About fear, anxiety and panic

A diagnosis of cancer is difficult to cope with. It is normal to feel anxious, frightened or panicky at times. How you cope with these feelings depends on

• The kind of person you are
• How advanced your cancer is
• The treatment you have
• How much support you have around you

You might feel frightened, and worry about what will happen to you, about side effects of treatment, or whether it will work. Or you may feel that you are coping well; you just get on with it and deal with any anxiety as it arises.

You may have much more extreme feelings. You might often feel frightened and panicky. For some people, it can be so bad that they have panic attacks. This is very different to just feeling worried.

Firstly, don’t feel bad about your feelings, and don’t compare yourself with other cancer patients you see. There is no right or wrong way to feel about having cancer. We all deal with things in our own way and a lot depends on other circumstances in our lives.

It is important to find ways to help you deal with your feelings. Tell your doctors and nurses if you feel anxious or scared about your illness, treatment, work or finances. Just voicing this will help you feel less alone and less helpless.

There will be people at your cancer centre who will be able to help you manage your anxiety. For example, your doctor or nurse may help you deal with some worries by explaining things in more detail. They may suggest you see a counsellor or psychologist for further help and support. Or they could put you in touch with someone who can help you learn relaxation techniques to help manage anxiety and panic attacks.

If you feel very frightened, panicky or anxious, you may have problems with

• Sleeping
• Lack of appetite
• Going out and seeing others socially
• Being short tempered
• Concentration

If your anxiety becomes a long term problem, you may constantly feel that something bad is about to happen. You may also

• Keep asking those close to you about your illness and what they think you should do
• Feel very negative
• Feel very upset
• Feel unable to cope with changes to your routine

Fear and anxiety can also have physical effects on you. This is a bit like feeling very nervous about an exam, job interview or giving a speech. You may have

• A thumping heart (palpitations)
• Shortness of breath, or an urge to over breathe (hyperventilating)
• Sweating
• Hand tremors or overall body shakes
• Dry mouth
• Tiredness
• Dizziness, or light or heavy headedness
• Diarrhoea
• Urgent need to pass urine
• Sickness
• Sensation of having a lump in your throat
• Difficulty swallowing
• Dry cough
• Tense and aching muscles especially in the neck and shoulder region
• Chest pain
• Pins and needles
• Ringing in your ears
• Abdominal pain
• Going red in the face or looking very pale

Being constantly anxious can also affect your relationships and sex life. You may lose interest in sex and have very low self esteem.

All these symptoms are very real and you may worry that your cancer is causing them. That is possible with some of them. But stress and anxiety are also likely causes.

When your body is faced with something stressful or frightening, it releases adrenalin (also called epinephrine), which prepares your body to either run, or fight the stress. This is known as the ‘fight or flight’ response.

The adrenalin speeds up your body functions. Your heart beats faster, your breathing becomes rapid, your muscles contract and your gut movements shut down.

These are natural responses that have evolved in humans over tens of thousands of years. They are there to protect us from danger. For example, if you cross a road and a car comes out of nowhere, the ‘fight or flight’ response helps you to leap out of the way to avoid being hit. Immediately afterwards, your heart is pounding and your mouth is dry. Soon after the fright has passed, your heart rate will slow down and you will feel normal again.

But if you are repeatedly in stressful situations throughout the day, such as seeing doctors, going through tests and having cancer treatment, your body does not have enough time to rest and return to normal between each stressful event. In the end, just the word ‘cancer’ coming into your mind can trigger the ‘fight or flight’ response.

The natural response that is supposed to protect you can become the problem. The more you worry, the more likely it is that your ‘fight and flight’ response kicks into action and so your symptoms increase. It can become a vicious circle and you may end up feeling as if you have no control over your situation.

Sometimes fear or anxiety gets so overwhelming that you may have a ‘panic attack’. These can come on very suddenly and for no obvious reason. People describe them as among the most terrifying experiences they have ever had.

You may have physical symptoms of anxiety, but they may be far more intense. Some people even feel as if they are going to die, or are going mad. Neither of these happens because of a panic attack, but it does feel very real at the time.

Panic attacks may feel awful, but they are not generally dangerous to your health. These attacks may only happen once and have no lasting effects. But frequent panic attacks can begin to seriously affect your quality of life. If this happens to you, do seek medical help.

Let your doctor or nurses know how you are feeling. They will be very understanding and may suggest that you have some treatment for your panic attacks. It is better to get help before other problems, such as phobias or depression set in.

In this section of CancerHelp UK, there is information about how to help yourself cope when you are feeling anxious.

Your anxiety may relate to

• Worries about treatment
• Worries about pain
• Worries about being cured

Worries about treatment

Many people with cancer worry about whether their treatment will work, or how unpleasant it might be.

There has been a lot of research into improving cancer treatments, and this research will continue. This means that today’s cancer treatments

• Are easier to cope with than they used to be
• Have less severe side effects that are often more easily controlled

You may hear stories about people having cancer treatments years ago, but this information will be out of date. Talk to your doctor about any worries you have about your treatment.

It may help to write a list of questions to ask, and take a close friend or relative with you to visit the doctor. They can help you remember everything you discussed. While you are with the specialist, don’t be afraid to

• Ask your doctor to repeat anything you don't understand
• Have your close friend or relative ask questions for you
• Ask for time to talk it over and decide on any treatment choices

If you have never been in hospital and are frightened, talk to your own GP or nurse, who should be able to help reassure you.

Worries about pain

'Will I be in pain?' and 'Will the pain be more than I can bear?' are other common fears. In fact, many patients with cancer have no pain. For people who do, many modern drugs and other forms of treatment can successfully relieve or control it.

We have a whole section on pain and pain control that you may find helpful. Generally the more you understand something, the less scary it seems.

Worries about being cured

The first thing most people ask about having cancer is: "Am I going to die?"

Remember - many people with cancer are cured, and others live for many years. Even when the cancer is not curable, things can be done to help manage pain or discomfort, or to slow the cancer down.

Unfortunately, it isn't usually possible for doctors to say for certain that cancer has been cured. They can’t definitely say that it will never come back. Living with this uncertainty is one of the most difficult things about having had cancer.

You may find it very worrying, not knowing whether the cancer may come back. Not knowing what is going to happen can be terrifying, but you can help yourself by

• Talking to your specialist or nurses
• Finding out as much about your illness as you can
• Talking about how you feel with your family and friends

It may help to talk about your feelings to a counsellor. We have a list of counselling organisations that you may find useful. To find out more, look at our counselling section.