Distress in cancer care

Overview

KEY POINTS

  • Anxiety and distress can affect the quality of life of patients with cancer and their families.
  • Patients with cancer have different levels of distress.
  • There are certain risk factors for high levels of distress in people with cancer.
  • Screening is done to find out if the patient needs help adjusting to cancer.

Anxiety and distress can affect the quality of life of patients with cancer and their families.

Patients living with cancer feel many different emotions, including anxiety and distress.

  • Anxiety is unease, fear, and dread caused by stress.
  • Distress is emotional, mental, social, or spiritual suffering. Patients who are distressed may have a range of feelings, from sadness and a loss of control to depression, anxiety, panic, and isolation.

Patients may have anxiety and distress when:

  • Being screened for cancer.
  • Waiting for test results.
  • Hearing a cancer diagnosis.
  • Being treated for cancer.
  • Worrying that cancer will recur (come back).

Anxiety and distress may cause problems such as nausea and vomiting before each treatment, having more pain than usual, and sleeplessness. Patients may decide to delay cancer treatment or miss check-ups when they feel anxiety and distress.

Even mild anxiety can affect the quality of life for cancer patients and their families and may need to be treated.

Patients with cancer have different levels of distress.

Some patients 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 problem, such as major depression.

This summary describes the less severe levels of distress in adults with cancer, including the following:

  • Normal adjustment—A condition in which a person makes changes in his or her life to manage a stressful event such as a cancer diagnosis. In normal adjustment, a person learns to cope well with emotional distress and solve problems related to cancer.
  • Psychological and social distress—A condition in which a person has some trouble making changes in their life to manage a stressful event such as a cancer diagnosis. The feelings of distress may range from normal feelings of vulnerability and sadness to feelings that affect quality of life, such as depression, panic, and spiritual crisis. Help from a professional to learn new coping skills may be needed.
  • Adjustment disorder—A condition in which a person has a lot of trouble making changes in his or her life to manage a stressful event such as a cancer diagnosis. Symptoms such as depression, anxiety, or other emotional, social, or behavioral problems occur and worsen the person’s quality of life. Medicine and help from a professional to manage these symptoms may be needed.
  • Anxiety disorder—A condition in which a person has severe anxiety. It may be because of a stressful event like a cancer diagnosis or for no known reason. Symptoms of anxiety disorder include extreme worry, fear, and dread. When the symptoms are severe, it affects a person’s ability to lead a normal life. There are many types of anxiety disorders, including the following:
    • Generalized anxiety disorder.
    • Panic disorder (a condition that causes sudden feelings of panic).
    • Agoraphobia (fear of open places or situations in which it might be hard to get help if needed).
    • Social anxiety disorder (fear of social situations).
    • Specific phobia (fear of a specific object or situation).
    • Obsessive-compulsive disorder.
    • Post-traumatic stress disorder.

There are certain risk factors for high levels of distress in people with cancer.

Nearly half of cancer patients report having a lot of distress. Patients 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 patients with cancer:

  • Trouble doing the usual activities of daily living.
  • Physical problems and side effects of treatment (such as fatigue, nausea, or pain).
  • Problems at home.
  • Unmet social and spiritual needs.
  • Depression, cancer-related post-traumatic stress, or other emotional problems.
  • Being younger, female, or non-White.
  • Having a lower level of education.

Patients 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 done to find out if the patient needs help adjusting to cancer.

Screening is usually done by asking the patient questions about how they feel, their energy level, relationships, work, and finances. Patients 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.

See the following PDQ summaries for information on depression and post-traumatic stress related to cancer: