Key points
- Sadness, worry and fear after a cancer diagnosis are normal. Nearly half of people with cancer say they have a lot of distress [2].
- Depression is different from ordinary sadness and affects about 2 in every 10 people diagnosed with cancer; depression can be treated [1].
- Fear of the cancer coming back is very common: in a large study, about 1 in 5 people had fear so strong that they needed specialist help [3].
- Talking, psychological therapies and regular exercise reduce anxiety and depression [6, 8].
- Medicines help some people, especially when symptoms are severe or other approaches have not been enough [6, 9].
- Thoughts of harming yourself or of suicide are an emergency: call your local emergency number or a crisis line straight away, or go to the nearest hospital emergency department [1].
How common are anxiety and depression with cancer?
Hearing that you have cancer, going through long treatment and waiting for test results are hard for anyone. Almost everyone with cancer feels distressed at some point, from sadness and fear to more serious problems such as depression, anxiety or panic attacks [2]. Nearly half of people with cancer say they feel some anxiety, and about 1 in 4 feel a great deal of anxiety [2].
Distress is most likely at these times: soon after diagnosis, at the start of treatment, at the end of treatment, during remission and if the cancer comes back [2]. The type of cancer usually makes little difference to how much distress people feel [2]. Having these feelings is not a sign of weakness; it is a sign that you are facing something hard.
Normal worry or depression?
A normal reaction: sadness, worry or fear come and go, but you can still manage your daily activities, stay in touch with family and friends, and things in life still have meaning and value for you [2].
Depression: this is more than feeling down now and then; it is ongoing sadness and hopelessness, loss of energy and difficulty coping with everyday life. If you feel this way most of the day for more than 2 weeks, it may be depression [1]. Other signs [1]:
- losing interest in, or pleasure from, things you used to enjoy
- changes in sleep and appetite
- unexplained tiredness, slowness or restlessness
- feeling worthless, hopeless, helpless or guilty for no reason
- trouble concentrating and the same thoughts going round and round
- thinking a lot about death or suicide
Severe anxiety often has physical symptoms too: shortness of breath, a fast heartbeat, sweating, restlessness, tight muscles, dizziness, nausea, irritability or fear that you are having a heart attack [2]. Some of these symptoms are similar to symptoms of the illness itself or side effects of treatment [9], so tell your doctor about them so that the cause can be checked.
A past history of depression or anxiety, lack of support from family and friends, uncontrolled pain, physical weakness and some medicines such as steroids make depression more likely [1].
Fear of the cancer coming back and "scanxiety"
Most people are glad when treatment ends, but they also have a new worry: "What if the cancer comes back?" Seeing the care team less often can make this worry worse [2]. In a large study of more than 9,000 cancer patients and survivors in 13 countries, nearly half had a fear that was probably a real problem, and about 1 in 5 had fear so strong that they needed specialist help [3]. This fear was seen in every type of cancer and at every point in the years after diagnosis; it was more common in women and became less common with age [3].
"Scanxiety" is the name given to the worry before scans and follow-up tests and during the days of waiting for results. Feeling distressed before follow-up visits and while waiting for test results is normal [2]. In nearly half of the studies that measured worry before and after a scan, worry was lower after the scan, and most of the approaches tested to reduce it (relaxation, distraction, information and emotional support) worked [5]. To find out what follow-up after treatment involves, see What is cancer recurrence and how is it followed up?
Coping with fear of the cancer coming back
- 1
Get the right information
Ask your care team what the follow-up plan is for your type and stage of cancer and which symptoms you should report quickly. Write down your questions and worries before each visit.
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Plan for scan day
Take someone with you and plan enjoyable things to do during the days of waiting. Relaxation and deep-breathing exercises, distraction and emotional support have helped reduce this worry in studies [5].
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Keep living your life
Carrying on with your usual routine and work, and doing things that matter to you, makes it easier to adjust [2]. See also the guide Returning to work and everyday life.
