How to Manage Anxiety During and After Breast Cancer
Breast cancer can trigger a lot of emotions, including feelings of fear and worry about the future. These feelings of anxiety are a common and normal response to stress.
If anxiety starts to interfere with your daily life, though, it’s important to talk with someone who can help. Mental health professionals on your healthcare team can help you identify new ways to cope and/or guide you to experts who can.
Anxiety triggers
Everyone responds to stress and uncertainty differently. Research shows that anxiety may be more intense at points of uncertainty during a cancer experience.
Anxiety after cancer diagnosis
Being diagnosed with breast cancer is stressful. Many people feel shocked and overwhelmed. Before you have all the information you need about the diagnosis and your treatment options, you may find your mind racing to worst-case scenarios. This is called catastrophic thinking.
Hopefully, you can schedule an appointment with members of your healthcare team as soon as possible so that you can learn more about your specific type of cancer and recommended treatments. Ideally, you’ll have the opportunity to ask them about your worries and concerns. Having a better understanding of what to expect and how treatment works may help reduce uncertainty and make these thoughts feel less overwhelming. You can also ask about support resources that may be able to help you cope.
Anxiety as you start cancer treatment
It’s natural to feel nervous about having surgery or starting a new treatment — including whether it’ll work, how it might make you feel, how long recovery will take, and how much it’ll cost.
Being aware of the potential treatment side effects and paying close attention to changes in your mood can help you work with your healthcare team to resolve issues as they come up.
Scanxiety and fear of recurrence
Many people worry about breast cancer coming back (recurring) and spreading (metastasizing). Anxiety often spikes around regular scans and other follow-up tests after treatment. This is known as “scanxiety.” Some studies suggest that more than 80% of people with a cancer diagnosis have moderate to severe fear of recurrence or the cancer getting worse.
Anxiety and metastatic breast cancer
People with metastatic breast cancer — who will be in treatment for life — sometimes find it particularly challenging to shake anxiety as they regularly question whether their treatment is working and what remaining treatment options they have if treatment stops working.
Anxiety as a side effect of treatment
Certain cancer treatments, such as chemotherapy, hormonal therapy, pain medicines, and radiation, can trigger ongoing anxiety. For example, anxiety can be a direct side effect of steroids and long-term use of pain medicines, whereas anxiety caused by chemotherapy and hormonal therapy may be the result of side effects like trouble sleeping and hormonal changes.
Talking with your healthcare team about side effects you’re experiencing during treatment can help you figure out if one of your treatments is making you feel anxious. If so, you might decide to switch to a different treatment. Your care team can also recommend treatments for side effects such as pain, insomnia, fatigue, hot flashes, or other menopausal symptoms, which can improve anxiety.
Anxiety risk factors
There are other factors that might increase the risk that a person with breast cancer experiences anxiety. These include:
a personal or family history of anxiety or depression
a history of trauma
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)
Anxiety symptoms
Uncontrolled anxiety can negatively affect your health by worsening treatment side effects, including pain and fatigue. With fears circling your mind and wearing you out, you may also find it harder to decide on a treatment plan and stick with it.
Symptoms of anxiety can include:
feeling worried, on edge, or unable to turn off your thoughts most of the time
trouble falling asleep and staying asleep (insomnia)
very low energy
loss of appetite
difficulty concentrating
lack of interest in everyday activities
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 aching muscles
Sometimes anxiety can trigger a panic attack — a sudden, intense feeling of fear or discomfort that leads to such symptoms as a pounding heart, shallow breathing, and feelings of being detached from your body. These symptoms typically resolve within minutes to an hour, and after a panic attack passes, you may feel tired.
How to manage anxiety
Managing anxiety is an important part of taking care of your mental health after being diagnosed with breast cancer. You may want to ask your cancer care team to refer you to a mental health professional who has experience working with people diagnosed with cancer.
In 2023, the American Society of Clinical Oncology (ASCO) released updated guidelines for doctors on how to manage anxiety and depression in people with cancer. These guidelines highlight the important role that exercise, individual and group therapy, and medicine can play in treating anxiety symptoms. A separate set of guidelines by ASCO and the Society for Integrative Oncology describes how mindfulness practices, such as meditation, mindful movement, and mindfulness-based stress reduction, can help lower anxiety.
Many cancer centers have psychiatrists, psychologists, psychotherapists, counselors, or social workers on staff, and/or they can make referrals to providers near you. Some hospitals and cancer programs also offer support groups and classes on relaxation techniques that may be able to help you manage anxiety, such as meditation or mindfulness.
Exercise for anxiety
The 2018 American College of Sports Medicine Roundtable found strong evidence that moderate-intensity aerobic exercise and resistance exercise during and after cancer treatment reduced anxiety and depressive symptoms. It also found that exercise was generally safe during and after cancer treatment.
Sami Mansfield, a certified cancer trainer and founder of Cancer Wellness for Life, demonstrates exercises to help manage anxiety in the video below. The exercises are challenging but doable, and can be modified based on your abilities.
Therapy for anxiety
Some people find that talking with a therapist one-on-one or participating in group therapy helps them manage anxiety about an illness. One type of therapy known to be particularly effective at treating anxiety is called cognitive behavior therapy (CBT). CBT teaches people to recognize unhelpful thoughts and behaviors that create stress so they can try to change those patterns. Studies show CBT can help to reduce fears of recurrence and improve quality of life in people with cancer.
Medicines to ease anxiety
Many medicines may help control anxiety. There are two main types: anti-anxiety medicines and antidepressants.
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. No matter which medication you take, it’s important to keep your cancer care team informed.
Anti-anxiety medicines include Xanax and Niravam (chemical name: alprazolam), Valium (chemical name: diazepam), Ativan (chemical name: lorazepam), Librium (chemical name: chlordiazepoxide), and Klonopin (chemical name: clonazepam).
Antidepressants include Lexapro (chemical name: escitalopram), Celexa (chemical name: citalopram), Zoloft (chemical name: sertraline), Cymbalta (chemical name: duloxetine), Effexor XR (chemical name: venlafaxine), and Pristiq (chemical name: desvenlafaxine).
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.
Some antidepressants — including Paxil (chemical name: paroxetine), Wellbutrin (bupropion), Prozac (chemical name fluoxetine), Cymbalta, and Zoloft — may interfere with the body’s ability to process tamoxifen. If you’re taking tamoxifen, ask your doctor which antidepressants are best for you.
Other ways to manage anxiety
In addition to exercise, therapy, and medication there are many other ways to help reduce anxiety. These include acupuncture, aromatherapy, hypnosis, music therapy, tai chi, yoga, and other complementary therapies.
Connect with others who understand
It can be helpful to connect with other people who understand where you’re coming from. Through the Breastcancer.org Community, you can access discussion forums where you can share and ask for guidance from other Community members. Breastcancer.org also hosts weekly virtual support groups for people living with breast cancer.
