Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. -- Tim Brunson, PhD

Nonpharmacologic approach to fatigue in patients with cancer.



Cancer-related fatigue is a common yet underappreciated problem with a significant impact on functional ability and quality of life. Practice guidelines mandate that all cancer patients and survivors be screened for cancer-related fatigue (CRF) at regular intervals. Comorbidities that could contribute to fatigue should be treated, and patients with moderate to severe fatigue should undergo a comprehensive evaluation. Nonpharmacologic interventions are important tools to combat CRF and should be incorporated into routine practice. Physical activity, educational interventions, and cognitive-behavioral therapy have the most supportive data and can be recommended to patients with confidence. From a practical standpoint, general education on CRF is something that most care providers can readily offer patients as part of routine care. Other interventions that appear promising but are as yet lacking convincing evidence include mindfulness-based stress reduction, yoga, and acupuncture. Reiki, Qigong, hypnosis, and music therapy may be worthy of further investigation.

Cancer J. 2014 Sep-Oct;20(5):313-8. doi: 10.1097/PPO.0000000000000064.

Pachman DR(1), Price KA, Carey EC. Author information: (1)From the *Division of Medical Oncology, and †Division of General Internal Medicine, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN.

Hypnosis in Breast Cancer Care: A Systematic Review of Randomized Controlled Trials.



Introduction. Many breast cancer patients and survivors experience pain and emotional stress related to their disease, its diagnostic procedures, or treatment. Hypnosis has long been used for the treatment of such symptoms. The aim of this review was to systematically assess the effectiveness of hypnosis in women with breast cancer, breast cancer survivors, and in women undergoing diagnostic breast biopsy. Methods. PubMed, Scopus, the Cochrane Library, PsycINFO, and CAMBASE were screened through February 2014 for randomized controlled trials (RCTs) of hypnosis in women with breast cancer or undergoing diagnostic breast biopsy. RCTs on postmenopausal women without a history of breast cancer were also eligible. Primary outcomes were pain, distress, fatigue, nausea/vomiting, and hot flashes. Safety was defined as secondary outcome measure. Risk of bias was assessed by 2 reviewers independently using the Cochrane Risk of Bias Tool. Results. Thirteen RCTs with 1357 patients were included. In women undergoing diagnostic breast biopsy (3 RCTs), hypnosis positively influenced pain and distress; 1 RCT on breast cancer surgery found effects of hypnosis on pain, distress, fatigue, and nausea. For women undergoing radiotherapy (3 RCTs), hypnosis combined with cognitive-behavioral therapy improved distress and fatigue. In 3 RCTs on women with and without a history of breast cancer experiencing hot flashes, hypnosis improved hot flashes and distress. Three RCTs on women with metastatic breast cancer found effects on pain and distress. Conclusions. This systematic review found sparse but promising evidence for the effectiveness of hypnosis in breast cancer care. While more research is needed to underpin these results, hypnosis can be considered as an ancillary intervention in the management of breast cancer-related symptoms.

© The Author(s) 2014.

Integr Cancer Ther. 2014 Sep 18. pii: 1534735414550035. Cramer H(1), Lauche R(2), Paul A(2), Langhorst J(2), Kümmel S(3), Dobos GJ(2). Author information: (1)Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany h.cramer@kliniken-essen-mitte.de. (2)Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. (3)Interdisclipinary Breast Cancer Center, Kliniken Essen-Mitte, Essen, Germany.

Preprocedural distress in children with cancer: an intervention using biofeedback ...



Full title: Preprocedural distress in children with cancer: an intervention using biofeedback and relaxation.

Children diagnosed with cancer experience many invasive procedures throughout diagnosis and treatment of their disease. These procedures, oftentimes a source of distress in children, can elicit a variety of anticipatory symptoms prior to the actual procedure. Although there have been efforts to develop approaches to alleviate this distress through use of distraction, relaxation, sedation, guided imagery, and hypnosis, there has not been a combination treatment that merged relaxation techniques and biofeedback within a pediatric framework. A group of 12 children diagnosed with cancer participated in a 4-session intervention combining relaxation and biofeedback. This feasibility study suggests that the combination intervention offered in a clinical setting may be beneficial to children experiencing procedural distress as a novel coping strategy.