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If worry is taking over your day, ask for help
Psychological therapies reduce fear of the cancer coming back, and the benefit largely lasts over time. Therapies that teach you to relate differently to worrying thoughts and to going over them again and again worked better [4].
What really helps?
Approaches that work
Talk about it
Share how you feel with family, friends or your care team. Emotional and social support, including support groups, information about cancer and relaxation training, has reduced depression and anxiety and increased hope [2].
Psychological therapies
Cognitive behavioural therapy (learning new ways of thinking and acting), behavioural activation (planning enjoyable and meaningful activities again), mindfulness programmes and other evidence-based therapies have reduced depression and anxiety in cancer survivors [6]. Sessions can be one-to-one or in a group [1].
Regular exercise
Moderate aerobic exercise, such as brisk walking, about 3 times a week for 30 to 60 minutes each time over 12 weeks, has reduced anxiety and symptoms of depression in cancer survivors [8]. Start small and build up gradually (Can I exercise during cancer treatment?).
Sleep and daily routine
Changes in sleep are a common sign of depression, and poor sleep can itself make your mood worse [1]. Keep regular times for going to bed and getting up, and tell your doctor if sleeplessness carries on. See also the guide Fatigue from cancer and its treatment.
Medicines, when needed
What can your doctor do?
Your care team should ask about your emotional well-being from the first visit and then at regular intervals, especially when your situation changes (for example at the end of treatment or if the cancer comes back) [7]. One simple tool is the "distress thermometer": you are asked to rate how distressed you have felt over the past week from 0 (no distress) to 10 (extreme distress). If your score is 4 or more, the team goes through a checklist with you to find out what is troubling you (practical, family, emotional, spiritual or physical problems) and what help you need [7].
Your doctor will also look for physical causes, because uncontrolled pain, anaemia, fever, thyroid problems, low vitamin B12 or folate, high or low levels of calcium, sodium or potassium in the blood, some medicines and poor sleep can all cause depression [1]. If nobody asks how you are feeling, say it yourself: "I'm not doing well and I need help." American cancer specialists' guidelines recommend that every patient be given information about depression and anxiety and that the type of help be matched to how severe the symptoms are [6].
Where can I get help?
- 1
Your own doctor or nurse
Start with your cancer care team. They can refer you to a social worker, psychologist, psychiatrist, palliative care specialist or faith-based counsellor [2].
- 2
A psychologist or psychiatrist
Seeing a psychologist or psychiatrist is advised if medicines have not helped after 2 to 4 weeks, if your depression is getting worse or if it is stopping you from continuing your cancer treatment [1].
- 3
Support groups
Talking with others who have been through something similar in a support group has reduced distress [2].
- 4
Think about your family too
Family members can also develop anxiety and depression; families who talk about their feelings and solve problems together are less likely to [1]. See the guide for family members and caregivers and, if you have children, How do I talk to my children about my cancer?
When should I call my doctor?
Urgent, right now: if you are thinking about harming yourself or about suicide, or have made a plan, call your local emergency number or a crisis line now or go to the nearest hospital emergency department, and do not stay alone [1]. If you are worried about someone you love, do the same for them.
Talk to your doctor or care team as soon as you can if:
- sadness, hopelessness or loss of interest lasts most of the day for more than 2 weeks [1].
- worry or fear stops you from sleeping, working or being with other people and is disrupting your daily life [2].
- you have sudden attacks of fear with a racing heart, shortness of breath, sweating or dizziness; a doctor should check these symptoms [2].
- your mood is making you want to stop your cancer treatment [1].
Frequently asked questions
Is depression normal after a cancer diagnosis?
Sadness and worry after a diagnosis are normal, but depression is a separate illness that can be treated. If sadness and hopelessness last most of the day for more than 2 weeks, or you cannot do your usual activities, talk to your doctor [1].
When does the fear of cancer coming back go away?
How can I reduce my anxiety before each scan?
Relaxation and breathing exercises, distraction, information about the test itself and emotional support have helped reduce this worry in most studies [5]. Take someone with you, and ask your care team when and how you will be given the results.
