After Treatment: Anxiety
Topics covered on this page:
Why might I experience anxiety after cancer treatment?
Cancer-related anxiety is a feeling of worry, nervousness, uncertainty, or stress. It is normal to feel anxious or stressed after your cancer treatment ends. You may have uncertainty about many things such as what will happen next, what questions to ask and where to find help. About one in 5 (20%) patients report high levels of anxiety after their treatment ends.
Many factors can contribute to anxiety after cancer treatment ends. Some common causes include:
Fear of cancer recurrence. You may feel anxious about your cancer returning. Feeling this way is common during the first year after treatment ends. For most people, this feeling slowly fades over time.
Fear of the unknown. You may feel unsure of what the future holds. You may wonder whether your life will ever return to how it was before your diagnosis.
Changes to your lifestyle. When you were diagnosed with cancer, you may have put aside some of your responsibilities. Questions or concerns about family, relationships, work, or finances may begin to resurface. It is common to experience a shift in priorities at this stage. This can cause feelings of anxiety and stress.
Physical changes. You may feel physical side effects as your body recovers from cancer treatment. There may be changes to your body image and sexuality. Wondering what these changes mean and how long they will last can trigger anxiety.
Feeling a loss of control. During treatment, your life was likely very structured around your cancer treatment. You had frequent tests, treatments, and visits with your healthcare team. After treatment, your routine changes, which may lead to feeling a loss of control.
How does it affect me?
Anxiety can prevent you from returning to your normal daily life. It can be felt in several different ways. Anxiety can affect you emotionally by experiencing feelings of fear, dread or worry. There may be physical symptoms such as increased heart rate, elevated blood pressure or difficulty breathing. The intensity of symptoms can vary from person to person.
Everyone experiences anxiety differently. Understanding how anxiety affects you can help you manage your symptoms. Signs of anxiety can include:
Physical symptoms: Such as diarrhea, excessive sweating, headaches, rapid heartbeat, or trouble breathing.
Cognitive symptoms: Such as memory issues, trouble concentrating or difficulty sleeping. These symptoms can make your everyday activities more challenging to complete.
Procrastination and avoidance. Putting off difficult tasks or avoiding things that may trigger your anxiety. This could include going to the doctor for a follow-up appointment for example.
Overthinking and constant worrying: Feeling overwhelmed, worrying excessively about everyday things and a sense that you have lost control of your life.
Feeling agitated and restless: Feeling on edge, irritated or angry. You may feel that you cannot control your emotions and react poorly in stressful situations.
Panic attacks: A brief period of extreme anxiety can be a panic attack. It is a feeling of intense fear, dread or worry. It can be accompanied by physical symptoms such as rapid heartbeat and sweating. If you experience panic attacks frequently, you may have a panic disorder.
In general, anxiety can affect you in three different ways:
Mild anxiety: This is common in everyday life. It generally does not last very long. For example, it can occur while waiting for exam results, or a job performance review.
Moderate anxiety: This type can make you focus only on the source of anxiety. It can occur when something serious happens and you ignore other tasks. Losing your wallet or getting in trouble with a person of authority are examples.
Severe anxiety: This is the most severe level of anxiety. It can affect your ability to focus or solve problems. Taking care of your basic needs may even get difficult. With severe anxiety, you may need outside help. Severe anxiety can be caused by a serious or unexpected event such as losing a job or loved one. It can also be long standing for someone living with generalized anxiety disorder.
Will it get better?
Feelings of anxiety tend to improve over time but may not go away completely. You may feel worried about your health many years after treatment ends. Certain events such as follow-up visits with your doctor may trigger your anxiety. You may worry about the cancer returning for example.
Many people find anxiety to be more distressing in recovery than during treatment. Many look forward to getting back to their “normal” life but find it difficult to return to how they felt before. How you coped with anxiety in the past or during treatment may not work for you now. It is important to adapt and find new coping strategies that meet your current needs. See the section “What can I do to help manage my anxiety” for strategies to help reduce your anxiety.
When should I get help for anxiety after cancer treatment?
It is normal to experience anxiety and distress after cancer treatment ends. However, if your anxiety is so bad that you feel like you can’t cope, you should talk to your healthcare team. If any of the situations are true for you, listed below, it probably means your anxiety is too much for you to handle on your own, and you may need additional support.
