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INTRODUCTION

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Anxiety is the most common and a very stressful condition in patients with cancer diagnoses. High level of anxiety is seen in up to 50% of newly diagnosed cancer patients.1 It has also been noticed that a large number of patients with a principal anxiety disorder have one or more coexisting diagnoses at the time of initial evaluation. Anxiety is more common in younger age groups, single females, with low level of education and poor social support, and those of lower economic status.2 The reason for this is that with maturity and more experience, the ability to mobilize resources, and adaptability, patients develop skills to cope better with illness. It has also been reported that patients with advanced disease and lower performance status endorse a higher level of stress.3

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The level of anxiety may fluctuate during the course of the illness, but the symptoms persist throughout the initial consultation, workup, follow-up visits, and treatment. Patients may become more anxious before the first consultation, and reassurance usually does not bring the anxiety level down.4 Anxiety level increases during treatment in anticipation of side effects, relapse, or spread of the disease. Patients with preexisting anxiety disorders are more likely to develop severe anxiety when faced with a cancer diagnosis.5

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Increased anxiety may interfere with patients' understanding of the disease, decision making, treatment compliance, and response to treatment. It may impair normal functioning and alter their quality of life. Reducing anxiety may play a big role in the overall treatment outcome. A better understanding of different anxiety states, their pathophysiological and psychological responses, and a measure of the strength and coping skills of patients is essential. It will help determine a treatment plan and strategies most effective and meaningful for patients.

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Anxiety may be state anxiety, which is situational anxiety in response to the current threat, or trait anxiety, which is baseline anxiety prevailing over a period of many years.1 The response to any threat or challenge is much more pronounced in patients with baseline anxiety.

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Anxiety may occur at different times during the course of the illness as the patient undergoes different stages from diagnosis to survivorship. The impact of being diagnosed with cancer is very stressful. At the same time the patient receives a lot of information regarding further workups, including blood tests, scans, and information about treatment options, chemotherapy versus surgery or radiation, side effects of the chemotherapeutic agents, the possibility of prolonged hospital stay, and short- and long-term follow-up plans. He or she feels overwhelmed and flooded with information. The patient sees himself or herself caged in a situation from which escape is impossible or life threatening. He or she is not able to absorb all the information and starts having psychological and physiological responses. The patient loses sleep and appetite, develops anxiety, feels helpless, and loses interest in other activities. From the ...

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