J Pediatr Oncol Nurs. 2013 May-Jun;30(3):129-38. doi: 10.1177/1043454213479035. Shockey DP, Menzies V, Glick DF, Taylor AG, Boitnott A, Rovnyak V. Virginia Commonwealth University, Richmond, VA 23298 , USA. dshockey@mcvh-vcu.edu

A systematic review of complementary and alternative medicine interventions...



Full title: A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue.

Fatigue, experienced by patients during and following cancer treatment, is a significant clinical problem. It is a prevalent and distressing symptom yet pharmacological interventions are used little and confer limited benefit for patients. However, many cancer patients use some form of complementary and alternative medicine (CAM), and some evidence suggests it may relieve fatigue. A systematic review was conducted to appraise the effectiveness of CAM interventions in ameliorating cancer-related fatigue. Systematic searches of biomedical, nursing, and specialist CAM databases were conducted, including Medline, Embase, and AMED. Included papers described interventions classified as CAM by the National Centre of Complementary and Alternative Medicine and evaluated through randomized controlled trial (RCT) or quasi-experimental design. Twenty studies were eligible for the review, of which 15 were RCTs. Forms of CAM interventions examined included acupuncture, massage, yoga, and relaxation training. The review identified some limited evidence suggesting hypnosis and ginseng may prevent rises in cancer-related fatigue in people undergoing treatment for cancer and acupuncture and that biofield healing may reduce cancer-related fatigue following cancer treatments. Evidence to date suggests that multivitamins are ineffective at reducing cancer-related fatigue. However, trials incorporated within the review varied greatly in quality; most were methodologically weak and at high risk of bias. Consequently, there is currently insufficient evidence to conclude with certainty the effectiveness or otherwise of CAM in reducing cancer-related fatigue. The design and methods employed in future trials of CAM should be more rigorous; increasing the strength of evidence should be a priority. KEYWORDS:

Integr Cancer Ther. 2013 Jul;12(4):276-90. doi: 10.1177/1534735413485816. Finnegan-John J, Molassiotis A, Richardson A, Ream E. Kings College London, London, UK.

Hypnosis for cancer care: Over 200 years young.



Answer questions and earn CME/CNE Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are: 1) to describe hypnosis and its components and to dispel misconceptions; 2) to provide an overview of hypnosis as a cancer prevention and control technique (covering its use in weight management, smoking cessation, as an adjunct to diagnostic and treatment procedures, survivorship, and metastatic disease); and 3) to discuss future research directions. Overall, the literature supports the benefits of hypnosis for improving quality of life during the course of cancer and its treatment. However, a great deal more work needs to be done to explore the use of hypnosis in survivorship, to understand the mediators and moderators of hypnosis interventions, and to develop effective dissemination strategies. CA Cancer J Clin 2012. © 2012 American Cancer Society.

CA Cancer J Clin. 2012 Nov 20. doi: 10.3322/caac.21165. Montgomery GH, Schnur JB, Kravits K. Director, Integrative Behavioral Medicine Program, Associate Professor, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY. guy.montgomery@mssm.edu.

Hypnosis and ultrasound-guided paravertebral block in breast cancer surgery.



The combination of hypnosis and paravertebral block (PVB) was studied in three patients scheduled for breast cancer surgery. The three procedures were realized under hypnosis. Median postoperative pain was rated at zero and comfort felt at 8 on a 10 points scale. Hypnosis could be an alternative to conventional anesthesia in combination with a PVB for breast cancer surgery.

Ann Fr Anesth Reanim. 2012 Jul;31(7-8):644-5. Epub 2012 Jul 3. Bouzinac A, Delbos A, Mazières M, Rontes O, Manenc JL. Service d'anesthésie, clinique Médipôle Garonne, 45, rue de Gironis, 31100 Toulouse, France.

Managing patient stress in pediatric radiology.



