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Evidence-Based Practice
Open Access Article

Putting Evidence Into Practice®: Evidence-Based Interventions for Anxiety

Lisa Kennedy Sheldon
Susan Swanson
Amy Dolce
Kathy Marsh
Julie Summers
CJON 2008, 12(5), 789-797 DOI: 10.1188/08.CJON.789-797

Anxiety is a common form of distress that oncology nurses often observe in their patients. The incidence of anxiety may be as high as 50% in recently diagnosed patients and may persist into survivorship. How nurses respond to patients experiencing distress and anxiety influences further assessment of the patient's concerns, identification of anxiety, and the initiation of appropriate interventions. Evidence-based interventions are essential to improving outcomes for patients experiencing anxiety and directing future research. The authors of this article reviewed the evidence of effectiveness for different interventions to reduce anxiety in patients with cancer.


Miller, D. K., Chibnall, J. T., Videen, S. D., & Duckro, P. N. (2005). Supportive-affective group experience for persons with lifethreatening illness: Reducing spiritual, psychological, and death-related distress in dying patients. <i>Journal of Palliative Medicine</i>, 8(2), 333-343.

American Psychiatric Association. (2000). <i>Diagnostic and statistical manual of mental disorders</i> (4th ed., text revision). Washington, DC: Author.

Andrykowski, M. A. (1990). The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: A review and synthesis. <i>Psychosomatic Medicine</i>, 52(4), 458-475.

Antoni, M. (2003). <i>Stress management intervention for women with breast cancer.</i> Washington, DC: American Psychological Association.

Antoni, M. H., Wimberly, S. R., Lechner, S. C., Kazi, A., Sifre, T., Urcuyo, K. R., et al. (2006). Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. <i>American Journal of Psychiatry</i>, 163(10), 1791-1797.

Arving, C., Sjoden, P. O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., et al. (2007). Individual psychosocial support for breast cancer patients: A randomized study of nurse versus psychologist interventions and standard care. <i>Cancer Nursing</i>, 30(3), E10-E19.

Badger, T., Segrin, C., Dorros, S. M., Meek, P., & Lopez, A. M. (2007). Depression and anxiety in women with breast cancer and their partners. <i>Nursing Research</i>, 56(1), 44-53.

Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Anotonio, TX: Psychological Corporation.

Bottomley, A. (1998). Anxiety and the adult cancer patient. <i>European Journal of Cancer Care</i>, 7(4), 217-224.

Burnham, T. R., & Wilcox, A. (2002). Effects of exercise on physiologic and psychological variables in cancer survivors. <i>Medicine and Science in Sports and Exercise</i>, 34(12), 1863-1867.

Centers for Disease Control and Prevention. (2007). Glossary of terms. Retrieved November 28, 2007, from <a target="_blank" href='http://www.cdc.gov/search'>http://www.cdc.gov/search</a>

Cheung, Y. L., Molassiotis, A., & Chang, A. M. (2003). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. <i>Psycho-Oncology</i>, 12(3), 254-266.

Chujo, M., Mikami, I., Takashima, S., Saeki, T., Ohsumi, S., Aogi, K., et al. (2005). A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence. <i>Supportive Care in Cancer</i>, 13(7), 503-514.

Derogatis, L. R., & Melisaratos, N. (1983). Brief Symptom Inventory: An introductory report. <i>Psychological Medicine</i>, 13(3), 595-605.

Deshler, A. M., Fee-Schroeder, K. C., Dowdy, J. L., Mettler, T. A., Novotny, P., Zhao, X., et al. (2006). A patient orientation program at a comprehensive cancer center. <i>Oncology Nursing Forum</i>, 33(3), 569-578.

Faysman, K. (2002). Cultural dimensions of anxiety and truth telling. <i>Oncology Nursing Forum</i>, 29(5), 757-759.

Federchuk, M. K., Mediondo, O. A., & Matar, J. R. (2003). Improving community cancer care: Bringing psychosocial support to private practice. <i>Journal of Psychosocial Oncology</i>, 21(2), 23-37.

