Anxiety

Anxiety is the subjective feeling of apprehension or uneasiness. Its causes can be physical distress, as in someone experiencing dyspnea; psychosocial distress, as in someone experiencing loss of income due to illness; emotional distress, which is often experienced in those with depression; and/or spiritual distress, as in someone questioning their spiritual beliefs due to serious illness.

• Assessment Anxiety can be subjectively assessed, like all symptoms, by using the PQRSTU mnemonic (see Symptom Assessment) or other numeric scales such as the ESAS (see Symptom Assessment). Further assessment can include questions about sleep patterns, medications that may cause anxiety such as oral steroids, and history of substance abuse. Objectively, signs of anxiety can include trembling, a tense posture, fidgeting, and clenched teeth.
• Treatment Potential causes of anxiety, such as pain and dyspnea, should be treated. If possible, medications that may be contributing to anxiety should be tapered or discontinued. Common pharmacologic management of anxiety can include benzodiazepines such as alprazolam, diazepam or lorazepam. Non-pharmacologic management should always include active, empathic listening and support for patients and their caregivers. Consult an evidence-based guideline for further information about the palliative manage of persons with anxiety. Referral to an interdisciplinary palliative care team should be considered for those with complex medical and psychosocial concerns.

Additional Resource

Clinical Practice Guidelines

• Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults with Cancer: An American Society of Clinical Oncology Guideline Adaptation
• Fast Facts
• Fraser Health
• Agency for Healthcare Research and Quality
• Qaseem, A., Snow, V., Shekelle, P., Casey Jr., D. E., Cross Jr., T. J., and Owens, D. K. “Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians.” Annals of Internal Medicine 148 (2008): 141-146.
• National Comprehensive Cancer Network (requires free registration)

References

• Block, S. D. Psychological Issues in End of Life Care. Journal of Palliative Medicine 9 no. 3 (2006): 751-772.
• Kuebler, K. K., Heidrich, D. E., and Esper, P. Palliative and End-of-Life Care: Clinical Practice Guidelines, 2nd ed. (St. Louis, MO; Saunders, 2007).
• Wrede-Seaman, L. Symptom Management Algorithms: A Handbook for Palliative Care, 3rd ed. (Yakima, Washington: Intellicard, Inc, 2009).