Anxiety

Managing anxiety can help you maintain your daily activities and relationships and improve your quality of life. Reducing anxiety can boost your ability to make skillful choices about your care and cope with cancer treatment.

Anxiety at a glance

Anxiety—a general feeling of worry, nervousness, or unease—is common among people with cancer. Identifying and managing anxiety may be important parts of your cancer treatment plan. Triggers include fear, uncertainty, and conflict. Symptoms of anxiety include excessive worrying, restlessness, agitation, difficulty concentrating, and more. Anxiety is linked to worse inflammation—a body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factor linked to cancer—and cancer outcomes. 

Several self-care practices and complementary therapies can help you manage anxiety. Those with the best evidence of effectiveness are listed here. Anxiety may also be a symptom of stress. If stress is contributing to your anxiety, managing your stress will be important in reducing it.

Top practices and therapies for managing anxiety

Therapies and practices we have reviewed

The effects of these practices and therapies are described below on this page. Full details of evidence are on the therapy reviews, accessible through the image links below.

Further therapies

Therapies recommended in clinical practice guidelines but that we haven’t yet reviewed; see belowUse your browser's Back button to return to this location. for guidelines ›

Hypnosis

Meditation

Music therapy and other forms of expressive arts therapies

Psychosocial therapies:

  • Cognitive-behavioral therapy
  • Cognitive-behavioral stress management (CBSM)
  • Mindfulness-based stress reduction (MBSR)
  • Supportive/expressive therapy

Other therapies

Several other therapies have some evidence of benefit. The benefit may be meaningful or even substantial, but our reviews show the evidence so far is preliminary.

Acupressure

Electroacupuncture

Guided imagery

Healing touch

Mistletoe

Moxibustion

Polarity therapy

Reiki

Reishi mushroom

Turmeric and curcumin

Seek professional help if needed. Diagnoses such as anxiety can require therapy from trained practitioners for management. We encourage you to explore the options available to you through your cancer team and others. Taking care of your mental health is as important as taking care of your physical health.

On this page

What is anxiety?

Anxiety is a common symptom among people with cancer.1Smith AB, Rutherford C et al. A systematic review of quantitative observational studies investigating psychological distress in testicular cancer survivors. Psycho-oncology. 2017 Nov 23; Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA A Cancer Journal for Clinicians. 2008 Jul-Aug;58(4):214-30. According to Cancer.Net, anxiety may be described as feeling nervous, “on edge,” or worried. A normal emotion, it alerts your body to respond to a threat.2Cancer.Net. Anxiety. American Society of Clinical Oncology. April 2016. Viewed March 16, 2022. 

Intense and prolonged anxiety may interfere with your daily activities and relationships. Anxiety may make coping with cancer treatment difficult and may interfere with your ability to make skillful choices about your care. Identifying and managing anxiety are important parts of your cancer treatment.3Cancer.Net. Anxiety. American Society of Clinical Oncology. April 2016. Viewed March 16, 2022.

What are the symptoms of anxiety? 

Anxiety can cause or show up as any of these symptoms.4Julson E. Signs and Symptoms of Anxiety Disorders. Healthline. August 26, 2021. Viewed March 16, 2022; Raypole C. Physical Symptoms of Anxiety: How Does It Feel? Healthline. March 15, 2019. Viewed March 16, 2022.

Mental/emotional symptoms
  • Excessive worrying
  • Agitation
  • Restlessness
  • Difficulty concentrating
  • Irritability
  • Difficulty falling or staying asleep
  • Panic attacks
  • Avoiding social situations
  • Irrational fears
Physical symptoms
  • Muscle tension or pain 
  • Stomach pain, nausea, or digestive trouble
  • Headache
  • Weakness or fatigue
  • Rapid breathing or shortness of breath
  • Pounding heart or increased heart rate
  • Sweating
  • Trembling or shaking

What may trigger anxiety?

If you are living with cancer, fears and worries related to cancer, treatments, and their impacts on you and your family may trigger anxiety.5Cancer.Net. Anxiety. American Society of Clinical Oncology. April 2016. Viewed March 16, 2022; Hendriksen E, Williams E et al. Worried together: a qualitative study of shared anxiety in patients with metastatic non-small cell lung cancer and their family caregivers. Supportive Care in Cancer. 2015 Apr;23(4):1035-41.

Pain may worsen anxiety.6Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer. BMJ Open. 2019 Jan 24;9(1):e026809. Alleviating either anxiety or pain to interrupt the feedback loop between them may provide relief of both symptoms. A prolonged stress response can also cause anxiety.