Fellowes, D., Barnes, K., & Wilkinson, S. (2004). Aromatherapy and massage for symptom relief in patients with cancer. <i>Cochrane Database of Systematic Reviews</i>, 2, CD002287.

Gobel, B. H., Beck, S. L., & O'Leary, C. (2006). Nursing-sensitive patient outcomes: The development of the Putting Evidence Into Practice® resources for nursing practice. <i>Clinical Journal of Oncology Nursing</i>, 10(5), 621-624.

Hernandez-Reif, M., Field, T., Ironson, G., Beutler, J., Vera Y., Hurley, J., et al. (2005). Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy. <i>International Journal of Neuroscience</i>, 115(4), 495-510.

Hidderley, M., & Holt, M. (2004). A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. <i>European Journal of Oncology Nursing</i>, 8(1), 61-65.

Hoff, A. C., & Haaga, D. A. (2005). Effects of an education program on radiation oncology patients and families. <i>Journal of Psychosocial Oncology</i>, 23(4), 61-75.

Holland, J. C., Morrow, G. R., Schmale, A., Derogatis, L., Stefanek, M., Berenson, S., et al. (1991). A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. <i>Journal of Clinical Oncology</i>, 9(6), 1004-1011.

Jacobsen, P. B., Donovan, K. A., Trask, P. C., Fleishman, S. B., Zabora, J., Baker, F., et. al. (2005). Screening for psychological distress in ambulatory cancer patients. <i>Cancer</i>, 103(7), 1494-1502.

Jacobsen, P. B., & Hann, D. M. (1998). Cognitive-behavioral interventions. In J. C. Holland (Ed.), <i>Psycho-Oncology</i> (pp. 717-729). New York: Oxford University Press.

Jane, S. (2005). Effects of full-body massage on pain intensity, anxiety, and physiologic relaxation in Taiwanese patients with metastatic bone pain: A pilot study. <i>University of Washington, PhD</i>, 1-148.

Jones, R. B., Pearson, J., Cawset, A. J., Bental, D., Barrett A., White, J., et al. (2006). Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: Randomised trial. <i>BMJ</i>, 332(7547), 942-948.

Katz, M. R., Irish, J. C., & Devins, G. M. (2004). Development and pilot testing of a psychoeducational intervention for oral cancer patients. <i>Psycho-Oncology</i>, 13(9), 642-653.

Kelly, A. E., Sullivan, P., Fawcett, J., & Samarel, N. (2004). Therapeutic touch, quiet time, and dialogue: Perceptions of women with breast cancer. <i>Oncology Nursing Forum</i>, 31(3), 625-631.

Khojainova, N., Santiago-Palma, J., Kornick, C., Breitbart, W., & Gonzales, G. R. (2002). Olanzapine in the management of cancer pain. <i>Journal of Pain and Symptom Management</i>, 23(4), 346-350.

Kim, S. D., & Kim, H. S. (2005). Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. <i>Cancer Nursing</i>, 28(1), 79-83.

Kissane, D. W., Bloch, S., Smith, G. C., Miach, P., Clarke, D. M., Ikin, J., et al. (2003). Cognitive-existential group psychotherapy for women with primary breast cancer: A randomized controlled trial. <i>Psycho-Oncology</i>, 12(6), 532-546.

Kwekkeboom, K. L. (2003). Music versus distraction for procedural pain and anxiety in patients with cancer. <i>Oncology Nursing Forum</i>, 30(3), 433-440.

Lehmand, S. W., & Rabins, P. V. (1999). Clinical geropsychiatry. In J. J. Gallo. J. Busby-Whitehead, P. V. Rabins, R. A. Silliman, J. B. Murphy (Eds.), <i>Riechel's care of the elderly: Clinical aspects of aging</i> (pp. 179-189). Philadelphia: Lippincott Williams and Wilkins.

