Anxiety in palliative care

Anxiety is a natural response to stresses in our lives and is common in people living with a terminal illness. In some people, anxiety can cause physical and emotional symptoms and reduce their quality of life. But there are things you can do to help.

On this page:

What is anxiety?

Anxiety is a feeling of worry or fear. It can be helpful in the short term by keeping us alert and ready to act when we feel under threat. But if these feelings continue for a long time or are difficult to cope with, they can affect people’s daily lives.

People express their anxiety in different ways, but symptoms may include:

• a churning feeling in the stomach
• restlessness and irritability
• feeling tired
• lack of concentration
• muscle tension or pain
• disturbed sleep.

Some people may have panic or anxiety attacks, where they feel intense or overwhelming fear and discomfort. Attacks can come on suddenly with no warning and can last up to 30 minutes. They may cause physical symptoms such as chest pain, dizziness, breathlessness, sweating or shaking.

There are different types of anxiety, including Generalised Anxiety Disorder (GAD), phobias, social anxiety and post-traumatic stress disorder. People may have had one or more of these types of anxiety before they were diagnosed with a terminal illness. Or they may have developed anxiety as a result of their terminal illness.

People may have a range of symptoms, covering more than one type of anxiety. They may also have other mental health problems at the same time, such as depression.

Anxiety can make it harder for someone to cope with their illness. Some people may lose trust in their healthcare team, stop taking medication or feel they no longer want to live.

What causes anxiety?

We know that people living with terminal illnesses face a lot of challenges, which can be distressing. It’s natural for people to feel anxious when they’re facing uncertainty about their future or the possibility of dying. Other possible causes of anxiety in people living with a terminal illness include:

• pain – people may worry about getting pain or dying with pain; those with cancer may worry that new pain is a sign of the cancer spreading or coming back
• medicines – anxiety can be a side effect of some medicines
• uncertainty about the future
• the end of treatment – people may struggle to adapt when their medical appointments suddenly stop or become less frequent
• being isolated from friends and family
• family worries – for example, worrying about being a burden or leaving family behind after they die
• money worries
• spiritual distress.

People may also have anxiety if they have difficulty accessing care, are going into different care settings or need care that is new for them. This can be particularly challenging for minority groups, including LGBTQ+ people, people with learning disabilities and people experiencing homelessness.

These worries can build up over time and it sometimes only takes something small to trigger an anxiety attack.

How is anxiety managed?

Support and understanding often go a long way to helping someone manage their anxiety. Getting the right support and treatment for anxiety can help people cope with their terminal illness and have a better end-of-life experience.

These things can help people cope with anxiety:

• Talking to someone they trust – see below for tips on talking to people with anxiety. People may find it reassuring if they’re able to speak to the same professional over a period of time.
• Treating symptoms, such as pain and breathlessness.
  
• Psychological therapies, such as cognitive behavioural therapy.
  
• Medicines, such as antidepressants and benzodiazepines.
• Practical help – for example, help with making plans, housing or finances. We have information for people living with terminal illnesses on planning ahead and benefits and finances.
• Spiritual care – supporting people to feel a sense of meaning, comfort, strength and connection in their life. 

How can psychological therapy help?

Psychological therapies can help some people with anxiety. But they can take a few weeks to have an effect and so people need enough energy to keep going with the therapy.

Face-to-face psychological therapies may include:

• cognitive behavioural therapy (CBT)
• relaxation therapies
• counselling
• art therapy
• music therapy
• group therapy
• mindfulness.

People can ask their GP to refer them for psychological therapy or they can refer themselves by contacting local services directly. Their doctor or specialist nurse can give them details of psychological services in their local area. But there can be long waiting lists in some areas and people may need to meet certain criteria for treatment.

Some people may benefit from self-help resources, such as cognitive behavioural therapy (CBT) or mindfulness. The NHS website has tips and tools for coping with anxiety  , and the Reading Well   website has lists of approved self-help books that are available from public libraries.

Podcasts and audiobooks can be easier to use than printed publications for people who find it hard to concentrate.

How can medication help?

If someone’s anxiety is severe and is affecting their wellbeing, their GP may prescribe medication.

Not all medicines are suitable for everyone. For example, benzodiazepines, such as lorazepam, can cause sedation and confusion. This may help people who have problems sleeping but may increase the risk of falls in others. Other medicines that are sometimes used to treat anxiety in people with a terminal illness include antidepressants, such as mirtazapine, and antipsychotic drugs.

