increase your risk of anxiety, such as:

  • a personal or family history of anxiety or depression

  • a metastatic breast cancer or triple-negative breast cancer diagnosis

  • not having a strong support system of friends and family 

  • financial difficulties 

  • health problems in addition to breast cancer

  • having to cope with many stressful situations at the same time (worrying about infertility, money, or having to take time off work)

Managing anxiety

If you have constant, intense anxiety that interferes with your everyday life, it’s important to talk to your cancer care team. Your cancer care team can figure out if one of your cancer treatments is making you feel anxious, and see if switching to a different treatment is possible. Your cancer care team can also recommend treatments for side effects such as insomnia, fatigue, hot flashes, or other menopausal symptoms, which can improve anxiety. 

You may also want to ask your cancer care team to refer you to an accredited mental health professional who has experience working with people diagnosed with cancer. Many cancer centers have psychiatrists, psychologists, psychotherapists, counselors, or social workers on staff or can make referrals to practices near you. Some hospitals and cancer programs also offer classes on relaxation techniques that may be able to help you manage anxiety, such as meditation or mindfulness.  

 
 

Some ways of managing anxiety include:

  • deep breathing

  • mindfulness-based stress reduction

  • mind-body relaxation techniques, such as progressive muscle relaxation and grounding techniques 

  • individual counseling (also known as behavioral or talk therapy)

  • anti-anxiety medicines, such as Xanax and Niravam (chemical name: alprazolam), Valium (chemical name: diazepam), Ativan (chemical name: lorazepam), Librium (chemical name: chlordiazepoxide), and Klonopin (chemical name: clonazepam)

  • antidepressant medicines, such as Lexapro (chemical name: escitalopram), Celexa (chemical name: citalopram), Zoloft (chemical name: sertraline), Cymbalta (chemical name: duloxetine), Effexor FR (chemical name: venlafaxine), and Pristiq (chemical name: desvenlafaxine). 

Some antidepressants — including Paxil, Wellbutrin, Prozac, Cymbalta, and Zoloft — may interfere with the body’s ability to convert tamoxifen into its active form, preventing people from getting its full benefit. If you’re taking tamoxifen, it’s essential to ask your doctor which antidepressants are safe for you. 

Your doctor can work with you to figure out which medicine relieves your anxiety with the fewest side effects. Typically, you begin taking a lower dose at first and, under your doctor’s guidance, increase it if and as needed until your symptoms improve. Anti-anxiety medicines pose some risk for addiction, so doctors prescribe them for short-term use. Doctors prescribe antidepressants for longer periods of time because it can take up to six weeks for the medicine to improve symptoms. Still, although doctors don’t consider antidepressants to be addictive in the traditional sense, it is possible to become dependent on them.

Support groups, one-to-one peer support, or Virtual Community Meetups (where you can talk to members of the Breastcancer.org community) also can connect you with others who can share ways they’ve eased their anxiety.

Additionally, some complementary therapies that have been shown to ease anxiety, stress, fear, and depression include:

Some of these complementary therapies may require a practitioner.

 
 
Helping yourself through anxiety

For some people, an effective way of treating anxiety is to combine different therapies, such as individual counseling, medicine, and complementary therapy. Patience with yourself is important. It can take some time to find the strategies that work best for you.

For mild to moderate anxiety, some people find the following strategies helpful:

  • being physically active every day, say walking for 30 minutes a day

  • avoiding alcohol and caffeine 

  • maintaining your normal routines as much as you can, such as mealtimes, bedtime, and daily activities

  • taking part in religious or spiritual practices if organized religion is or has been part of your life

  • doing any activities that you found naturally relaxing before breast cancer, such as painting, playing music, or going on nature hikes

Written by: Kristine Conner, contributing writer

Reviewed by 1 medical adviser
 
Stephanie Ross, PhD
NorthShore University HealthSystem, Evanston, IL
Learn more about our advisory board

— Last updated on September 23, 2022, 7:18 PM

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