Research has shown that short-and long-term effects can result from stressful or invasive medical procedures performed on children in the radiology department. Short-term effects for the pediatric patient include pain, anxiety, crying, and lack of cooperation. The patient's parents also may experience short-term effects, including elevated anxiety and increased heart rate and blood pressure. Potential long-term effects include post-traumatic stress syndrome; fear; changes in pain perception and coping effectiveness; avoidance of medical care; and trypanophobia. To identify common sources of stress in pediatric radiology, investigate short-and long-term effects of stressful and invasive medical procedures in pediatric patients, and compare different strategies used in radiology departments to minimize stress in pediatric patients. Searches were conducted using specific databases to locate literature related to stress in pediatric radiology. Articles were included that addressed at least 1 of the following topics: common sources of stress in the pediatric radiology department, the short-or long-term effects of a stressful and invasive medical procedure, or a stress-minimizing strategy used in a pediatric medical environment. Consistency of care can be improved among the different radiology modalities by providing similar and effective strategies to minimize stress, including interventions such as parental involvement, preprocedural preparation, distraction, sedation, use of a child-life specialist, hypnosis, protecting the child's privacy, and positive reinforcement. Future research is needed to identify additional ways to improve the consistency for care of pediatric patients in the radiology department and to investigate stress management in areas such as pediatric vascular interventional radiology, cardiac catheterization, emergency/trauma imaging, and gastrointestinal procedures.

Radiol Technol. 2012 Jul-Aug;83(6):549-60. Alexander M. Magnetic Resonance Imaging Department, UNC Hospitals.

Hypnosis for symptom management in women with breast cancer: a pilot study.



Eight women who were in treatment for breast cancer (n = 4) or breast cancer survivors (n = 4), presenting with 1 or more of 4 symptoms (chronic pain, fatigue, hot flashes, and sleep difficulties), were given 4 to 5 sessions of self-hypnosis training for symptom management. Analyses revealed (a) significant pre- to posttreatment decreases in pain intensity, fatigue, and sleep problems and (b) that pain intensity continued to decrease from posttreatment to 6-month follow-up. Although there was a slight increase in fatigue severity and sleep problems from posttreatment to 6-month follow-up, the follow-up scores did not return to pretreatment levels. The findings provide initial support for using hypnosis to manage symptoms in women who are breast cancer survivors. Clinical trials evaluating hypnosis efficacy over and above other treatments are warranted.

Int J Clin Exp Hypn. 2012 Apr;60(2):135-59. doi: 10.1080/00207144.2012.648057. Jensen MP, Gralow JR, Braden A, Gertz KJ, Fann JR, Syrjala KL. University of Washington School of Medicine, Seattle, WA 98104, USA. mjensen@uw.edu

Is the spiritual life of cancer patients a resource...



Full title: Is the spiritual life of cancer patients a resource to be taken into account by professional caregivers from the time of diagnosis?

Background and aim. Spiritual life can be defined as the search for personal contact with the transcendent. Careful assessment of spiritual life can help to value its importance to cancer patients from the moment of their diagnosis.Methods. This is a cross-sectional study. Two hundred fifty-seven patients undergoing cancer treatment filled in the validated Italian version of the Systems of Belief Inventory (SBI-15R). Patients were also asked to attribute themselves to one of the following, mutually exclusive categories: believer and churchgoer, believer but no churchgoer, and non-believer. Results. Five patients did not report their religious stance and were therefore excluded from the analysis. Of the remaining 252 patients, 49% declared to be believers and churchgoers, 43% believers but not churchgoers, and 8% non-believers. Of the 20 cancer patients who declared not to have a religious faith, 7 patients agreed with the statement that they felt certain that God exists in some form, and 4 had experienced peace of mind through prayer and meditation. Almost all of the patients who declared to have a religious faith and to be churchgoers explicitly affirmed to have been helped by prayer and meditation in coping with their illness. Among believer churchgoers, only 30% declared to seek out the religious or spiritual community when they needed help. Conclusions. A large proportion of cancer patients find themselves involved with the search for a personal contact with the transcendent, also beyond any specific religious affiliation. These spiritual issues may be important even when they are not expressed as participation in religious rituals or adherence to specific religious beliefs. On the other hand, participation in religious rituals often implies the need for a personal spiritual life, both through those rituals and beyond them, as through personal prayer and meditation. These results ask for more attention on the part of professionals towards spiritual resources among cancer patients. It might be appropriate to look systematically for these resources from the moment of the diagnosis, through the sensitive administration of an easy and valid assessment tool like the SBI-15R.

Tumori. 2012 Jan;98(1):158-61. doi: 10.1700/1053.11515. Miccinesi G, Proserpio T, Pessi MA, Maruelli A, Bonacchi A, Borreani C, Ripamonti C.

Interventions for sexual problems following treatment for breast cancer: a systematic review.



Sexual functioning is an important element of quality of life. Many women experience sexual problems as a result of a breast cancer diagnosis and its treatment. Little is known about the availability and the effectiveness of interventions for sexual problems in this patient population. Six electronic databases were searched using Medical Subject Headings and keywords. Additional hand searching of the references of relevant papers was also conducted. The searches were conducted between October 2010 and January 2011. Papers were included if they evaluated interventions for sexual problems caused as a result of breast cancer or its treatment. Studies were only included if sexual functioning was reported using a patient-reported outcome questionnaire. Studies were excluded if sexual functioning was measured but improving sexual problems was not one of the main aims of the intervention. 3514 papers were identified in the initial search. 21 papers were selected for inclusion. Studies were of mixed methodological quality; 15 randomised trials were identified, many included small sample sizes and the use of non-validated questionnaires. Three main types of interventions were identified: Exercise (2), medical (2) and psycho-educational (17). The psycho-educational interventions included skills-based training such as problem-solving and communication skills, counselling, hypnosis, education and specific sex-therapies. Interventions were delivered to individual patients, patients and their partners (couple-based) and groups of patients. The widespread methodological variability hinders the development of a coherent picture about which interventions work for whom. Tentative findings suggest the most effective interventions are couple-based psycho-educational interventions that include an element of sexual therapy. More methodologically strong research is needed before any intervention can be recommended for clinical practice. Improved screening and classification of sexual problems will ensure interventions can be more effectively targeted to suit individual patient needs.

Breast Cancer Res Treat. 2011 Sep 9. Taylor S, Harley C, Ziegler L, Brown J, Velikova G. Psychosocial Oncology and Clinical Practice Research Group, St James's Institute of Oncology, University of Leeds, Leeds, UK, s.s.taylor@leeds.ac.uk.

Effectiveness of hypnotherapy with cancer patients' trajectory...



Full Title: Effectiveness of hypnotherapy with cancer patients' trajectory: emesis, acute pain, and analgesia and anxiolysis in procedures.

Clinical hypnosis in cancer settings provides symptom reduction (pain and anxiety) and empowers patients to take an active role in their treatments and procedures. The goal of this paper is to systematically and critically review evidence on the effectiveness of hypnotherapy for emesis, analgesia, and anxiolysis in acute pain, specifically in procedures with an emphasis on the period from 1999 to 2006. Further, it aims to provide a theoretical rationale for the use of hypnosis with cancer populations in the whole spectrum of illness/treatment trajectory in several clinical contexts. Finally, a treatment protocol for management of overt anxiety and phobic reactions in the radiotherapy suite is presented, with the intent of having such a protocol empirically validated in the future.

Int J Clin Exp Hypn. 2007 Jul;55(3):336-54. Néron S, Stephenson R. Jewish General Hospital, Montréal, Quebec, Canada. sylvain.neron@mcgill.ca

Possibilities of hypnosis and hypnosuggestive methods in oncology.



Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.

Magy Onkol. 2011 Mar;55(1):22-31. Epub 2011 Mar 31. Jakubovits E. Alapozó Egészségtudományi Intézet, Semmelweis Egyetem Egészségtudományi Kar, Morfológiai és Fiziológiai Tanszék, Budapest. jakedit@se-etk.hu Abstract

A prospective, randomized trial of integrative medicine for women with ovarian cancer.