Your symptoms of anxiety:
Interfere with your daily activities
Prevent you from sleeping
Prevent you from working
Prevent you from engaging in social interactions
Affect you more than four days of the week for six months or longer
Although you finished your active cancer treatments, your healthcare team is still there for you. Post-treatment follow-up appointments include screening for symptoms of anxiety. Discuss your concerns and worries with your team. Together you can create a plan to help manage your anxiety.
Talk to someone in your healthcare team immediately if you have:
- A history of depression or anxiety disorder
- A history of physical or emotional trauma
- Suicidal thoughts or plans
- Frequent panic attacks
- Thoughts about harming yourself or others. If you are having suicidal thoughts and you can’t reach someone on your healthcare team, please call your local mental health services helpline or call 9-1-1. For residents of Quebec, call Suicide Action Montreal at 1-866-277-3553 or call 9-1-1
What can I do to help manage anxiety after cancer treatment?
There are many ways to manage your anxiety and prevent it from getting worse. You may have to test out a few strategies to see what works best for you. Below are some suggestions you can try.
Take a break from thinking and talking about cancer. Make time to do something you enjoy every day. It could be as simple as listening to music, reading a book, watching a funny movie or spending time with people who make you laugh. Think of creative outlets that brought you joy in the past. You may also want to try something new that you’ve always wanted to do.
During treatment, you may have kept a diary of your symptoms. A symptom diary is also useful after treatment ends. Sharing this information with your healthcare team helps them to understand your anxiety. Some important details to include:
- How often are you feeling anxious?
- What are your worries and fears?
- What seems to make it worse? What makes it better?
- For more information, see Symptom Diary.
You can share what you are feeling with your healthcare team. They can help you find ways to manage your anxiety. You can speak to your oncologist, a nurse in your cancer center or your family doctor.
When speaking to your healthcare team, be honest and open about your fears and worries. A conversation about your symptoms may even help to relieve some of your anxiety. Your healthcare team can guide you on whether your worries require follow up. Together you can discuss a follow-up plan to feel more in control of your health.
Getting good quality sleep can give you more energy and help to reduce anxiety. Below are some strategies to practice good sleep habits:
- Wait to feel sleepy before going to bed.
- Try to wake up at the same time everyday.
- Spend less time in bed while you are awake.
- Turn off all screens at least 30 minutes before bedtime. The light from screens can trick your brain into thinking it is daytime.
- Try to avoid big meals and caffeine close to bedtime. Choose light snacks in the evening.
- Wind down before going to bed. Find an activity that relaxes you. Examples include reading, listening to music, meditating, or taking a warm bath.
- Develop a routine before going to bed (e.g., brushing your teeth, putting on your pajamas.).
- Get out of bed if you cannot fall asleep after around 20 minutes. Do something calm and relaxing, then go back to bed when you feel sleepy.
A healthy and well-balanced diet is important for your physical and mental well-being. This can improve your mood and help reduce anxiety. Below are some strategies to get started:
- Eat energy boosting foods such as fruits, vegetables, and whole grains. These foods keep you full longer, giving you energy throughout the day. They also contain vitamins, fiber, and antioxidants.
- Include healthy fats in your diet. Low saturated fats are another good source of energy. Options include salmon, tuna, mackerel sardines, nuts, seeds, avocados, and olive oil.
- Add protein to every meal. Try to select proteins that are low in saturated fat. Examples include fish, lean meats, eggs, legumes, nuts, and seeds.
- Limit alcohol and caffeine consumption. Both can worsen anxiety and affect your sleep pattern. Caffeine can be found in many beverages such as tea, energy drinks, sodas and chocolate.
- Ask your healthcare team for resources about nutrition. Find out if your team has a dietician to refer you to, as they could help you make healthy eating choices.
- For more information see Looking After Yourself.
Exercising regularly can give you a better quality of life. Physical activity can improve your appetite, sleep and help you relax. Below are some strategies you can try to get started:
- Choose activities you enjoy. You are more likely to continue a physical activity that you have enjoyed in the past. Exercising with a friend can also help you stay motivated.
