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.