Canterbury DHB

Anxiety in Cancer Patients

Anxiety symptoms are common in people with cancer. The presence of these may not necessarily present a clinical problem, and in many could be considered part of a ‘normal’ reaction. However, the rate of diagnostically-significant anxiety disorders ranges from 10-30%.

Clinically significant disorders likely to arise include panic disorder, adjustment disorders, phobic disorders, and conditioned responses such as anticipatory nausea.

As with depression (see below), the applicability of traditional diagnostic criteria is complicated by cancer symptoms and treatment.

Duration of symptoms is usually important in distinguishing between normal anxiety in the face of a threat, and clinically significant anxiety.

Level of functional disruption is another dimension to consider. Highly disrupted concentration, psychomotor agitation, impaired social functioning, and other activities of daily living should be appraised, along with avoidance and checking behaviours, or evidence of seeking excessive reassurance.

Anxiety can often co-occur with depression, and treatment of this latter condition can dramatically improve anxiety.

A range of psychological and pharmacological treatments have been found to be relatively effective in cancer patients with anxiety disorders.

Unless urgency dictates otherwise, referral for a fuller assessment of symptoms and diagnostic work-up can be made to the Clinical Psychologists (email) in the first instance. A brief written referral is preferred (especially for Haematology Outpatients), although verbal referrals in the context of ward rounds/reviews are acceptable. More specialised reviews by others (e.g. Psychiatrists) will be arranged where requested or indicated. Cover for referrals (in hours) is provided by the Psychiatric Consultation-Liaison Service (ph 3638-100). Psychiatric emergencies out-of-hours should be referred to the on-call Psychiatric Emergency Service (3640-482).

Topic Code: 5048