- Start slowly. It is important to start slow and build up your strength. Find a balance between activity and rest. As you get stronger, gradually increase the amount and difficulty of exercise.
- Use regular activities as exercise. One way you can get moving is to use chores as a form of physical activity such as housework or yard work.
- Get a personal trainer. A personal trainer can help you develop an exercise program that is right for you.
Talk to your healthcare team before starting a new exercise program. For more information, see Get Moving.
Relaxation techniques are an effective way to help relax your mind and body. This can reduce anxiety. There are many different techniques that you can try, below are some suggestions:
- Breathing exercises. Practice slow deep breathing. Even a few minutes of deep breathing can help you relax.
- Progressive muscle relaxation. This involves tensing and relaxing a muscle, or group of muscles, one at a time.
- Guided imagery or visualization. This technique uses your imagination to create a daydream. It uses your senses such as sight, hearing, touch, smell, and taste. It helps a person to imagine a place that feels calm in real life. Guided means someone talks you through the process either in person or using a recording.
- Meditation. Meditation is a practice of quieting the mind. The focus is on breathing and being in the present moment. You can meditate while sitting, lying down and even walking.
- Explore complementary therapies. Complementary therapies may help reduce stress and improve your emotional wellbeing. Some examples are massage therapy, music therapy, acupuncture, healing touch and reflexology.
- Massage therapy. It is important to use a certified massage therapist. They should also have experience working with cancer patients.
For more information, see Relaxation Strategies.
Planning your day in advance can help reduce your stress and anxiety. It also can give you a sense of control. Tips to organize your day include:
- Prioritize the most important items on your list.
- Use a journal or agenda to keep track of your tasks and activities.
- Reduce activities that take up too much of your energy or time.
- Ask for help with tasks that are more challenging.
Anxiety can cause you to avoid people or situations that make you nervous. However, avoiding these things can make anxiety worse.
To help, finding the right support and being prepared can help you step out of your comfort zone. For example, you may be delaying a doctor’s appointment because it makes you anxious. It may be easier to go if you prepare for the appointment. For example, knowing where to go, what time it is at, who you are meeting and preparing any questions you have for your team ahead of time. What also could help is to ask a family member or friend to go with you.
You do not have to deal with your anxiety on your own. In addition to your healthcare team, there are other people who can help support you.
- Connect with family and friends. It can be difficult to ask for help, particularly from family and friends. However, it is important to inform the people in your life when you need help.
- Talk to a therapist. Talk to a professional if you have trouble managing your anxiety on your own. A therapist can help you to think about your worries differently. They can also give you ideas on how to manage stress and anxiety. Most cancer centers offer psychology services.
- Join a support group. It often helps to talk to people who share similar experiences. You might learn new ways to cope with your anxiety. You can try one of the online communities listed in the services section below.
- Seek out other healthcare professionals. There are different professionals that can help you manage your daily activities such as occupational or physical therapists. Talk to your doctor if this might be a good option for you.
⚠ Important information about cannabis
Some patients do use cannabis to reduce pain, help with relaxation or as a sleeping aid. However, the research is still unclear about the use of cannabis to manage cancer-related symptoms, including anxiety. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: http://www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis.
Available services
The Quebec Cancer Foundation supports people with cancer and their loved ones throughout Quebec, through services suited to their needs and daily concerns.
Services offered
Several services and activities offered by the Quebec Cancer Foundation can be useful in managing your anxiety.
Guided Meditation and Restorative yoga may help to ease your anxiety. The foundation also offers Massage therapy and Art therapy which may also help. Use their resource directory below to find services near you.
Telephone peer-matching can connect you with someone who may have similar experiences. You can call the Info-Cancer hotline for more information and get the help you need.
Info-Cancer Library is a document lending service which covers a wide range of topics related to cancer. Their materials include books, web resources, online articles, and webcasts. They are free to borrow, and materials are sent by mail or email anywhere in Quebec.
Their information services also feature a virtual library.
Contact
1 (800) 363-0063
The mission of the Quebec Breast Cancer foundation is to prioritise the wellbeing of people who have been affected by cancer and their families through research and innovation, support, and awareness.
