Treatment of Cancer-Related Anxiety
For cancer-related anxiety, a combination of mindfulness-based interventions (MBIs), yoga, and other integrative approaches should be offered as first-line treatments, with pharmacotherapy reserved for those who don't respond to non-pharmacological interventions or have severe symptoms. 1
First-Line Treatment Approaches
During Active Cancer Treatment
For patients experiencing anxiety during active cancer treatment, the following interventions are recommended:
- Mindfulness-Based Interventions (MBIs) - Highest level of evidence for reducing anxiety symptoms 1
- Yoga - Particularly effective for breast cancer patients 1
- Relaxation techniques - Including progressive muscle relaxation and guided imagery 1
- Music therapy - Shown to reduce anxiety during treatment phases 1
- Reflexology - Can help manage anxiety symptoms 1
- Aromatherapy (using inhalation) - May provide symptomatic relief 1
Post-Cancer Treatment
For patients experiencing anxiety after completing cancer treatment:
- MBIs - Continue to be effective post-treatment 1
- Yoga - Recommended especially for breast cancer patients 1
- Acupuncture - May help manage post-treatment anxiety 1
- Tai chi and/or qigong - Beneficial for managing anxiety after treatment 1
- Reflexology - Can continue to provide benefit 1
Psychological and Behavioral Interventions
For moderate anxiety symptoms, clinicians should offer:
- Cognitive Behavioral Therapy (CBT)
- Behavioral Activation (BA)
- Structured physical activity
- Acceptance and Commitment Therapy 1
For severe anxiety symptoms, clinicians should offer:
- Cognitive therapy
- Behavioral Activation
- CBT
- Mindfulness-Based Stress Reduction (MBSR)
- Interpersonal therapy 1
Pharmacological Management
Pharmacotherapy should be considered when:
- Patients don't have access to first-line psychological treatments
- Patients prefer medication
- Patients have previously responded well to medication
- Patients haven't improved with psychological/behavioral interventions 1
When pharmacotherapy is indicated:
Benzodiazepines may be used short-term for acute anxiety symptoms
- Alprazolam starting at 0.25 to 0.5 mg three times daily, may increase at 3-4 day intervals to maximum 4 mg/day in divided doses 2
- Caution is warranted with benzodiazepines due to risk of dependence and adverse effects including cognitive impairment 1
- Use should be time-limited according to psychiatric guidelines 1
SSRIs may be considered for longer-term management
Follow-Up and Monitoring
Monthly follow-up is recommended until symptoms subside:
- Assess compliance with psychological/psychosocial referrals and satisfaction with services
- Evaluate medication compliance, concerns about side effects, and symptom relief
- Consider tapering medications if anxiety is controlled and environmental sources of anxiety are no longer present
- If compliance is poor, address obstacles or consider alternative interventions
- If symptoms persist after 8 weeks despite good compliance, alter the treatment approach 1
Important Considerations
- Patient education is essential - all patients and their families should be offered information about anxiety and available resources 1
- Screening should be routine using validated measures to identify patients needing intervention 1
- Avoidance behaviors are common in anxiety - patients may not follow through on referrals or treatment recommendations 1
- Reassurance alone may not be effective and can sometimes be counterproductive for highly anxious patients 3
- Health anxiety is common in cancer patients, even when in remission, affecting approximately one-third of patients 3
- Quality of life is significantly impacted by anxiety disorders in cancer patients, particularly through symptoms like insomnia 4
By implementing this comprehensive approach to cancer-related anxiety, clinicians can significantly improve patients' psychological well-being, quality of life, and potentially their overall cancer outcomes.