People living with cancer feel many different emotions, including anxiety and distress.
People with cancer may have anxiety and distress when:
Anxiety and distress may cause problems such as nausea and vomiting before each treatment, having more pain than usual, and sleeplessness. People may decide to delay cancer treatment or miss check-ups when they feel anxiety and distress.
Even mild anxiety can affect quality of life for people with cancer and their families and may need to be treated.
Some people with cancer have a low level of distress, and others have higher levels of distress. The level of distress ranges from being able to adjust to living with cancer to having a serious mental health disorder, such as major depression.
This summary describes the less severe levels of distress in adults with cancer, including the following:
Nearly half of people with cancer report having a lot of distress. People with lung, pancreatic, and brain cancers may be more likely to report distress, but in general, the type of cancer does not make a difference. Factors that increase the risk of anxiety and distress are not always related to the cancer.
The following are risk factors for high levels of distress in people with cancer:
People who have a high level of distress when they are diagnosed with cancer are more likely to have continued high levels of distress after their diagnosis.
Screening is usually done by asking the person questions about how they feel, their energy level, relationships, work, and finances. People who show a medium to high level of distress may be referred to a social worker, mental health professional, palliative care specialist, or pastoral counselor for further evaluation and therapy.
This summary is about adjustment to cancer, anxiety, and distress in adults with cancer.
For information on depression and post-traumatic stress related to cancer, see the following:
The way people with cancer cope is usually linked to their personality traits (such as whether they usually expect the best versus the worst, or if they are shy versus outgoing).
People find it easier to adjust if they can carry on with their usual routines and work, keep doing activities that matter to them, and cope with stress in their lives. People who adjust well to coping with cancer continue to find meaning and importance in their lives. People who do not adjust well may withdraw from relationships or situations and feel hopeless.
People who are having trouble coping with cancer may find it helpful to talk with a professional about their concerns and worries. These specialists may include the following:
Distress can occur when people feel they are unable to manage or control changes caused by cancer. People with the same diagnosis or treatment can have different levels of distress. People have less distress when they feel the demands of the diagnosis and treatment are low or the amount of support they get is high. For example, a health care professional can help the person adjust to the side effects of chemotherapy by giving medicine for nausea.
Living with a diagnosis of cancer involves many life adjustments. Normal adjustment involves learning to cope with emotional distress and solve problems caused by having cancer.
The coping skills needed will change at different points in a person's cancer journey. These include the following:
The process of adjusting to cancer begins before people hear the diagnosis. People may feel worried and afraid when they have unexplained symptoms or are having tests done to find out if they have cancer.
A diagnosis of cancer can cause people to have more distress when their fears become true. It may be difficult for people to understand what the doctors are telling them during this time. For more information, see Communication in Cancer Care.
Additional help from health professionals for problems such as fatigue, trouble sleeping, and depression may be needed during this time.
As people go through cancer treatment, they use coping skills (also known as coping strategies) to adjust to the stress of treatment.
People who have comorbidities, a decreased ability to manage their daily routines, or a self-reported diagnosis of depression or back pain may be more likely to experience anxiety during chemotherapy treatment than those who do not.
Adjusting to cancer treatment might involve coping skills that help the person change their thoughts or behaviors. For example, changing a daily routine or work schedule to manage the side effects of cancer treatment is a coping skill.
People may be glad that treatment has ended but feel increased anxiety as they see their treatment team less often. Other concerns include returning to work and family life and being worried about any change in their health.
Many people will feel increased distress after finishing treatment, but this usually does not last long and may go away within a few weeks.
During remission, people may become distressed before follow-up medical visits because they worry that the cancer has come back. Waiting for test results can be very stressful.
Cancer that comes back after treatment may cause an increase in distress from having:
A person's quality of life may be improved if they are able to manage their cancer and have support from friends and family.
Sometimes cancer comes back or does not get better with treatment. The treatment plan then changes from one that is meant to cure the cancer to one that gives comfort and relieves symptoms. This may cause the person to have an increase in anxiety or depression. For more information, see Depression and Cancer-Related Post-Traumatic Stress.
People who adjust to the return of cancer often keep up hope in meaningful life activities. Some people look to spirituality or religious beliefs to help keep up their quality of life. For more information, see Spirituality in Cancer Care.
