June 18, 2024

The Impact of Anxiety on Oncology Patients and How Digitally Delivered CBT Can Help

There are approximately 18 million cancer patients and survivors in the United States today, nearly half of whom experience psychosocial distress, anxiety, or depression. In this article we discuss how cancer can impact a person’s life and ways in which we can use CBT to intervene and help.

The Impact of Anxiety on Oncology Patients and How Digitally Delivered CBT Can Help
“I was given drugs which made me feel sick all the time. I lost my appetite, got more and more pain, and just felt awful. I worried the whole time and used to cry a lot when on my own. My husband and daughter used to try to cheer me up by saying ‘You’ll get better soon’, but after a while I didn’t believe them any more.” (Moorey et al., 2012)

How does Cancer affect a Person’s Mental Health

Even though a cancer diagnosis is an emotionally distressing experience, 58% of cancer patients still feel that their emotional needs are not met and regarded. What’s even more alarming is that even 10 years after remission, cancer survivors can still face psychological issues associated with their illness (Grassi et al., 2023).

These declines in mental health can increase mortality rates by 39% but are also associated with a decrease in immune function, frequent infections and in some cases, lower adherence to cancer treatments (Fernandez, 2021).

“I was very scared at first, then I felt very low. I didn’t want to see anyone; I couldn’t tell my wife how I felt, I still can’t.” (Cancer patient interviewed for Alex DTx)

The most common forms of co-morbid mental health conditions for cancer patients are depression and anxiety but other burdens on patient mental health like fatigue are also prevalent. These co-morbidities can infiltrate patient experience with cancer in various ways across the continuum:

  1. Chemotherapy Induced Nausea and Vomiting (CINV): The anticipation of such side effects can bring about fear and anxiety which can be overwhelming (read more from our previous article here)
  2. Insomnia/ Sleep disturbances: Most chemotherapy patients experience disturbances in their sleep or even insomnia which have been associated with anxiety, depression and other burdens on the patient’s quality of life and treatment adherence (National Cancer Institute, 2020).
  3. Treatment Side effects: Side effects like skin changes, pain and cognitive impairment have been shown to contribute to fatigue for patients which in some cases can last up to 10 years after treatment (Grassi et al., 2023; National Cancer Institute, 2021) .

Although there is a psychological burden at every step of the continuum, therapies such as acceptance and commitment therapy (ACT) have been shown to reduce fear of recurrence, increases life meaning, and manageability and comprehensibly of disease. As well as, cognitive behavioural therapy (CBT) shows it can help improve functional outcomes of cancer alongside managing pain, insomnia and anxiety (Moorey et al., 2012).

Ultimately, cancer can be seen as a threatening and thus induce high-anxiety in patients. People with cancer can experience difficulties such as fear of the unknown before diagnosis, adjustment disorder in which they are unable to cope with the news of cancer diagnosis, worry during treatment and testing and even fear of recurrence after remission. The anxiety associated with cancer is present every step of the way yet the psychological impact of cancer is forgotten or unreachable for many.

Making Cancer-Care More Accessible

With such a high-burden disease, considering efficacy alongside feasibility and logistics of interventions to aid in disease management is crucial. Evidence showing that internet based cognitive behavioural therapy or iCBT have been shown to be equally as effective as face-to-face options which offers a path towards a possible future where holistic cancer care is more accessible, widely available, less stigmatised and on-demand (Galiano-Castillo, 2021).

At Alex Therapeutics, we co-develop drug companion apps with partners with out expertise in utilising CBT for anxiety as a co-morbidity based on  RCT evidence from our recent clinical trial. Looking at this gap in reaching patients’ needs throughout the cancer continuum, Alex looks forward to innovating with industry partners further to help address this need and support people experiencing cancer.

About Alex Therapeutics

Alex Therapeutics, a digital health company, partners with pharmaceutical companies to help patients with disease and treatment-specific challenges through clinically validated apps. With its proven, scalable technology platform, as well as expertise in patient-centric design and evidence-based behavior change, Alex Therapeutics treats patients and supports healthcare professionals globally. Alex Therapeutics, alongside its partners, has extensive experience in multi-jurisdiction Software-as-a-Medical-Device (SaMD) regulatory processes, including CE and FDA approval, as well as clinical evidence generation for SaMDs.


American Cancer Society. Cancer Facts & Figures 2022. American Cancer Society. Published 2022. Accessed June 17, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf

Mehnert A, Hartung TJ, Friedrich M, Vehling S, Brähler E, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A. One in two cancer patients is significantly distressed: Prevalence and indicators of distress. Psychooncology. 2018;27(1):75-82.

Moorey S, Greer S, eds. Oxford Guide to CBT for People with Cancer. 2nd ed. Oxford Guides to Cognitive Behavioural Therapy. Oxford; 2011. Online ed. Oxford Academic; June 1, 2015. https://doi.org/10.1093/med:psych/9780199605804.003.0001. Accessed June 12, 2024.

Grassi L, Caruso R, Hammelef K, et al. Quality of Life and Psychosocial Oncology: A Multinational Study of Psychosocial Distress in Cancer. Cancer. Published online June 12, 2023. Accessed June 17, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540791/

National Cancer Institute. Depression (PDQ®) – Health Professional Version. National Cancer Institute. Updated June 10, 2022. Accessed June 17, 2024. https://www.cancer.gov/about-cancer/coping/feelings/depression-hp-pdq

Fernandez G. Johns Hopkins Bloomberg School of Public Health. The intersection of mental health and chronic disease. Published December 16, 2021. Retrieved June 17, 2024, from https://publichealth.jhu.edu/2021/the-intersection-of-mental-health-and-chronic-disease

Alex Therapeutics. Prescription Drug-Induced Nausea and Vomiting and How Psychological Interventions Can Help. Alex Therapeutics. Published January 25, 2023. Accessed June 17, 2024. https://www.alextherapeutics.com/post/prescription-drug-induced-nausea-and-vomiting-and-how-psychological-interventions-can-help

National Cancer Institute. Sleep disorders (PDQ®)–health professional version. National Cancer Institute website. Updated November 13, 2020. Accessed June 17, 2024. https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-hp-pdq#_10

Galiano-Castillo N, Ariza-García A, Cantarero-Villanueva I, Fernández-Lao C, Díaz-Rodríguez L, Del-Moral-Ávila R, et al. Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial. J Med Internet Res. 2021;23(3). doi:10.2196/19458.

National Cancer Institute. Fatigue (PDQ®)–Health Professional Version. National Cancer Institute website. Updated June 30, 2021. Accessed June 17, 2024. Available from: https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue.

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