OBJECTIVES: Despite increased use of integrative medicine in cancer therapy, little data exist on its efficacy. This prospective, randomized, pilot trial sought to evaluate the feasibility of combined modality integrative medicine (CM-IM) in women with ovarian cancer (OvCA) and evaluate its effects on quality of life (QoL), chemotherapy toxicity and immunologic profiles. METHODS: Women with newly diagnosed OvCA requiring chemotherapy were offered enrollment. Those randomized to the experimental arm received hypnosis, therapeutic massage and healing touch with each cycle of chemotherapy. The control arm received chemotherapy without CM-IM. All patients completed QoL questionnaires prior to cycles 1, 3 and 6, and 6-months after chemotherapy. Immunologic profiles were measured. Statistical analysis was based on intent-to-treat. Student's t-test and Fischer's exact-test were used to determine differences. RESULTS: Forty-three women enrolled. All women randomized to CM-IM were successfully treated. There were no statistical differences between the groups in age, stage, grade, histologic cell type, CA125 levels, or surgical cytoreductive status. There was no difference in overall QoL measurements. Re-hospitalization rates, treatment delays, anti-emetic use, and infection rates were similar. Immunologic profiles revealed no difference between arms for WBC or salivary IgA levels. Women receiving CM-IM had consistently higher levels of CD4, CD8 and NK cells, although this did not reach statistical significance. CONCLUSIONS: Prospective clinical evaluation of integrative medicine for women with gynecologic malignancy is feasible. This first, pilot study of CM-IM in gynecologic oncology demonstrated no improvement in QoL or chemotherapy toxicity. Integrative medicine-associated improvements in immunologic profiles warrant further investigation.

Gynecol Oncol. 2011 Aug 22 Judson PL, Dickson EL, Argenta PA, Xiong Y, Geller MA, Carson LF, Ghebre R, Jonson AL, Downs LS Jr. H. Lee Moffitt Cancer Center & Research Institute, Department of Women's Oncology, USA.

Use of antioxidant and other complementary medicine by patients treated by antitumor chemotherapy...



Full title: Use of antioxidant and other complementary medicine by patients treated by antitumor chemotherapy: a prospective study.

Use of complementary and alternative medicine (CAM) has been reported to be more and more frequent among cancer patients in USA. The aim of this study was to analyze among French cancer patients the prevalence of CAM use, focusing on antioxidants (AO) that could interfere with antitumor agents. Seventy-nine patients, treated by antitumor chemotherapy in oncology day care unit, participated to an interview (medium age ?= ?60 years old). CAM use was reported by 42% of patients: mostly AO (24%) (selenium, green tea and vitamins ACE, more specifically), but also relaxation, acupuncture, hypnosis (19%) and homeopathy (15%). Among patients using CAM, 66% of them indicated that their physicians were not aware of this use and 47% of them thought that CAM use was safe. Nevertheless, for seven patients who have taken AO, previous in vitro and preclinical studies suggested interactions with antitumor chemotherapy. Therefore, CAM use and, more specifically, AO use is common among cancer patients treated by antitumor chemotherapy in France. Nevertheless, AO could generate interactions with conventional treatment. Clinical studies are warranted to evaluate these interactions, and adequate communication with patients is needed.

Bull Cancer. 2011 Jun;98(6):645-53. doi: 10.1684/bdc.2011.1375. Thomas-Schoemann A, Alexandre J, Mongaret C, Azibi S, Dauphin A, Goldwasser F, Lemare F. Hôpital Cochin, service de pharmacie, Paris, France. schoemann.audrey@gmail.com

Possibilities of hypnosis and hypnosuggestive methods in oncology.



Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.

Magy Onkol. 2011 Mar;55(1):22-31. Jakubovits E. Alapozó Egészségtudományi Intézet, Semmelweis Egyetem Egészségtudományi Kar, Morfológiai és Fiziológiai Tanszék, Budapest. jakedit@se-etk.hu

Prevalence of complementary medicine use in a phase 1 clinical trials program.



Full title: Prevalence of complementary medicine use in a phase 1 clinical trials program: The MD Anderson Cancer Center Experience.