They offer many services including information and support hotlines, as well as resources adapted to the needs of people affected by cancer and their families.
Services offered
My Active Health: a service that helps by offering physical activities on a regular basis which can help in relieving your anxiety. Their activities include:
- My mobile application
- My exercise videos
- My oncologic Yoga
- Dragon Boat Teams
The Quebec Breast Cancer foundation offers psychosocial support and family counselling. The social workers from their support service can help with strategies to cope with your anxiety. You can contact their support help line here for private or peer support.
Free virtual clinic: a service of first aid offered to people affected by breast cancer. We aim to help manage the secondary effects that arise after treatment and those that persist long term. The clinic is:
- Easy-to-use
- Accessible 24/7
- Better monitoring and screening
- Management of secondary side effects that arise after treatment and those that stay permanent
- Promotion in health and healthy life habits
- Coordination of care between specialists and generalists
Contact
1-855-561-ROSE
General information
The Canadian Cancer Society offers support for people with cancer and their family, friends and caregivers.
Their information specialists are there to answer your questions and offer up-to-date, reliable information on topics that include:
- cancer treatment and side effects
- clinical trials
- coping with cancer
- emotional support services
- prevention
- help in the community
- complementary therapies
Services Offered
The Cancer Information helpline is available Monday to Friday in English and French from 6am to 6pm EST. For other languages, they can access an interpreter service.
Website and live-chat: Talk to an information specialist | Canadian Cancer Society
Contact form: Cancer information and support | Canadian Cancer Society
Online Community: Cancer Connection| Canadian Cancer Society
You can also access the CCS database below to find support services in your area.
Contact
General information: https://cancer.ca/en/
Cancer Information helpline: (Toll free) number: 1-888-939-3333
To access their website and live chat: https://cancer.ca/en/living-with-cancer/how-we-can-help/talk-to-an-information-specialist
Online community: https://cancer.ca/en/living-with-cancer/how-we-can-help/connect-with-our-online-community
Service locators
Below is a list of organizations that can help identify local support services for you and those that support you. The quality of the services has not been verified by e-IMPAQc. Before using these services, verify with your healthcare practitioner.
The Canadian Cancer Society offers a service locator resource where you can find services and programs in your city or nearest your postal code.
Contact
1-888-939-3333 (Monday-Friday)
The Regroupement des Organisations Communautaires en Oncologie (ROCO) offers a service locator resource specific to the province of Quebec. It lists support resources available by region.
Contact
514-506-3503
The Quebec Cancer Foundation offers a resources directory of community, association and public resources by region or postal code.
Contact
1-800-363-0063 (Monday to Friday, 9 AM to 5 PM EST)
Resources
For more information on cancer-related anxiety, self-management strategies and support organizations, check out the resources below.
Canadian Cancer Society – Anxiety
Canadian Cancer Society – Coping When You Have Cancer
Cancer Care Ontario – How to Manage Your Anxiety (download patient guide)
Quebec Cancer Foundation – Anxiety and Depression
Anxiety Canada – Anxiety in Adults
Cancer.Net – Coping With Uncertainty
Canadian Psychological Association – “Psychology Works” Fact Sheet: Cancer in Adults
Info-aidant – Support for Caregivers (info-aidant@lappui.org or call 1 855 852-7784)
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- ASCO: Cancer.net. What is Survivorship?
- ASCO Answers: Cancer.net. Survivorship.
- Dana-Farber Cancer Institute. Your Body after Treatment.
- Dana-Farber Cancer Institute. The Cancer-Nutrition Link.
- Macmillan Cancer Support. Managing Worry and Anxiety. 2018.
- National Cancer Institute. Facing Forward: Life After Cancer Treatment.
- National Cancer Institute. Cancer Survivorship.
- National Cancer Institute. Facing Forward: Life After Cancer Treatment. 2018.
- National Cancer Institute. Helping Cancer Survivors Cope with Cancer-Related Anxiety and Distress. 2018.
- National Cancer Institute. Coping with Fear of Recurrence. 2018.
- St. Mary’s Research Centre. Looking Forward: Rebuilding Your Life After Cancer Treatment.
Healthcare professional endorsement
The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.
Disclaimer
Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.
Reproduction and copyright
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