Anxiety occurs in many patients with cancer varying from the 'normal' worries and fears associated with a life-threatening illness, through subsyndromal distress, adjustment disorders, and generalized anxiety disorder and anxiety due to the medical condition. (22,23) The four common causes of anxiety in patients with cancer are noted in Table.?. Most frequent is situational anxiety associated with hearing the diagnosis, on reaching a crisis in illness or treatment, during conflicts with staff or family, anticipating a frightening procedure or a test results, and fear of recurrence. Disease-related anxiety occurs most often from poorly controlled pain. However, metabolic disorders, hormone-secreting tumours and paraneoplastic disorders can produce anxiety. (24) Treatment-related causes are anxiety-producing drugs, especially the akathisias associated with antiemetic drugs. Withdrawal states and conditioned responses to cues associated with chemotherapy cause anxiety. The fourth area is anxiety that occurs as an exacerbation of a pre-existing anxiety disorder: phobias, panic or generalized anxiety, and post-traumatic stress disorder either in response to prior trauma or as a result of traumatic cancer treatments.(25)

Table 9 Causes of anxiety in patients with cancer

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