**7.1 Management of anxiety**

The first step is impeccable assessment keeping the following components in mind. Firstly, look for the common features of anxiety like- vigilance, scanning, autonomic hyperactivity, increased motor tension and excessive worrying. Secondly, we need to assess the character of anxiety, whether it is acute or chronic in nature, whether it is part of a psychiatric syndrome. Thirdly, there may be some features leading to anxiety, which may be reversible. For example, the patient's symptom control could be better or the medical team could address anxiety resulting from fear of unknown prognosis by counseling the caregiver in depth regarding patient's cancer related prognosis. It is important to note here that, one needs to give ample time to listen to the caregiver, so the real reasons behind the anxiety could be explored. The main concerns and worries mentioned by the caregiver will be helpful in understanding the reasons behind anxiety. Just the act of sharing these concerns may result in decreased anxiety. Treatment approach could be pharmacological or non-pharmacological. The non-pharmacological options are- psychological counseling, progressive muscular relaxation and distraction. The main pharmacological management is use of benzodiazepines like- Lorazepam, Diazepam, Midazolam and Clonazepam. Medications should be used only for short period to break the cycle of anxiety; non-pharmacological approaches are the main stay of management.
