Anxiety and Patient with Cancer (by guest blogger Nicole Muscari)

What do we know about Anxiety?

• It can be temporary – An emotional response to a stressful event
• Sometimes anxiety is more general or long standing
• Anxiety is an emotional and physiological response
• It can range from a common reaction to a more extreme dysfunctional type of response – often seen in anxiety disorders
• Each individual has their own personal life experiences, coping strategies, maturing and unique abilities for managing or not managing their anxiety

What does Anxiety look like?

• Fear of the unknown or future
• Worry about death and dying
• Persistent thoughts about their cancer diagnosis
• Fear of treatments like chemotherapy or radiation and all the potential side effects
• Concern about their functioning in their everyday life at home or work
• Difficult sleeping
• Physical symptoms often are apparent such as:
  • Increased heart rate
  • Feeling short of breath
  • Restlessness or fidgeting
  • Stomach upset or unable to eat
  • Sweating
  • Headaches

How does Anxiety impact our patients and their care?

• It may affect our patient’s decision making and ability to think clearly and rationally
• Anxiety can impact a patient’s adherence to treatment – for example, a patient may be worried or anxious about taking a medication because of the side effects and is unable to think about the benefit outweighing the risk of taking their medication as prescribed.
• May impact a patient’s ability to function socially or potentially could impact their overall quality of life depending on the severity.
• Anxiety may occur at any given time:
  • a change in the plan of care
  • beginning or ending of treatment
  • during a test or scan
  • disease progression
  • financial difficulty
  • inability of functioning or having to rely on others for help with self-care, transportation or other daily living needs
  • transitioning to hospice or palliative care

What can nursing do about it? What does the evidence say?

• Coaching – addressing patient needs by providing guidance and education
• Exercise – educating patients about the benefits of exercise and referring them to physical therapy when needed
• Music Therapy, Mindfulness-based stress relievers, guided imagery and other relaxation techniques – provide patients with education material or resources such as James Care for Life programming
• Massage Therapy – referring patients to Survivorship Massage Therapist when appropriate
• Aromatherapy – Licensed staff may complete a CE class from one of our Mental Health Clinical Nurse Specialists to be able to provide aromatherapy intervention to patients
• Mindful Breathing Techniques – a simple intervention that can be completed within a couple minutes

Goals and strategies for addressing Anxiety:

• Help prepare your patient with interventions and strategies that they may use at any time that they experience anxiety
• Encourage patients to have a conversation with their medical oncologist about their anxiety, worry and fear
• Empathize with the patient and provide them with tools and resources
• Involve social work, psycho-oncology, support group and any other ancillary services that may be helpful to relieving a patient’s anxiety
• Utilize resources: www.ons.org/practice-resources/pep/anxiety
• Assess for increased risk for anxiety:
  • any history of anxiety disorder or trauma
  • any chronic or severe pain
  • if functional limitations exist
  • is there a family/social support system
  • Evaluate for signs and symptoms of anxiety
  • Use validated assessment instruments, such as the National Comprehensive Cancer Network’s Distress Thermometer

Background of Guest Blogger: Nicole Muscari is a Graduate Student at The Ohio State University studying Psychiatric Mental Health Advanced Practice Nursing and plans to graduate in May 2017. She has been a registered nurse for 15 years and has worked for The James Cancer Hospital for 13 years. She received her undergraduate BSN degree from The Ohio State University College of Nursing.