Manne, S. L., Ostroff, J. S., Winkel, G., Fox, K., Grana, G., Miller, E., et al. (2005). Couple-focused group intervention for women with early stage beast cancer. <i>Journal of Consulting and Clinical Psychology</i>, 73(4), 634-646.

Marrs, J. A. (2006). Stress, fears, and phobias: The impact of anxiety. <i>Clinical Journal of Oncology Nursing</i>, 10(3), 319-322.

Mentes, S. D., Unsal, D., Baran, O., Argun, G., & Ertunc, F. N. (2005). Effect of sedation with midazolam or propofol on patient's comfort during cancer chemotherapy: A prospective, randomized, double-blind study in breast cancer patients. <i>Journal of Chemotherapy</i>, 17(3), 327-333.

Midtgaard, J., Rorth, M., Stelter, R., Tveteras, A., Andersen, C., Quist, M., et al. (2005). The impact of a multidimensional exercise program on self-reported anxiety and depression in cancer patients undergoing chemotherapy: A phase II study. <i>Palliative and Supportive Care</i>, 3(3), 197-208.

Mitchell and Friese. (n.d.). Weight of evidence. Retrieved September 14, 2008, from <a target="_blank" href='http://www.ons.org/outcomes/tables/sleep/woe.shtml'>http://www.ons.org/o...

Nainis, N., Paice, J. A., Ratner, J., Wirth, J. H., Lai, J., & Shott, S. (2005). Relieving symptoms in cancer: Innovative use of art therapy. <i>Journal of Pain and Symptom Management</i>, 31(2), 162-169.

National Center for Complementary and Alternative Medicine. (2007). What is CAM? Retrieved March 6, 2008, from <a target="_blank" href='http://nccam.nih.gov/health/whatiscam'>http://nccam.nih.gov/health/whati...

National Center for Homeopathy. (2007). What is homeopathy? Retrieved March 7, 2008, from <a target="_blank" href='http://nationalcenterforhomeopathy.org'>http://nationalcenterforhomeopat...

National Comprehensive Cancer Network. (2008). <i>NCCN Clinical Practice Guidelines in Oncology™: Distress management</i> [v.1.2008]. Retrieved March 6, 2008, from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf'>http:/...

Noyes, R., Holt, C. S., & Massie, M. J. (1998). Anxiety disorders. In J. C. Holland (Ed.), <i>Psycho-Oncology</i> (pp. 548-563). New York: Oxford University Press.

Oncology Nursing Society. (n.d.). Outcomes resource area. Retrieved March 6, 2008, from <a target="_blank" href='http://www.ons.org/outcomes'>http://www.ons.org/outcomes</a>

Oncology Nursing Society. (2007). Oncology Nursing Society research agenda 2005-2009. Retrieved March 13, 2008, from <a target="_blank" href='http://ons.org/research/information/agenda.shtml'>http://ons.org/researc...

Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety and quality of life in cancer survivors: Meta-analysis. <i>International Journal of Psychiatry in Medicine</i>, 36(1), 13-34.

Pasquini, M., Biondi, M., Constantini, A., Cairoli, F., Ferrarese, G., Picardi, A., et al. (2006). Detection and treatment of depressive and anxiety disorders among cancer patients: Feasibility and preliminary findings from a liaison service in an oncology division. <i>Depression and Anxiety</i>, 23(7), 441-448.

Pilkington, K., Kirkwood, G., Rampes, H., Fisher P., & Richardson, J. (2006). Homeopathy for anxiety and anxiety disorders: A systematic review of the research. <i>Homeopathy</i>, 95(3), 151-162.

Pirl, W. F., Muriel, A., Hwang, V., Kornblith, A., Greer, J., Donelan, K., et al. (2007). Screening for psychosocial distress: A national survey of oncologists. <i>Journal of Supportive Oncology</i>, 5(10), 499-504.

