The Case of the Anxiety Answer
Kris is a 46-year-old newly diagnosed with stage III cervical cancer. She is an avid runner and vegetarian, and she believes strongly in taking care of herself. “I never thought I would get cancer,” she says. “I thought I did everything I could to avoid this.”
She has been married to her husband for 18 years, and together they have three children. She is scheduled to begin pelvic external-beam radiation therapy and concurrent cisplatin at the clinic today.
When Robin, the clinic nurse, goes to the waiting room, she finds Kris’s husband sitting alone. He tells Robin that Kris left and he thinks she is probably walking around outside the hospital. “She has really bad anxiety sometimes, that’s why I think she runs as much as she does; it really helps. I don’t know if she can endure being cooped up in here.”
What Would You Do?
“Depression and anxiety are not uncommon among people diagnosed with cancer. Stress is often a trigger for depression and anxiety, and cancer is one of the most stressful events that a person may experience. These conditions may interfere with cancer treatment. For example, the patients with untreated depression or anxiety may be less likely to take his cancer treatment medication (http://en.journals.sid.ir/ViewPaper.aspx?ID=440171) and continue good health habits because of fatigue or lack of motivation. They may also withdraw from family or other social support systems, which means they will not ask for the needed emotional and financial support to cope with cancer. This in turn may result in increasing stress and feelings of despair.”
Robin asks if someone will cover for her, then walks outside to see if she can find Kris. She finds her walking on the sidewalk outside the hospital. Robin asks if she will go with her to a quiet corner where they can talk. Once there, Robin begins by normalizing her fears and anxiety. “I was looking for you and heard you may be taking a walk on campus. May I walk with you so we can talk?”
ONS’s Putting Evidence Into Practice evidence-based resources have a topic on anxiety (https://www.ons.org/practice-resources/pep/anxiety) in patients with cancer. “Anxiety is an emotional and/or physiologic response that is a common experience among patients coping with any cancer diagnosis. Anxiety responses can range from normal reactions to extreme dysfunction that can affect decision making, adherence to treatment, and numerous aspects of quality of life and function. Anxiety can occur at different times throughout different phases of cancer care. Usually, anxiety is highest shortly after diagnosis and decreases over time; however, 20%–30% of patients continue to experience anxiety after completion of treatment.”
One of the treatments recommended for practice is mindfulness-based stress reduction, and Robin practices this herself, especially after having a stressful day. Mindfulness is defined as “bringing one’s complete attention to the present, moment-to-moment experience in a nonjudgmental or accepting way. The intention is that, through mindfulness, the course can help people become more aware of the automatic reactions (http://journals.sagepub.com/doi/abs/10.1177/1534735414546567) to situations in life so that they can then choose to respond more effectively.”
Robin begins to talk Kris through a simple mindfulness exercise. “Grasp your hands together really tight and hold for 10–15 seconds, then release and pay attention to how your hands feel, moving each finger, flexing and unflexing.”
After a couple of minutes, Kris seems calmer, and they walk back into the cancer center together.