Some medications used during cancer treatment or for other conditions may trigger anxiety. Check the inserts with any prescription medications you use or ask your pharmacist if you have concerns. Some therapies that may trigger anxiety:

Some foods are linked to risk of anxiety:

  • Higher scores or risk of anxiety among people eating a pro-inflammatory diet high in commercially baked goods, fried foods and fatty meats, and low in fruits and vegetables (good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))
  • Higher reported anxiety symptoms among people with higher caffeine use (modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently)

Exposure to traffic noise is also linked to an increased risk for anxiety (preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently)).

Alcohol can trigger anxiety.8Mosel S. Anxiety and alcohol: does drinking cause anxiety & panic attacks? American Addiction Centers. July 26, 2021. Viewed August 24, 2021.

Risk factors

You are more likely to experience anxiety if you have these risk factors:9Cancer.Net. Anxiety. American Society of Clinical Oncology. April 2016. Viewed March 16, 2022; Okuyama M, Takaishi O et al. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scandinavian Journal of Gastroenterology. 2017 Jan;52(1):44-49. 

  • Previous diagnosis or family history of anxiety or depression
  • Lack of support from friends and family
  • Financial burdens
  • Gastroesophageal reflux disease (GERD)

Personal stories

Elizabeth Louise O’Riordan: Anxiety, depression and PTSD can set in months or even years later when the reality of what you’ve been through, what you look like and what might happen in the future starts to sink in. How do you deal with the grief of infertility, altered body image, scars, pain, premature menopause or the financial difficulties and trying to go back to work? None of it is easy. And most of this collateral damage is hidden to the outside world. Everyone tells you that you look great—if only they knew.

It is these months and years after treatment when patients need the most support.

Why is managing anxiety important?

Anxiety is linked to higher risks of cancer, of recurrence, and of cancer-related death, and also worse inflammation, a body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factor linked to cancer. We don’t know whether anxiety contributes to worse health, or if worse health contributes to anxiety, or if the link works in both directions. Since we have good evidence of links, managing your anxiety may be one step you can take to improve your outcomes.

Anxiety and cancer outcomes

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of increased risk of cancer among people experiencing anxiety

Good evidence of higher risk of recurrence among people with cancer experiencing anxiety

Good evidence of higher cancer-specific and all-cause mortality among people with cancer experiencing anxiety

Anxiety and your body terrain

Good evidence that anxiety is linked to inflammation

Anxiety and side effects

Cognitive difficulties: Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower cognitive performance and self-perception of worse memory and attention before surgery among people with clinically relevant anxiety, mostly for brain tumors

Depression: Modest evidence of more depressive symptoms after surgery among people with clinically relevant anxiety before surgery, mostly for brain tumors

Quality of life and physical function: Modest evidence of lower health-related quality of life before surgery among people with clinically relevant anxiety

Surgical outcomes: Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower Quality of Recovery Scale scores among people with higher anxiety before and/or after elective abdominal surgery

What approaches can help you manage anxiety?

We present many approaches to reducing anxiety and the evidence regarding their effectiveness.

Conventional approaches

Various prescription drugs may help manage anxiety. Ask your doctor for recommendations, but also ask about side effects from their use.

Self-care practices

Foods that may help you manage anxiety

Modestly lower risk of anxiety symptoms among people eating the recommended diet patterns or a vegetarian/vegan diet (good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))

Little impact on reducing anxiety from diet alone (modest evidence)significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently)

Recommended in a practice guideline for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Moving More: mixed evidence

A small improvement in anxiety without regard to treatment phase among people participating in exercise (strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently))

Slightly less anxiety during chemotherapy, radiotherapy, adjuvant therapytherapy used before a main treatment, such as chemotherapy, radiation therapy, and hormone therapy before surgery, or hormone therapy among people participating in exercise (good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))

Small to moderate improvement in anxiety among people participating in exercise after cancer treatment (strong evidence)

No evidence of an effect on anxiety among adults with advanced cancer participating in exercise in a combined analysis of studies

Recommended in a practice guideline for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Combining Eating Well and Moving More may help even more.

  • Slightly less anxiety among people participating in a combined intervention of diet and physical activity (modest evidence)at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (randomized controlled trials (RCTs) or observational studies), or several small studies aggregated into a meta-analysis found no effect (this is the CancerChoices definition; other researchers and studies may define this differently)
  • Less anxiety among women with overweight or obesity participating in an intervention of physical activity and/or diet (modest evidence)

Managing Stress: good evidence

Lower anxiety and distressemotional, social, spiritual, or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious, or lonely; people in distress may also feel that they are not able to manage or cope with changes caused by normal life activities or by having a disease, such as cancer among people with better acceptance of cancer (good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))

Recommended in a practice guideline for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Anxiety may be a symptom of stress. If stress is contributing to your anxiety, managing your stress will be important in reducing your anxiety.

