Managing Anxiety

Anxiety and the Palliative Care Patient

Terminal Breast Cancer Patient sits at a table
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Anxiety is a common symptom in patients nearing death. Some patients may experience mild anxiety, but for others, full-blown panic attacks can occur. Regardless of the cause, anxiety needs to be treated promptly.

Recognizing Anxiety

Reactions to anxiety can vary. Some may be able to verbalize what they are feeling and other may not. It's important to know what anxiety looks like so you can easily recognize it when it happens.

Anxiety is driven by adrenaline, and its symptoms indicate that the body's "flight or fight" response has been initiated.

Anxiety has cognitive, emotional, behavioral, and physical manifestations ranging from mild to severe.

Cognitive Symptoms of Anxiety

  • Mild anxiety: The patient may be hyper-alert and have narrowed focus.
  • Moderate anxiety: She may have difficulty concentrating and be easily distracted.
  • Severe anxiety/panic: The patient may not be able to focus, even when clear directions are given. Severe anxiety may lead to a disconnected state.

Emotional and Behavioral Manifestations of Anxiety

  • Mild anxiety: The patient may be irritable or mildly upset. She might be short-tempered or easily annoyed.
  • Moderate anxiety: The patient may be restless, visibly upset, and have increasing irritability. She may be tearful and express feelings of worry or uneasiness.
  • Severe anxiety: The patient may be crying uncontrollably, appear greatly agitated, and even yell and scream. She may express feelings of doom, dread, or terror, or exhibit irrational or repetitive self-soothing behaviors.

    Physical Manifestations of Anxiety

    Many of the physical manifestations of anxiety listed below are similar to those caused by the underlying illnesses and treatments.

    • Mild anxiety: The patient may have insomnia and difficulty resting.
    • Moderate anxiety: She may have an increased heart rate or palpitations. Her breathing may be faster, and she might complain of feeling nauseated or have diarrhea.
    • Severe anxiety: The patient may have all the above symptoms, but more severe. She may vomit or soil herself. She might hyperventilate or have chest pains. Her pupils will dilate and she may sweat profusely.
    • Other physical symptoms of anxiety include dry mouth, muscle twitching or trembling, and abdominal pain.

    Treating Anxiety

    If your loved one is beginning to show signs of anxiety, the first thing you should do is try to calm him down. Sometimes simple distraction could be enough to reduce anxiety level and keep him calm. Try discussing something other than their illness or symptoms -- perhaps the latest ball game or celebrity gossip.

    Whether the anxiety passes or continues to increase, it's important to call the treating doctor to report the symptom and get medical advice. If your loved one is on hospice care, contact the hospice agency and report to the nurse that he is showing signs of anxiety. The hospice nurse will give you specific instructions and may send a nurse out to evaluate the situation.

    Most hospice agencies supply their at-home patients with a special kit of medications to be used in case of emergency. These kits, sometimes called comfort kits or emergency kits, most often contain at least one medication to treat anxiety. The hospice nurse may give you instructions to start one of the medications and record it on a medication log.

    If your loved one isn't on hospice care, you'll need to get instructions from the treating doctor or the doctor on-call. She may call in a prescription to the pharmacy or request to see the patient in the office.

    Medications for Anxiety

    These medications are commonly prescribed to treat anxiety:

    • Ativan (Lorazepam)
    • Serax (Oxazepam)
    • Klonopin (Clonazepam)
    • Xanax (Alprazolam)
    • Valium (Diazepam)

    Treating Underlying Causes of Anxiety

    Two of the most common causes of anxiety are pain and shortness of breath (dyspnea). If your loved one is experiencing one of these symptoms, it's important that it be treated along with the anxiety.


    Ferrell, BR and Coyle, N; Textbook of Palliative Nursing, Oxford University Press, 2006.

    Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002.

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