NCCN Guidelines for Patients
Distress, Version 1.2017
What is distress?
Part 1 explains the basics about distress.
You can learn what distress is and how it
may affect your life. Part 1 also describes
who may have higher levels of distress.
Likewise, the time points at which distress
is more likely are listed.
Distress is an unpleasant experience of a mental,
physical, social, or spiritual nature. It can affect the
way you think, feel, or act. Distress may make it
harder to cope with having cancer, its symptoms, or
Distress occurs across a range of experience. It
can be mild and consist of common feelings like
sadness, fear, and helplessness. On the other hand,
it can be more severe. Higher levels of distress can
cause problems in one or more areas of life. You may
struggle with taking care of yourself, your social life,
emotions, faith, and so forth.
Everyone with cancer has some distress at some
point in time. It is normal to feel sad, fearful, and
helpless. You are not “crazy” if you are distressed.
Distress is expected.
There are many symptoms of distress. See
. The type and number of symptoms differ
between people. Certain symptoms can be caused
by things other than distress. Thus, it is important
to tell your treatment team if you have any of these
symptoms. Tips for talking with your cancer care
team are given in Part 4.
Guide 1. Symptoms of distress
Some symptoms of distress are:
• Sadness, fear, and helplessness
• Anger, feeling out of control
• Questioning your faith, your purpose, the meaning
• Pulling away from too many people
• Concerns about illness
• Concerns about your social role (ie, as mother,
• Poor sleep, appetite, or concentration
• Depression, anxiety, panic
• Frequent thoughts of illness and death