Sleeping Well: modest evidence

More anxiety among people with breast or lung cancer with poorer sleep quality (modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently)); improving sleep quality may lead to less anxiety

Creating a Healing Environment: preliminary evidence

Increased risk for anxiety among adults with increased exposure to traffic noise (preliminary evidence); avoiding traffic noise may help ease anxiety

Sharing Love and Support: preliminary evidence

Less anxiety among people with colorectal cancer with more social support (preliminary evidence)

Healthy Habits: mixed evidence

Overweight or obesity: obesity is linked to increased risk of anxiety (modest evidence); losing weight may lead to less anxiety

Alcohol use: anxiety and alcohol use or abuse are closely related (good evidence); reducing or stopping alcohol use may lead to less anxiety

With both obesity and alcohol use, the link with anxiety could work in several ways. Obesity or alcohol use may increase risk of anxiety, but anxiety may also increase risk of obesity or alcohol use. Researchers suspect that causation works in both directions. This may mean that reducing either anxiety or obesity may lead to less of the other, and the same may be true for anxiety and alcohol use. 

Tobacco use: modest evidence of long-term improvement in symptoms following short-term increases in anxiety with smoking cessation

We are still researching overweight or obesity, alcohol use, and tobacco use; these assessments are from our work so far.

Complementary therapies

We present complementary therapies supported by evidence for managing anxiety. Those with the best evidence are presented first. Details of research evidence are on our reviews of each therapy.

A therapy may show a stronger effect or have more evidence in some situations than in others.

Good or modest evidence of benefit

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.

Acupuncture: mixed evidence

Less anxiety before surgery among people treated with acupuncture (modest evidence)

Less anxiety or worry, irritation, and tenseness during or after chemotherapy among people treated with acupuncture (preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently))

No evidenceoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. of additional benefit from massage therapy for anxiety during autologous tissue breast reconstruction among people treated with acupuncture

Cannabis: mixed evidence

Fewer anxiety symptoms among people with non-cancer medical conditions  treated with pharmaceutical THC either with or without CBD (modest evidence)

Insufficient evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of fewer anxiety symptoms among people with cancer using cannabis or cannabinoids

Melatonin: good evidence

These results are not specific to people with cancer.

  • Less anxiety while preparing for surgery among adults treated with melatonin, comparable to results with benzodiazepines (good evidence); note cautions about the effects of melatonin on anesthesia in Safety and precautions › 
  • Less anxiety after surgery among people treated with melatonin (good evidence)
Relaxation techniques, often used with guided imagery: modest to weak evidence

Lower anxiety without regard to treatment stage among people with cancer participating in relaxation training, often with other mind-body therapies (modest evidence)

Less anxiety during chemotherapy among people treated with relaxation, sometimes also with guided imagery (modest evidence)

Less anxiety during or soon after radiotherapy among people treated with relaxation, sometimes also with guided imagery (preliminary evidence)

Less anxiety soon after surgery among people with cancer treated with relaxation, sometimes with other complementary therapies (modest evidence)

Less anxiety among hospitalized children with cancer treated with relaxation and guided imagery (weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently))

Less anxiety among parents of hospitalized children with cancer treated with relaxation and guided imagery (preliminary evidence)

Less anxiety among people with cancer in hospice with interactive guided imagery and progressive muscle relaxation (preliminary evidence)

Lower subjective ratings of anxiety after a stressful task among people with reflux disease receiving a relaxation intervention (preliminary evidence)

Caution: occasionally, people using relaxation techniques report negative experiences such as increased anxiety, intrusive thoughts, or fear of losing control

Recommended in a practice guideline for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Support groups and interventions: mixed evidence

In-person support groups are linked to less anxiety, but other support interventions are not.

