A cancer diagnosis can impact the emotional health of patients, families, and caregivers. Common exaggerated emotions during this life-changing experience include anxiety, distress, frustration and depression. We all have different roles to play; as per William Shakespear, seven stages of life, like roles at home, school, and work, can be affected. It's important to pick these changes early and get help when needed.

About fifty per cent of cancer patients with advanced cancer meet the criteria for a psychiatric disorder, the most common being adjustment disorders to new norms of cancer life (11%-35%) and depression (5%-26%). In addition to that, we have treatment for psychosocial and pharmacological treatments for Anxiety and depression.

What is Anxiety?

Anxiety means feeling uncomfortable, worried, or scared about a real, imaginary or future situation. It's essential to recognize anxiety symptoms and take steps to prevent and manage them from getting worse.

General Anxiety

Anxiety is a common issue for patients with a cancer diagnosis. Cancer patients and their families and caregivers may feel fearful and anxious during treatment and recovery in different situations. For example, simply finding a lump or possible other sign or symptom of cancer can cause anxiety and fear, along with finding out that they have cancer or there is cancer recurrence. In addition, fear of cancer treatment, frequent doctor visits, and tests might also cause apprehension (the feeling that something terrible will happen).

Diagnosing Anxiety

It's normal to feel bad when you're sick. People may be worried of uncontrolled pain, death, or what happens after death, including fate of loved ones. And again, these same emotions may be experienced by family members and friends. Signs and symptoms of Anxiety includes:

l  Anxious facial expressions.

l  Uncontrolled worry.

l  Trouble solving issues and focusing on thoughts.

l  Body tension (the person may also look tense).

l  Trembling or shaking of hands.

l  Restlessness.

l  Dry mouth.

l  Irritability or angry outbursts.

What the patient and caregiver can do?

Cancer patients and caregivers both might have signs and symptoms of Anxiety. The signs and symptoms might be more severe if they happen most of the day, nearly every day, and they interfere with day-today activities. In these cases, patients should be referred for mental health evaluation. Remember that a person may overlook these feelings despite having all the symptoms. But if they're willing to accept that they feel distressed or uncomfortable, therapy can often help.

Things to do:

l  Share feelings, fears and thoughts that you or the anxious person may be having.

l  Listen carefully to each other's feelings and ideas. Offer support, but don't deny or downplay feelings.

l  Remember that it's alright to feel sad and frustrated.

l  Get help through counselling and/or support groups.

l  Some psychoeducation may help. Psychoeducation combines education with group or individual counselling.

l  Mindfulness activities such as yoga may help focus and are recommended for some anxiety levels.

l  Meditation, prayer, yoga or other types of spiritual support might help to overcome Anxiety.

l  Try deep breathing and relaxation exercises. For example, close your eyes, breathe deeply (inhalation and exhalation), focus on each body part and relax;  start with your toes and work up to your head. Be mindful of your body. When settled, try to think of a pleasant place such as a lake or forest in the morning.

l  From light walking to a regular workout routine, exercise may help lower Anxiety, and it is done for 15 -20 minutes a day.

l  Talk with your physicain or registered nurse about using  anti-depressant medicines.

Things not to do

l  Keep feelings inside.

l  Force someone to talk if they're not ready to.

l  Blame yourself or another person for feeling fearful or anxious.

Try to reason with a person whose fears and anxieties are severe; talk with the doctor about medicines and other help.

Panic attacks can be an alarming symptom of Anxiety. Panic attacks happen very suddenly and often reach their worst within about 10 minutes. The person may seem fine between attacks but is usually very afraid that they will happen again.

Symptoms of Anxiety

l  Shortness of breath or rapid rise in the rate of breathing.

l  Racing heart, the patient becomes conscious of the heartbeat.

l  The feeling of dizziness, unsteadiness, lightheaded, or faint.

l  Chest pain or discomfort.

l  Feel of choking, trembling or shaking.

l  Sweating.

l  Fear of losing control of the situation.

l  An urge to escape from the present moment.

l  Numbness or tingling sensations.

l  Feeling "unreal" or "detached" from surroundings.

l  Chills  or hot flashes (may involve sweating or facial reddening).

These signs and symptoms also can be signs of other, more severe issues such as shock, heart attack, collapsed lung, or allergic reaction; it's not safe to assume that they are panic or anxiety-related until diagnosed by a physician.

If the person has had panic attacks in the past, and it happens again the same as before, caregiver can often recognize it as a panic attack.

If the person recovers completely within a few minutes and has no more symptoms, it's more likely to be a panic attack. If these attacks are diagnosed by a doctor, brief therapy and medicines be helpful.

Things a caregiver can do

l  Check with the doctor to ensure signs and symptoms are caused by panic and not any other medical problem.

l  Stay calm and speak gently during a panic attack.

l  Sit with the patient during panic attacks until they feel fine.

l  Call for help if needed.

l  After the panic attack is over, encourage and counsel the person to get treatment for the panic attacks.

l  Provide transportation to treatment if needed. The person may be afraid that a panic attack will happen while driving.

Treating underlying psychiatric conditions improves the quality of life in patients with advanced cancer. Oncologists play a crucial role in screening for psychiatric issues, initiating first-line treatments for depression and Anxiety, and communicating with patients and caregivers about prognosis and end-of-life issues.

Cancer is just a chapter in life, not a whole story.