If someone has been taking anxiety medication for a long time, but they’re still having symptoms, it should be reviewed by the GP.

If someone has anxiety and depression, their GP may recommend they use medication and a psychological therapy together.

What else can help?

Regular physical activity can help reduce anxiety and other problems caused by terminal illness, such as fatigue. It can also improve the results of psychological therapy. People may have good days and bad days, so they may need to vary how much activity they do. You can help them go for short walks or do gentle exercises in bed. The NHS website has information on exercises that people can do sitting in a chair. You may find it helpful to share our free booklet on keeping active with the person you’re caring for.

There isn’t much evidence to support the use of complementary therapies but some people find that therapies such as reiki, gentle massage and acupuncture help them cope with their anxiety. If someone would like to try a complementary therapy, their doctor, district nurse or specialist nurse can tell them if the therapy is safe for them and whether it’s available on the NHS.

Many hospices and local support groups provide complementary therapies. Or people can pay to see a private therapist. They can check whether a therapist is qualified and registered with a professional organisation by searching the Professional Standards Authority website  . 

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How can I help someone with anxiety?

People cope with anxiety in different ways. Some prefer to sit and talk, whereas others need practical help. Some people may not tell anyone that they’re feeling anxious, so you may need to ask them if they’re worried about anything and if they have any symptoms of anxiety.

If you know what’s causing someone’s anxiety, this can help you find the best way of supporting them. Find out what support is available locally by asking the healthcare team or visiting the NHS website. It can also help to ask whether the patient used these services before and if they helped.

People may need practical or emotional support to help them manage their anxiety.

Some people may behave aggressively if they’re worried and angry about their situation. If you can give them the space to express themselves safely, it can help them deal with their anxiety.

Tips for talking to people with anxiety

People with anxiety often say it helps them when they feel listened to. Here are some tips for talking to someone about their anxiety:

• Reassure them that anxiety is common, especially in people receiving palliative care.
  
• Acknowledge their feelings without judging or minimising them.
• Ask open-ended questions.
• Allow pauses in the conversation without rushing to fill them.
• Repeat or rephrase what the person has told you, to show them you understand what they’re saying.
• Use everyday language where you can and explain any medical terms you use.
• Provide information in the person’s preferred language and format.
• Take time to build a trusting relationship where they feel able to open up to you.
• Ask them how their anxiety affects them and what makes it better or worse.
• Ask them how you can help when they’re feeling anxious. For example, they may want you to talk to them calmly, distract them with another activity or help them with breathing exercises.  
• Try not to pressure them into doing anything they’re not ready for – this can make anxiety worse.

Supporting the person’s family and friends

Anxiety can also affect someone’s family and carers. You can help them by:

• talking to them about how they’re feeling and what their worries are
• keeping them informed of how the person’s illness is progressing, with the person’s permission
• supporting them to care for the person, if they want to be involved
• telling them what to expect in the last few days of life, if they want to know
• talking to them about what practical help they need, such as respite care or help with claiming benefits.

When should I ask for help?

Contact the GP if you think someone has symptoms of anxiety or another mental health problem.

If anxiety is long-lasting or is affecting someone’s daily life, they may need psychological or medical treatment. Their GP can suggest self-help resources and local support services. Or they can prescribe medicines or refer the person for psychological therapies.

Sometimes anxiety is caused by practical problems, such as money or housing. Other professionals, such as solicitors or social workers may be able to help.

Some people may seek comfort from a spiritual or faith leader.

If someone is having medical treatment for their anxiety, you can ask their healthcare team for details of what you should do and who to contact in a crisis.

Some people become agitated and restless towards the end of their life. This is sometimes called terminal agitation. Tell the GP, district nurse or specialist palliative nurse if someone is showing these signs.

Where can I get support?

It takes time and practice to build the confidence to talk to people about their anxiety. Your colleagues may support you by offering advice and helping you reflect on how you handled a situation. It can also be helpful to observe how more experienced colleagues handle conversations with people with anxiety.

We have more information on good communication at end of life.

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Useful resources

NICE guideline: Generalised anxiety disorder and panic disorder in adults: management  

British Association for Psychopharmacology Guidelines: Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder  

Royal College of Nursing: Communication  

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Disclaimer

This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals. 

The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.