In-person support groups: less anxiety among people with breast cancer participating in in-person support groups (modest evidence)

Recommended in a practice guideline for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Group emotional and educational intervention: no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on anxiety among people participating in a group emotional and educational intervention in a preliminary study

One-on-one peer support: no evidence of an effect on anxiety after recent surgery among people with newly diagnosed breast cancer participating in one-on-one peer support interventions in a preliminary study

Caution: Online or phone-based support interventions: More anxiety among people participating online or phone-based support interventions (preliminary, conflicting evidence)

Tai chi or qigong: modest evidence

Less anxiety among people with breast cancer practicing either tai chi or qigong (modest evidence)

Recommended in a practice guideline for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Time in nature or forest bathing: modest and preliminary evidence

Less anxiety among people with cancer in an educational facility with outlooks on natural scenery (preliminary evidence)

Not specific to people with cancer:

  • Lower anxiety among people participating in forest bathing or spending time in a forest (modest evidence)
  • Less anxiety and agitation among people without cancer in critical care listening to recordings of nature-based sounds (modest evidence)
Yoga: good evidence

Less anxiety, usually only for a short time after practice, among people with cancer practicing yoga (good evidence)

Recommended in clinical practice guidelines for treating anxiety; see belowUse your browser's Back button to return to this location. for guidelines ›

Therapies with preliminary or weak evidence of benefit for anxiety

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

Acupressure Learn moreSee Less
Electroacupuncture Learn moreSee Less
Guided imagery Learn moreSee Less
Healing touch Learn moreSee Less
Mediterranean diet Learn moreSee Less
Mistletoe Learn moreSee Less
Moxibustion Learn moreSee Less
Polarity therapy Learn moreSee Less
Reiki Learn moreSee Less
Reishi mushroom Learn moreSee Less
Turmeric and curcumin Learn moreSee Less

Therapies with no evidence or insufficient evidence of benefit

Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) ›

  • No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on anxiety during chemotherapy among people with stomach cancer treated with celecoxib in a preliminary study

Therapeutic Touch™ ›

  • Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of less anxiety among people with cancer treated with TT

Further therapies used to manage anxiety

These therapies are used to manage anxiety, but we have not yet reviewed their effectiveness or safety. Those in bold are recommended in at least one clinical practice guideline; see belowUse your browser's Back button to return to this location. for guidelines ›

Breathing therapies

Electromagnetics

Hypnosis

L-theanine

Laughter therapy

Massage therapy

Meditation

Music and other arts therapies

Omega-3 fatty acids (EPA and DHA) ›

Psilocybin and other psychedelics

Rhodiola rosea

Vitamin B6 supplements, sometimes combined with magnesium

Vitamin C supplements › (high-dose sustained-release)

Psychosocial therapies:

  • Acceptance and commitment therapy (ACT)
  • Cognitive-behavioral stress management (CBSM)
  • Cognitive-behavioral therapy
  • Mindfulness-based stress reduction (MBSR)
  • Supportive/expressive therapy

Resources for managing anxiety

Helpsy Health

Helpsy empowers members to take control of their health through a real-time virtual nurse support service. This service is available via mobile devices, a Helpsy website and automated phone calls.

Access the Helpsy website

HeartMath

A free mobile app is available, but full functionality requires purchase of a sensor to provide heart rate variability coherence feedback.

Relieving Stress and Anxiety

Calm Mindfulness App

A free version is available, but premium access requires a paid subscription.

Calm Together

How do integrative experts manage anxiety?

Both medical groups and integrative experts provide recommendations for managing anxiety. Learn more about the approaches and meanings of recommendations.

Clinical practice guidelines

2013 evidence-based clinical practice guidelines provide these weak recommendations with moderate quality evidence for managing anxiety.

Massage therapy when anxiety is not controlled by usual care, and as part of a multi-modality cancer supportive care program

Mind-body approaches as part of a multidisciplinary approach: 

  • Hypnosis
  • Mindfulness-based stress reduction (MBSR)
  • Meditation
  • Music therapy
  • Psychosocial approaches, including cognitive behavioral therapy, relaxation training, imagery/visualization, psychoeducation, and behavioral approaches
  • Yoga

The American Society of Clinical Oncology (ASCO) recommends screening for anxiety at diagnosis and at regular periods during treatment and recovery.

The 2022 NCCN Guidelines® on Survivorship include a recommendation to develop a plan for regular physical activity and healthy nutrition as part of management and treatment of anxiety, depression, and distress.

Society for Integrative Oncology

Two guidelines discuss managing anxiety among people with cancer.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment ›

The 2017 SIO clinical practice guidelines regarding people with breast cancer provide these recommendations to professionals for managing anxiety during and after treatment for breast cancer. This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).21Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.

