Breathing and Relaxation Before Cancer Appointments

The appointment itself is often the easy part. It is the ninety minutes before it that undo people: the parking garage, the waiting room, the sound of your own name being called.

Anxiety around cancer appointments is close to universal. NCI reports that almost half of people with cancer say they feel some anxiety, and about a quarter say they feel a great deal of it. Almost half report a lot of distress. Waiting for test results is singled out as especially stressful.

Breathing and relaxation techniques help with this. They help less than the internet suggests, and it is worth being straight about the difference.

The National Center for Complementary and Integrative Health, part of NIH, reviews this research and publishes what it finds, including the parts that are weak.

On the encouraging side: NCCIH reports evidence that relaxation techniques can reduce blood pressure, inflammatory cytokines, and oxidative stress. Slow, deep breathing may modestly lower blood pressure and reduce cortisol levels. A 2019 review found preliminary evidence that diaphragmatic breathing exercises may help reduce stress. A 2018 review found that relaxation therapy reduced symptoms of anxiety, depression, phobia, and worry.

Two findings speak directly to appointments. NCCIH notes that relaxation exercises help reduce anxiety before surgery. And a 2018 review of needle procedures found that hypnosis, cognitive behavioral therapy combined with strategies including relaxation, and breathing exercises all helped reduce pain and distress.

Now the caveats, which NCCIH states plainly. Much of this research is low to very low quality. Studies are often small, designs vary, and follow-up is short. NCCIH notes that researchers recommend combining relaxation with cognitive behavioral therapy rather than using it alone.

The Society for Integrative Oncology recommends relaxation techniques for people with breast cancer to improve mood and depression, and NCCIH notes they might help reduce stress and anxiety during chemotherapy.

Read that as: a real tool with modest, uneven evidence, not a cure for fear.

NCCIH describes six main approaches. Three are practical to use in a waiting room.

Breathing exercises. Slow, deep breathing from the diaphragm rather than the upper chest. Put one hand flat on your stomach and breathe so that hand moves rather than your shoulders. Slow the pace deliberately. This is the only one nobody can see you doing.

Progressive muscle relaxation. Tense one muscle group, hold briefly, then release, and work through the body group by group. Start at the feet and move up. The release is the part that matters.

Guided imagery. Picture a calm, detailed scene and stay in it. Detail is what makes it work: the temperature, the sound, what is under your feet.

The other three NCCIH lists are autogenic training, which uses self-suggestion focused on bodily relaxation, biofeedback-assisted relaxation, which uses a device to show you your own physiological signals, and self-hypnosis.

This is the step people skip, and skipping it is why the technique fails.

A breathing exercise attempted for the first time in a scanner is a new, strange task added to an already stressful moment. The same exercise, practiced at home for a week on ordinary days, is a familiar routine your body already recognizes.

Ten minutes a day for a week is enough to make it automatic. Practice it while calm, not while frightened.

• Do the anxious admin the night before. Insurance card, question list, medication list, directions, parking. Rushing loads the tank before you arrive.
• Ask for an early slot. The first appointment of the day is the one least likely to run late, and a long wait is what most people find hardest.
• Bring someone. Not only for company. A second person hears what you miss.
• Bring headphones. Waiting rooms remove most of your control over sound.
• Do a round of breathing in the car, before you walk in, rather than once you are already keyed up.
• Have your questions written down. Anxiety eats working memory, and a list means you do not have to hold anything in your head.
• Plan what happens after. Somewhere to go, someone to call. A blank afternoon after bad news is hard.

"I'm anxious about appointments" is too broad to fix. Narrow it, because different fears have different answers.

Fear of needles and ports has research behind it, as above, and there are practical options worth asking about. Claustrophobia in a scanner is a known problem your imaging team deals with regularly, and it should be raised before the day rather than on the table. Fear of the result is a different animal, and no breathing exercise touches it. That one is better met with counseling and with clarity about when and how you will be told.

NCCIH considers these techniques generally safe, with two honest exceptions.

Some people report negative experiences, including increased anxiety, intrusive thoughts, or a fear of losing control. And there are rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions.

If turning your attention inward makes things worse, that is a real response, not a failure to relax properly. Say so and try something external instead: music, conversation, a task for your hands.

NCI's position on the broader question is useful here. It suggests trying counseling before medicine, while noting that counseling does not help everyone, and that people with severe anxiety or major depression may need antianxiety or antidepressant medicine alongside counseling.

Raise it with your team if:

• You have delayed, rescheduled, or skipped a scan or appointment because of dread.
• Anxiety is present most of the day, most days, rather than around appointments.
• You have panic episodes with a pounding heart, shortness of breath, or a sense of losing control.
• You are not sleeping, not eating, or withdrawing from people.
• Physical symptoms such as chest pain or breathlessness are new. These need to be checked medically before being called anxiety.
• You have thoughts of harming yourself. In the United States, call or text 988 for the Suicide and Crisis Lifeline.

• Can I be referred to a psycho-oncology service or a counselor?
• Is there anything you can offer for scan anxiety or needle anxiety specifically?
• How and when will I be told results, and can I get them the same day?
• Can appointments be scheduled early, or scans and clinic visits combined into one trip?
• Would counseling, medicine, or both make more sense in my situation?
• Is there a support group here for people at my stage of treatment?

Read next: Coping While Waiting for Test Results, Waiting for Results: How to Cope, Cancer Anxiety and Uncertainty, Questions at Your First Oncology Visit, and Getting Back to Daily Activity After Treatment.

• https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know
• https://www.nccih.nih.gov/health/stress
• https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq