Anxiety and sleep disorders in cancer patients

Even though most cancer patients do not meet diagnostic criteria for any specific mental disorder 1, many experience symptoms such as anxiety and sleep disturbances that may interfere with their overall adjustment to their disease. Anxiety is a common reaction to a cancer diagnosis and a normal response to perceived threats like loss of body functions, alterations in appearance, family disruption, death, etc. Anxiety may persist throughout the disease process, affecting the patient’s quality of life significantly, and often coexists with depression in cancer patients. Anxiety tends to appear or worsen at critical points during the course of the illness (diagnosis, beginning and end of treatment, recurrence, survival and terminal stage). Sleep disorders are frequently associated with the psychological impact of cancer as well as with the physical illness itself, pain, hospitalisation and specific medical treatments. Altered sleep adversely affects emotional wellbeing and daytime performance, and may be an early sign of delirium in the oncology setting. In the general population, persistent insomnia has been associated with a higher risk of developing clinical anxiety or depression 2. To effectively adjust patient needs to optimal treatment interventions, health-care professionals must be able to distinguish normal adjustment to cancer from altered reactions to the disease. This paper will focus on anxiety and sleep disorders in the oncology setting and will describe their clinical presentation, assessment, aetiology and treatment.