High certainty that the net benefit is substantial: offer or provide this modality:

  • Meditation

High certainty that the net benefit is moderate; offer or provide this modality:

  • Music therapy
  • Stress management (longer group programs are likely better than self-administered home programs or shorter programs)
  • Yoga

Moderate certainty that the net benefit is small; offer or provide this modality for selected patients, depending on individual circumstances:

  • Acupuncture
  • Massage
  • Relaxation

Therapies with insufficient evidence to make a recommendation with anxiety:

  • Art therapy
  • Electrical nerve stimulation
  • Healing touch
  • Hypnosis
  • Myofascial release
  • Reflexology
  • Reiki
  • Tai chi

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals ›

The 2009 SIO guidelines for complementary therapies and botanicals provide these recommendations for managing anxiety with cancer.

Mind-body therapies: support and psychotherapy approaches as part of a multidisciplinary approach (strong recommendation, high-quality evidence):

  • Cognitive-behavioral therapy
  • Cognitive-behavioral stress management (CBSM)
  • Support groups
  • Supportive/expressive therapy

Other mind-body therapies as part of multimodality treatment (strong recommendation, moderate-quality evidence): 

  • Hypnosis
  • Meditation
  • Music therapy and other forms of expressive arts therapies 
  • Relaxation techniques
  • Tai chi
  • Yoga

Energy therapies (strong recommendation, moderate-quality evidence), including Therapeutic Touch™, healing touch and reiki

  • Reiki
  • Polarity therapy
  • External qigong 
  • Electromagnetics 

Massage therapy delivered by an oncology-trained massage therapist as part of multimodality treatment (strong recommendation, low- or very low-quality evidence)

Published programs and protocols

These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care provide guidance for managing anxiety.

We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including anxiety.

Keith Block, MD

Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.

The integrative Block Program has recommendations to people who are at different places along the cancer continuum:

  • Those who’ve been recently diagnosed
  • Those in treatment
  • Those who’ve concluded treatment and need to remain vigilant to prevent recurrence

Lorenzo Cohen, PhD, and Alison Jefferies, MEd

Cohen L, Jefferies A. Anticancer Living: Transform Your Life and Health with the Mix of Six. New York: Viking. 2018.

This book introduces the concept of the Mix of Six, which is identical to six of our 7 Healing Practices › Dr. Cohen and Ms. Jefferies explain that while each plays an inde­pendent role, the synergy created by all six factors can radically transform health, delay or prevent many cancers, support conventional treatments, and significantly improve quality of life.

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.

This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.

David Servan-Schreiber, MD, PhD

Servan-Schreiber D. Anticancer: A New Way of Life. New York: Penguin Books. 2009.

This book provides tips on how people living with cancer can fight it and how healthy people can prevent it.

Author, clinical professor and CancerChoices advisor Rachel Naomi Remen, MD, demonstrates a breathing technique to help lower anxiety.

The relaxing breath

Shanti Norris, a yoga teacher who works with people with cancer, explains: “One cannot feel anxious as long as one is breathing slowly and deeply.” These are her instructions for managing stress with “The Relaxing Breath”22Norris S. Progressive Relaxation. Smith Center for Healing & the Arts. Viewed April 18, 2018.

  1. Sit in a comfortable position or lie on your back on the floor. Take a moment to get comfortable. Feel your body. Take a deep breath or two.
  2. Now take a breath by inhaling into the nose and exhaling out the mouth. The exhalation is like an audible sigh: AAAHHH! Do this three or four times. In through the nose and out through the mouth. AAHH. This is the most relaxing breath.
  3. Continue for one to two minutes.
  4. Let the breath come back to normal.

Traditional medicine

Practitioners of traditional Chinese medicine and Ayurveda offer therapies and approaches to manage anxiety.

Learn more about traditional medicine and how to find practitioners.

Explore other side effects and symptoms

Are you a health professional?

This section does not replicate the other information on this page but provides additional details or context most relevant to professionals.

Treatment evidence

A large RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects found that the Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) program may increase access to mental health care, lessen hospitalizations, and improve providers’ management of psychosocial needs, but does not appear to impact overall functioning over time.23O’Hea E, Kroll-Desrosiers A et al. Impact of the Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) program on oncology patient outcomes, health care utilization, and health provider behaviors: a multi-site randomized control trial. Patient Education and Counseling. 2020 Mar;103(3):607-616.

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Authors

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Maria Williams

Research and Communications Consultant
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Maria Williams is a research and communications consultant who brings over 15 years’ experience in research, consumer education, and science communication to CancerChoices. She has worked primarily in public health and environmental health.

Maria Williams Research and Communications Consultant

Reviewer

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Last update: July 5, 2022

Last full literature review: July 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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