People adjust to finishing cancer treatment and being long-term cancer survivors over many years. Some common problems reported by cancer survivors as they face the future include the following:
Regular exercise and individual or group counseling may help improve these problems and the person's quality of life.
Most people adjust well and some even say that surviving cancer has given them a greater appreciation for life, a better understanding of what is most important in their life, and stronger spiritual or religious beliefs.
Some people may have more trouble adjusting because of medical problems, fewer friends and family members who give support, money problems, or mental health problems not related to the cancer.
Almost all people living with cancer have feelings of distress. Feelings of distress range from sadness and fears to more serious problems such as depression, anxiety, panic, feeling uncertain about spiritual beliefs, or feeling alone or separate from friends and family.
People who are in distress during any phase of cancer need treatment and support. People are more likely to need to be checked and treated for distress during the following periods:
Studies have shown that people who are having trouble adjusting to cancer are helped by treatments that give them emotional and social support, including the following:
Benefits from these therapies include having lower levels of depression, anxiety, and cancer- and treatment-related symptoms, as well as feeling more hopeful. People who have the most distress seem to get the most relief from these therapies.
An adjustment disorder occurs when a person's reaction to a stressful event:
Stressful events for people with cancer include diagnosis, treatment, cancer recurrence, and when side effects occur. People who have trouble coping with these events may develop an adjustment order. An adjustment disorder usually begins within 3 months of a stressful event.
Individual (one-to-one) and group counseling have been shown to help people with cancer who have adjustment disorders. Counseling may include treatment that focuses on the person's thoughts, feelings, and behaviors.
The following may help people cope:
People who are having trouble adjusting to cancer should try counseling before medicine. Counseling may not help everyone, and some people may have a mental health disorder, such as severe anxiety or major depression. These people may need an antianxiety or antidepressant medicine along with counseling. For more information, see Depression.
Studies show that almost half of all people with cancer say they feel some anxiety and about one-fourth of all people with cancer say they feel a great deal of anxiety. A person may become more anxious as cancer spreads or treatment becomes more aggressive. This is especially true for people who had an anxiety disorder before their cancer diagnosis.
For some people, anxiety may feel like it is more than they can handle and this may affect their cancer treatment.
Symptoms of anxiety disorders include the following:
People are more likely to have anxiety disorders during cancer treatment if they have any of the following:
An anxiety disorder diagnosis is based on how symptoms of anxiety affect the person's quality of life, what kinds of symptoms began since the cancer diagnosis or treatment, when the symptoms occur, and how long they last.
Anxiety disorders cause serious symptoms that affect day-to-day life, including the following:
In addition to anxiety caused by a cancer diagnosis, the following may cause an anxiety disorder in people with cancer:
Anxiety from these causes is usually managed by treating the cause of the anxiety.
When people who had an anxiety disorder in the past are diagnosed with cancer, the anxiety disorder may come back. These people may feel extreme fear, be unable to remember new information, or be unable to follow through with medical tests and procedures.
People who have intense fear, have trouble understanding information about their cancer, or are unable to cooperate with medical tests should be screened for the following types of anxiety disorders:
People with cancer who have OCD may be unable to follow through with treatment because of persistent thoughts and behaviors. They may also have obsessive thoughts about their cancer coming back. OCD is rare in people with cancer who did not have an anxiety disorder before being diagnosed with cancer.
People with anxiety disorders need information and support to understand their cancer and treatment choices. Psychological treatments can also be helpful. These include the following:
Using different methods together may be helpful for some people. For more information, see the Psychological and Social Distress section.
Antianxiety medicines may be used alone or combined with other psychological therapies. These medicines relieve symptoms of anxiety, such as feelings of fear, dread, uneasiness, and muscle tightness. They may relieve daytime distress and lessen trouble sleeping.
Studies show that antidepressants are useful in treating anxiety disorders. Children and teenagers being treated with antidepressants have an increased risk of thinking about suicide and must be watched closely. For more information, see the Treatment section in Depression.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
This PDQ cancer information summary has current information about normal adjustment issues, and the pathophysiology and treatment of psychosocial distress and the adjustment disorders. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
The best way to cite this PDQ summary is:
PDQ® Supportive and Palliative Care Editorial Board. PDQ Adjustment to Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389325]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.
The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.