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High-Quality Management of Physical and Depressive Symptoms May Reduce Severe Anxiety at End of Life for Patients with Cancer, Study Finds

A new study published today on suggests that severe anxiety at end of life in patients with cancer is caused not solely by proximity to death, but by disease burden and psychosocial issues.

FORT WASHINGTON, PA — A new study out of Chang Gung University School of Nursing in Taiwan suggests that people with cancer experience severe anxiety toward end of life, not solely due to proximity to death, but rather to factors related to psychosocial issues and disease burden. To offset symptoms of severe anxiety in patients with terminal cancer, researchers led by Siew Tzuh Tang, DNS, Chang Gung University, suggest early integration of palliative care incorporating high-quality management of physical and depressive symptoms.

The study, “Longitudinal Analysis of Severe Anxiety Symptoms in the Last Year of Life among Patients with Advanced Cancer: Relationships with Proximity to Death, Burden, and Social Support,” was published today ahead of print of the June 2016 issue of JNCCN – Journal of the National Comprehensive Cancer Network. Complimentary access to the article is available until August 31, 2016.

“This study uncovered abundant evidence that palliative care can help terminally ill patients with cancer relieve their severe anxiety symptoms by adequately managing both physical and depressive symptoms. Patients with strong social support can lighten perceived burden to others,” said Dr. Tang. “It is the health care professionals’ turn to integrate palliative care early in the cancer treatment process  so that patients benefit from these interventions to improve their psychological well-being when fighting their cancer and facing their mortality.”

The study followed 325 Taiwanese patients and data were collected on anxiety symptoms within five groups of variables:

  • Demographics – sex, age, marital status, education level, and religious affiliation
  • Disease-related characteristics
  • Disease burden – physical and psychological symptom distress and functional dependence
  • Perceived burden to others – patients’ dependence on others for assistance
  • Social support – positive social interaction and emotional, informational, tangible, and affectionate support

In the patient sample, severe anxiety symptoms increased as death approached; however, the prevalence of anxiety symptoms did not change significantly in the patients’ last year. Instead, researchers found that the patients’ severe anxiety stemmed from perceived burden to others, disease burden, and lack of social support.

Integrating earlier palliative care and incorporating high-quality management of the causes of patient anxiety may prevent the onset of distress in patients with advanced cancer, researchers suggest. According to the study, palliative care could better manage physical symptoms and provide psychological interventions to help patients. Moreover, evidence-based interventions may increase patients’ coping skills for both current and future stressors associated with their diseases.

“This study points to the growing recognition of the importance of monitoring distress in patients with cancer and presents the oncology team with an immediate opportunity to improve the quality of life of terminally ill patients and their families through recognition and treatment of anxiety symptoms,” said Mary Daly, MD, PhD, FACP, Chair of the Department of Clinical Genetics at Fox Chase Cancer Center, and Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Genetic/Familial High-Risk Assessment: Breast and Ovarian.

“Despite a substantial number of terminally ill patients suffering from anxiety symptoms, anxiety has not been as extensively studied in psycho-oncology research as depression but represents a unique problem in its own right,” said Dr. Tang. “The most important finding in our study is that increasing severe anxiety symptoms are not inevitable throughout the dying process but rather related to factors modifiable by high-quality end-of-life care.”

To access the article, visit Full access to the article is available until August 31, 2016.


About JNCCN – Journal of the National Comprehensive Cancer Network

More than 23,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit For a FREE subscription to JNCCN, visit

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit

The NCCN Member Institutions are:

  • Abramson Cancer Center at the University of Pennsylvania
  • Fred & Pamela Buffett Cancer Center
  • Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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  • Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Comprehensive Cancer Center
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Rogel Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • University of Wisconsin Carbone Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital