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Anxiety

Anxiety is a common symptom among people with cancer.² According to Cancer.net, anxiety may be described as feeling nervous, "on edge" or worried. A normal emotion, it alerts your body to respond to a threat. However, intense and prolonged anxiety is a disorder which may interfere with your daily activities and relationships. Anxiety may make coping with cancer treatment more difficult and may also interfere with your ability to make choices about your care. Therefore, identifying and managing anxiety are important parts of cancer treatment.³

Managing Anxiety

The Society for Integrative Oncology evidence-based clinical practice guidelines cite the following complementary approaches as being useful in an integrative plan to manage anxiety:⁶

• Mind-body approaches including these:
• Cognitive-behavioral therapy (CBT)
• Guided imagery
• Hypnosis
• Meditation
• Mindfulness-based stress reduction (MBSR)
• Music therapy
• Relaxation training
• Supportive/expressive therapy stress management
• Support groups
• Yoga
• Massage from a trained massage therapist
• Nature immersion, such as forest bathing
• Therapies based on a philosophy of bioenergy fields, such as these:
  • Reiki
  • Healing Touch
  • Therapeutic Touch®

Some natural products can impact anxiety and stress levels. A 2017 review reported these conclusions:⁷

• Supplementation with essential fatty acids (linoleic acid and alpha-linolenic acid) reduced perceived stress and salivary cortisol levels, with effects dependent on hormone status and whether depression was also evident
• Vitamin B₆ supplements, sometimes combined with magnesium, reduced anxiety in some women for conditions other than cancer.
• High-dose sustained-release vitamin C supplements reduced anxiety and blood pressure in response to stress.⁸

Medical cannabis is reputed by some to reduce anxiety, although a 2018 review found insufficient evidence to support this use.⁹ In fact, for some, cannabis can increase feelings of uneasiness or anxiety, especially the strains that are higher in THC.

In addition to complementary therapies, consider seeing a professional such as a therapist, oncology social worker or oncology navigator to help you explore your stressful situation and identify an approach that is right for you.

Anxiety and Breathlessness (Dyspnea)

Breathlessness (dyspnea) is a common symptom among people with advanced cancer. “Breathlessness can be associated with and made worse by accompanying anxiety and can severely impact quality of life and exercise capacity."¹⁰

A review of 29 studies (randomized control trials) found that people with advanced cancer experienced relief from symptoms of breathlessness with nonpharmacologic therapies.¹¹ Relief lasted a few minutes to a few hours in a hospital setting:¹²

1. Fan therapy: blowing air from a fan into the face of patients experiencing breathlessness
2. Air pressure delivered through a face mask covering the mouth and nose (bilevel ventilation)

In outpatient settings, these therapies were associated with improved breathlessness, although the strength of evidence was judged as low. Relief lasted for a few weeks to months:

1. Acupressure and reflexology
2. Multicomponent interventions (combined activity and rehabilitation, behavioral and psychoeducational, and integrative medicine)

Integrative Programs, Protocols and Medical Systems

• Programs and protocols 
• Block program¹³
• Traditional systems
  • Ayurveda
  • Traditional Chinese medicine

Commentary

Laura Pole, RN, OCNS, October 18, 2018: Ruth Hennig, a two-time breast cancer survivor, has written blog posts describing her experience using acupuncture and other complementary approaches to bolster her resilience during treatment and tame her anxiety upon learning the breast cancer had recurred. Her tips and insights for taking care of herself after a double mastectomy are simple and practical, and they may be incredibly valuable for others having a mastectomy. See her posts in the Our Blog box below.

Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update on March 30, 2021.

1. Cancer.Net. Anxiety. American Society of Clinical Oncology. April 2016. Viewed February 8, 2018.
2. Smith AB, Rutherford C et al. A systematic review of quantitative observational studies investigating psychological distress in testicular cancer survivors. Psychooncology. 2017 Nov 23.
3. Cancer.net. Anxiety. American Society of Clinical Oncology. April 2016. Viewed February 8, 2018.
4. Lapedis M, Adler SR et al. Qualitative analyses from a prospective clinical study of a whole systems Ayurvedic intervention for breast cancer survivorship. Journal of Alternative and Complementary Medicine. 2014 May; 20(5):A75.
5. Johns SA, Stutz PV et al. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: a 3-arm pilot randomized controlled trial. Cancer. 2020;126(1):211–218.
6. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120; Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S; Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
7. McCabe D, Lisy K, Lockwood C, Colbeck M. The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2017;15(2):402–453.
9. Abrams DI. The therapeutic effects of cannabis and cannabinoids: an update from the National Academies of Sciences, Engineering and Medicine report. European Journal of Internal Medicine. 2018 Mar;49:7-11.
10. The ASCO Post Staff. Fan therapy may relieve breathlessness associated with advanced cancers. ASCO Post. December 25, 2020. Viewed March 30, 2021.
11. Gupta A, Sedhom R et al. Nonpharmacological interventions for managing breathlessness in patients with advanced cancer:  a systematic review. JAMA Oncology. 2021 Feb 1;7(2):290-298.
13. Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.

View All References

More Information

• Cancer.net: Anxiety
• SIO clinical practice guidelines:
  • Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
  • Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
  • Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232.
• Psychedelic Support
• Dr. Cynthia Li: Brave New Medicine
• Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
• Helpsy Inc.: Helpsy Health
• Andrew Weil Center for Integrative Medicine: Breast Cancer: An Integrative Approach (2019-2021)
• Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
• Integrative Cancer Review
• Martin L. Rossman, MD: Fighting Cancer from Within
• Belleruth Naparstek: Guided Meditations to Promote Successful Surgery
• Mala Cunningham, PhD: Before and After Surgery
• September 2018 Issue of the Journal of Alternative and Complementary Medicine
• Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
• Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
• Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
• Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
• Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
• Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
• Fang Fu, Huaijuan Zhao, Feng Tong, and Iris Chi: A Systematic Review of Psychosocial Interventions to Cancer Caregivers
• Martin L. Rossman, MD: The Healing Mind
• Martin L. Rossman, MD: Fighting Cancer