Can I take an antidepressant during chemotherapy?
Yes, under your doctor's care. Some antidepressants, such as citalopram, escitalopram and fluoxetine, are commonly used in people with cancer and work well to treat depression [1]. Because some cancer medicines interact with certain antidepressants, foods or herbal supplements, tell your doctor about all your medicines and supplements [1].
Does exercise really help with depression?
If I talk about my mood, will my doctor think I am weak?
No. Cancer guidelines recommend that distress be recognised, recorded and treated promptly at every stage of the illness [7]. Asking about your emotional well-being is part of standard cancer care.
Notes for physicians (for doctors)
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- ASCO 2023 (adult survivors): stepped-care model (the most effective and least resource-intensive intervention matched to symptom severity); education on depression and anxiety for all patients. Moderate depression: CBT, behavioural activation (BA), MBSR, structured physical activity or empirically supported psychosocial interventions. Moderate anxiety: CBT, BA, structured physical activity, ACT or psychosocial interventions. Severe symptoms: cognitive therapy, BA, CBT, MBSR or interpersonal therapy. Pharmacotherapy for patients without access to first-line treatment, who prefer medication, who previously responded well to medication or who have not improved with psychological or behavioural management; pharmacological evidence in cancer survivors was inconsistent [6].
- NCCN (distress management): screening with the Distress Thermometer (0 to 10, past week) and a 39-item Problem List in five domains (practical, family, emotional, spiritual or religious, physical); a score of 4 or more → review the Problem List and ask further questions. Screen at least at the initial visit, at appropriate intervals and as clinically indicated, especially with changes in disease status (remission, recurrence, progression, treatment complications). Distress should be recognised, monitored, documented and treated promptly at all stages of disease; surveys have found significant distress in 20% to 52% of patients [7].
- Fear of cancer recurrence (FCR): individual participant data meta-analysis (46 studies, 9,311 respondents, FCRI-SF range 0 to 36): 58.8% scored 13 or more (possible clinical-level FCR), 45.1% scored 16 or more (likely clinical FCR) and 19.2% scored 22 or more (severity requiring specialised intervention); lower with increasing age and higher in women [3]. Psychological interventions (23 controlled trials): g 0.33 post-intervention and 0.28 at follow-up; contemporary CBTs focused on cognitive processes (worry, rumination, attentional bias) had larger effects (g 0.42 versus 0.24); moderate-strength evidence (GRADE) [4].
- Scanxiety: review of 57 studies: prevalence highly variable (0 to 64% with prespecified thresholds); moderate to severe scanxiety in 4 to 28%; 9 of 20 studies showed a significant reduction after the scan; 6 of 10 interventions (relaxation, distraction, education, psychological support) were effective [5].
- Antidepressants (Cochrane 2023; 14 trials, 1,364 participants): at 6 to 12 weeks they may reduce symptoms versus placebo (SMD −0.52; 95% CI −0.92 to −0.12; RR 0.74; 95% CI 0.57 to 0.96), but the certainty of evidence is very low; no difference between SSRIs and tricyclics; drug choice based on evidence in the general population and the more favourable safety profile of SSRIs in people with serious medical illness [9]. Check interactions with anticancer drugs before prescribing [1].
- Suicide risk: meta-analysis of 28 studies (more than 22 million patients): standardised mortality ratio for suicide 1.85 (95% CI 1.55 to 2.20) versus the general population, related to prognosis, stage, time since diagnosis and geographic region; close monitoring for suicidality is recommended, especially in patients with risk factors [10].
- Exercise (ACSM 2019): for anxiety and depressive symptoms, aerobic exercise at 60 to 80% of maximum heart rate, 30 to 60 minutes, 3 sessions a week for 12 weeks, or combined aerobic and resistance training 2 to 3 sessions a week [8].
Scientific evidence
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Scientific evidence
2 itemsManagement of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update
Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable
References
10 referencesShow all references, 2 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 10Suicide risk and mortality among patients with cancer
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/guides/anxiety-depression-cancer/