Quattrin, R., Zanini, A., Buchini, S., Turello, D., Annunziata, M. A., Vidotti, C., et al. (2006). Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: Methodology and outcomes. <i>Journal of Nursing Management</i>, 14(2), 96-105.

Razavi, D., Allilaire, J. F., Smith, M., Salimpour, A., Verra, M., Desclaux, B., et al. (1996). The effect of fluoxetine on anxiety and depression symptoms in cancer patients. <i>Acta Psychiatrica Scandinavica</i>, 94(3), 205-210.

Schneider, S. M., & Hood, L. E. (2007). Virtual reality: A distraction intervention for chemotherapy. <i>Oncology Nursing Forum</i>, 34(1), 39-46.

Segar, M. L., Katch, V. L., Roth, R. S., Garcia, A. W., Portner, T. I., Glickman, S. G., et al. (1998). The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. <i>Oncology Nursing Forum</i>, 25(1), 107-113.

Shahrokh, N. C., & Hales, R. E. (2003). <i>American psychiatric glossary.</i> Washington, DC: American Psychiatric Association.

Shames, K. H., & Keegan, L. (2000). Touch: Connecting with the healing power. In B. M. Dossey, L. Keegan, & C. E. Guzzetta (Eds.), <i>Holistic nursing: A handbook for practice</i> (3rd ed., p. 614). Gaithersburg, MD: Aspen.

Shear, M. K. (2003). Optimal treatment of anxiety disorders. <i>Patient Care</i>, 37, 18-32.

Shepherd, L., Goldstein, D., Whitford, H., Thewes, B., Brummell, V., & Hicks, M. (2006). The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: Results of a pilot study. <i>Journal of Pain and Symptom Management</i>, 32(5), 453-461.

Sloman, R. (2002). Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. <i>Cancer Nursing</i>, 25(6), 432-435.

Speilberger, C. D. (Ed.). (1983). <i>Manual for the State Trait Anxiety Inventory</i> (form Y). Palo Alto, CA: Consulting Psychologists Press.

Stephenson, N. L., Swanson, M., Dalton, J., Keefe, F. J., & Engelke, M. (2007). Partner-delivered reflexology: Effects on cancer pain and anxiety. <i>Oncology Nursing Forum</i>, 34(1), 127-132.

Targ, E. F., & Levine, E. G. (2002). The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. <i>General Hospital Psychiatry</i>, 24(4), 238-248.

Tsang, K. L., Carlson, L. E., & Olson, K. (2007). Pilot crossover trial of Reiki versus rest for treating cancer-related fatigue. <i>Integrative Cancer Therapies</i>, 6(1), 25-35.

Vitek, L., Rosenzweig, M. Q., & Stollings, S. (2006). Distress in patients with cancer: Definition, assessment, and suggested interventions. <i>Clinical Journal of Oncology Nursing</i>, 11(3), 413-418.

Wald, T. G., Kathol, R. G., Noyes, R., Jr., Carroll, B. T., & Clamon, G. H. (1993). Rapid relief of anxiety in cancer patients with both alprazolam and placebo. <i>Psychosomatics</i>, 34(4), 324-332.

Wilkinson, S. M., Love, S. B., Westcombe, A. M., Gambles, M. A., Burgess, C. C., Cargill, A., et al. (2007). Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: A multicenter randomized controlled trial. <i>Journal of Clinical Oncology</i>, 25(5), 532-539.

Williams, S. A., & Schreier, A. M. (2004). The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer [Online exclusive]. <i>Oncology Nursing Forum</i>, 31(1), E16-E23. Retrieved August 27, 2008, from http://ons.metapress.com/content/b366435/01rul712/fulltext.pdf <a target="_blank" href='http://ons.metapress.com/content/b366435/01rul712/fulltext.pdf'>http://o...

Young, P. (2007). Caring for the whole patient: The Institute of Medicine proposes a new standard of care. <i>Community Oncology</i>, 4, 748-751.

Zigmund, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. <i>Acta Psychiatrica Scandinavica</i>, 67(6), 361-370.