Anxiety and Breast Cancer

Written by Kristine Conner

Medically reviewed by Kevin Fox, MD University of Pennsylvania, Philadelphia, Pennsyvlania
 

Anxiety is common after a breast cancer diagnosis. Here’s how you can manage it.


Anxiety is unease, fear, and dread caused by stress. While some anxiety is a normal response to the stress of breast cancer, if your anxiety interferes with your daily living, it can hurt your overall health.  

When you might feel anxiety

Anxiety is a common response to unknowns about a breast cancer diagnosis or treatment plan. You may feel anxious waiting to learn of a diagnosis or the results of tests or scans. You may worry about starting a new treatment, including whether it’ll work and how sick it might make you feel. You may worry the cancer will come back or the treatment will stop working. It’s understandable that these situations have you worried, but it’s also important for you to do what you can to protect your well-being, which includes managing any anxiety and stress you’re feeling.

Anxiety levels and symptoms

Everyone responds to stress differently. Some people with breast cancer learn to manage their anxiety using various coping methods, such as seeing a counselor or joining a support group. For others, anxiety can become intense and begin to interfere with their quality of life. When anxiety does not go away, it’s considered to be an anxiety disorder. 

Symptoms of an anxiety disorder can include:

  • trouble falling asleep and staying asleep (insomnia)
  • very low energy
  • loss of appetite
  • an inability to concentrate
  • lack of interest in normal everyday activities
  • feeling worried, on edge, or unable to turn off your thoughts most of the time

Anxiety can also cause physical symptoms such as:

  • sweating
  • nausea
  • chest pain
  • increased heart rate (palpitations)
  • shortness of breath
  • stomach pain or diarrhea
  • headaches
  • dry mouth
  • shaking or trembling
  • faintness or dizziness
  • tense or aching muscles
  • panic attacks (sudden, incapacitating feelings of anxiety)


Side effects linked to anxiety

Certain cancer treatments, such as chemotherapy, pain medicines, steroids, and hormonal therapy, can trigger ongoing anxiety — either directly or indirectly because of the following side effects:

  • fatigue
  • trouble sleeping
  • joint pain
  • nerve pain
  • hormonal changes

 

Anxiety risk factors

There are also factors that can increase your risk of anxiety, including:

  • a personal or family history of anxiety or depression
  • a metastatic breast cancer or triple-negative breast cancer diagnosis
  • not having a strong support system of friends and family
  • financial difficulties
  • health problems in addition to breast cancer
  • having to cope with many stressful situations at the same time (worrying about infertility, money, or having to take time off work)

 

Managing anxiety

If you have constant, intense anxiety that interferes with your everyday life, it’s important to talk to your cancer care team. They can figure out if one of your treatments could be making you feel anxious, and if so, decide if you can be switched to a different treatment. Your care team can also recommend treatments for side effects such as insomnia, fatigue, hot flashes, or other menopausal symptoms, which can improve anxiety. 

Managing anxiety is an important part of taking care of your mental health after being diagnosed with breast cancer. You may want to ask your cancer care team to refer you to an accredited mental health professional who has experience working with people diagnosed with cancer. Many cancer centers have psychiatrists, psychologists, psychotherapists, counselors, or social workers on staff or can make referrals to practices near you. Some hospitals and cancer programs also offer classes on relaxation techniques that may be able to help you manage anxiety, such as meditation or mindfulness.

Reduce anxiety with exercise

The 2018 American College of Sports Medicine Roundtable found that there was strong evidence that moderate-intensity aerobic exercise and resistance exercise during and after cancer treatment reduced anxiety and depressive symptoms. It also found that exercise was generally safe during and after cancer treatment.

To help people with anxiety, Breastcancer.org partnered with Sami Mansfield, a certified cancer trainer and founder of Cancer Wellness for Life, to develop a series of exercise videos tailored to help ease specific side effects, including anxiety. [Go to article to see video - https://www.breastcancer.org/treatment-side-effects/anxiety.]

Other techniques to manage anxiety

In addition to exercise, there are many other options to help reduce anxiety. These include:

  • acupuncture
  • aromatherapy
  • chiropractic therapy
  • guided imagery
  • hypnosis
  • journaling
  • massage
  • medical cannabis
  • meditation
  • music therapy
  • progressive muscle relaxation
  • Reiki
  • Shiatsu
  • spirituality and prayer
  • support groups, one-to-one peer support, or Breastcancer.org Virtual Community Meetups 
  • tai chi yoga

Medicines to ease anxiety

There are also many medicines that may  help control anxiety. There are two main types: anti-anxiety medicines and antidepressants.

Anti-anxiety medicines include Xanax and Niravam (chemical name: alprazolam), Valium (chemical name: diazepam), Ativan (chemical name: lorazepam), Librium (chemical name: chlordiazepoxide), and Klonopin (chemical name: clonazepam)

Antidepressants include Lexapro (chemical name: escitalopram), Celexa (chemical name: citalopram), Zoloft (chemical name: sertraline), Cymbalta (chemical name: duloxetine), Effexor FR (chemical name: venlafaxine), and Pristiq (chemical name: desvenlafaxine).

Some antidepressants — including Paxil, Wellbutrin, Prozac, Cymbalta, and Zoloft — may interfere with the body’s ability to convert tamoxifen into its active form, preventing people from getting its full benefit. If you’re taking tamoxifen, ask your doctor which antidepressants are best for you.

Your doctor can work with you to figure out which medicine relieves your anxiety with the fewest side effects. Typically, you begin taking a lower dose at first and, under your doctor’s guidance, increase it if and as needed until your symptoms improve. Anti-anxiety medicines pose some risk for addiction, so doctors prescribe them for short-term use. Doctors prescribe antidepressants for longer periods of time because it can take up to six weeks for the medicine to improve symptoms. Still, although doctors don’t consider antidepressants to be addictive in the traditional sense, it is possible to become dependent on them.

Posted in: Emotional/Mental Health