Treatment of Symptoms Distress: Anxiety and Cancer … Pulmonary embolism ? Heart failure • Drugs ? Corticosteroids … Palliative Care Notes Anxiety and Cancer July 2000 INSIDE THIS ISSUE 1 Causes of Anxiety in patients with cancer 2 Serious Anxiety Reactions 3 Symptoms and Signs of Anxiety 4 Evaluating the Anxious Patient 5 Reference Anxiety may consist of Anxiety may consist of fear and uncertainty fear and uncertainty about the future. about the future.•

Evaluating the Anxious Patient Patient History ? ? Specific troubling symptoms ? ? Previous personality ? ? Previous experience with illness or cancer, and coping strategies used ? ? Previous episodes of anxiety (before cancer diagnosis) ? ? Knowledge and beliefs about the disease, stage of disease and prognosis ? ? Specific fears ? ? Insomnia and nightmares ? ? Current and recently discontinued medications ? ? Prior history of depression Physical ? ? Vital signs: tachycardia, tachypnea Class of Drug Specific Drug Dosage When to Use the Drug Benzodiazepines Lo raze pam 0.5-2mg PO/IV/IM q3-6h short acting drug that is (BZD) safe in patients w/ hepatic disease Diazepam 2.5-10mg PO/IM/PR q3-6h Longer acting drug Mid azo lam Start with 2-10mg/day IM Ideal for continous SQ infusion. or continuous SQ Drug of choice for terminal restlessness Clonazepam Start with 0.5mg PO tid Treatment of anxiety in patients and titrate up w/brain tumors, mania, or neuropathic pain Neuroleptics Haloperidol 0.5-4mg PO/IM/IV q4-6h When BZDs are insufficient. When patient has agitated or apathetic delirium or psychosis. Thioridazine Start with 10mg PO or IV tid When insomnia and and titrate up agitation are prominent. Try cyclic Imipramine Start with 10-25mg tid, When anxiety is accompanied Antidepressants and titrate up by depression or panic disorder. Reference: Waller, Alexander and Caroline, Nancy L. Palliative Care in Cancer . Copyright 1996. The content in this newsletter was taken, essentially verbatim, from the above-mentioned textbook. Dr. Waller is Acting Medical Director of the Tel Hashomer Hospice in Tel Hashomer, Israel. Dr. Caroline is the Medical Director of the Hospice of Upper Galilee in Metulla, Israel. ? ? Head: tense or worried expression ? Chest: wheezes, rales, egophony Management of Anxiety ? Control the patient’s pain and any other distressing symptoms, especially constipation, dyspnea and nausea ? Ensure physical contact with the patient, by family or staff ? Provide rapid relief of anxiety by pharmacological means (Rapid relief establishes credibility and enables the patient to talk about fears from an island of relative calm.) ? Treat specific problems detected on history and physical exam ? Stop drugs that produce symptoms of anxiety ? Address the patient’s fears ? Give patient an opportunity to ventilate all of his/her worries ? Teach the patient relaxation techniques

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