How to Cope With Anxiety When You Have Metastatic Non-Small-Cell Lung Cancer

Lung Cancer and Anxiety: A Special Case

While anxiety is common with many forms of cancer, there are some issues unique to lung cancer that make patients particularly vulnerable.

Another widespread source of anxiety for people with NSCLC is a sense that other people blame them for their condition. “The very first thing many people say upon learning that someone has lung cancer is not ‘I’m sorry’ but ‘Did you smoke?’” says Ellen Ormond, PhD, a psychologist in the biobehavioral oncology program at the University of Pennsylvania Medical Center's Hillman Cancer Center in Pittsburgh.

Other common sources of anxiety for those with metastatic NSCLC include fear of death and fear of the unknown, says Lanie K. Francis, MD, the director of the wellness and integrative oncology program at the Hillman Cancer Center.

“Many people are also anxious about the particulars of treatment — whether they will have nausea or pain or lose their hair,” says Dr. Francis. “Concerns about finances are enormous, as is a sense that they will need to depend on others during treatment and beyond.”

Anxiety May Interfere With Treatment

That’s because unmanaged anxiety can cause people to miss or delay cancer treatments, Francis says, adding that “anxiety may obscure listening skills, so people may not hear important discussions about what side effects to report and when to call the medical team.”

Anxiety can impair sleep and other aspects of self-care, too, Francis says, which can reduce the effectiveness of cancer treatments by limiting your body’s ability to recover.

What Are the Signs of Anxiety, And What Can You Do About It?

• Frequent worrying that’s difficult to control
• Agitation or restlessness
• Poor sleep, or difficulty falling or staying asleep
• Feelings of uneasiness, dread, panic, fear, or irritation
• Difficulty concentrating
• Nausea
• Muscle tension

If you have metastatic NSCLC and experience symptoms like these, here are some steps you can take to relieve your anxiety:

• Get help. If you report symptoms of anxiety to your oncologist or primary care doctor, they should be able to offer a referral to a psychologist or therapist, Francis says. If your anxiety is severe or complicated, or if you think you might need medication, such as antidepressants or antianxiety medications, you should be referred to a psychiatrist, she says, “particularly someone with experience in treating people with cancer.” When she sees people with NSCLC for anxiety, Dr. Ormond employs a range of discussion techniques, “from addressing existential concerns to suggesting behavioral ways to stop worrying and relax.”
• Work out. Exercise has been shown to have benefits in treating both anxiety and lung cancer. In a meta-analysis of almost 1,000 people with lung cancer, those who exercised had lower levels of anxiety and depression.

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   With your doctor’s permission, try some gentle walking or bicycling. And listen to your body — even a few minutes of exercise repeated throughout the day can help.

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• Try yoga. “Yoga, with movement and breath awareness, can help people with lung cancer engage in the present moment and reduce their sense of being out of control,” says Francis. A meta-analysis of 11 studies that included almost 900 people with lung cancer found that mind-body exercises like yoga and tai chi improved patient anxiety.

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• Practice mindfulness. Mindfulness, aka the practice of focusing your mind on something in the present moment, can help manage anxiety, says Francis. A meta-analysis of 17 studies with over 1,600 people with lung cancer found that mindfulness significantly reduced cancer fatigue, anxiety, depression, and quality of sleep.

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   One way to try using mindfulness is through apps like Calm, a mindfulness app that provides guided meditations as well as soothing sounds, and Headspace, which offers meditations and sleep exercises.
• Consider acupuncture. A review study of over 33 trials that included over 3,000 people with lung cancer found that acupuncture significantly improved anxiety, insomnia, depression, and fatigue, along with some physical symptoms, such as nausea and pain, compared with people who did not have acupuncture.

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   Ask your provider if there are any specialized oncology acupuncturists at your local hospital or nearby.
• Get an oncology massage. According to guidelines published in the CHEST Journal, massage therapy is effective at reducing anxiety, depression, and pain in patients with lung cancer. Ask your doctor to recommend a massage therapist who specializes in working with people with cancer.

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• Try a support group. Joining a lung cancer support group can provide a social experience while helping you realize you’re not alone in what you’re going through. Ask your doctor for recommendations for both local groups and online communities, or check out the local and remote support options offered by the American Lung Association and GO2 for Lung Cancer.

With additional reporting by Julie Marks.