BACKGROUND: A key end point of early cancer clinical trials is the assessment of toxicities and their possible association with new experimental drugs. Therefore, the concurrent use of complementary and alternative medicine (CAM) in patients with advanced malignancies seen in a dedicated phase 1 clinic was evaluated. METHODS: An investigator-designed survey was anonymously completed by patients seen in the phase 1 clinic. Pharmacologic CAM included any oral, topical, or intravenous agent, including vitamins, dietary supplements, and herbal products. Nonpharmacologic CAM included prayer, meditation, hypnosis, massage, and acupuncture. RESULTS: Of the 404 patients approached about completing the CAM survey, 394 (98%) agreed to respond, and 309 (78%) surveys were returned. Of those 309 patients, 162 (52%) used 1 or more CAM. Of the 162 CAM users, 77% utilized pharmacologic CAM, 71% used nonpharmacologic CAM, and 48% used both modalities. The most frequent CAM used were vitamins (70%), prayer (57%), and herbal products (26%). CAM utilization was not significantly associated with race, age, level of education, employment, or income level but was used more by women than men (P < .01). There was no statistically significant association between the use of CAM and quality of life as perceived by patients. Of the CAM users, 43% of patients had been using CAM for >5 years. Only 5% reported having side effects from using CAM, whereas 23% did not fully disclose their CAM use to their physicians. CONCLUSIONS: CAM usage is common in patients with advanced malignancies seen in a phase 1 clinic. Cancer 2011. © 2011 American Cancer Society.

Cancer. 2011 Apr 28. doi: 10.1002/cncr.26164. Naing A, Stephen SK, Frenkel M, Chandhasin C, Hong DS, Lei X, Falchook G, Wheler JJ, Fu S, Kurzrock R. Department of Investigational Cancer Therapeutics (Phase 1 Program), The University of Texas MD Anderson Cancer Center, Houston, Texas. anaing@mdanderson.org.

Use of antioxidant and other complementary medicine by patients treated by antitumor chemotherapy,



Full title: Use of antioxidant and other complementary medicine by patients treated by antitumor chemotherapy: a prospective study.

Use of complementary and alternative medicine (CAM) has been reported to be more and more frequent among cancer patients in USA. The aim of this study was to analyze among French cancer patients the prevalence of CAM use, focusing on antioxidants (AO) that could interfere with antitumor agents. Seventy-nine patients, treated by antitumor chemotherapy in oncology day care unit, participated to an interview (medium age?=?60 years old). CAM use was reported by 42% of patients: mostly AO (24%) (selenium, green tea and vitamins ACE, more specifically), but also relaxation, acupuncture, hypnosis (19%) and homeopathy (15%). Among patients using CAM, 66% of them indicated that their physicians were not aware of this use and 47% of them thought that CAM use was safe. Nevertheless, for seven patients who have taken AO, previous in vitro and preclinical studies suggested interactions with antitumor chemotherapy. Therefore, CAM use and, more specifically, AO use is common among cancer patients treated by antitumor chemotherapy in France. Nevertheless, AO could generate interactions with conventional treatment. Clinical studies are warranted to evaluate these interactions, and adequate communication with patients is needed.

Bull Cancer. 2011 Jun 3. Thomas-Schoemann A, Alexandre J, Mongaret C, Azibi S, Dauphin A, Goldwasser F, Lemare F. Hôpital Cochin, service de pharmacie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, FranceHôpital Cochin, service de pharmacie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, FranceHôpital Cochin, service de pharmacie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.

"Waiting and the waiting room: how do you experience them?"



Full title: "Waiting and the waiting room: how do you experience them?" emotional implications and suggestions from patients with cancer.

Waiting can increase discomfort. The goal of this study was to identify moods and fears of cancer patients while in a waiting room and to capture their concrete suggestions for an anthropocentric transformation of waiting itself. A 15-item questionnaire was given to 355 patients who came to our Out-patient Oncology Clinic. Eighty-three percent of patients felt that waiting has an emotional cost, 35% were upset by talking about their condition with others while waiting, and 26% suffered a major emotional impact seeing other sick people and witnessing their clinical decline. Eighty-nine percent of patients suggested that alternative activities, such as meetings with professionals, doctors, and psychologists, be organized during the waiting period; 65% suggested fun activities (music therapy, drawing courses, library, TV). Most patients asked to have the freedom to leave the waiting room. This option, feasibly by means of IMs/"beepers," would limit their sense of having a lack of freedom or being robbed of their time. This study highlighted the complexity and heterogeneity of emotional implications that waiting causes in patients with cancer and collected many patients' suggestions about how to create a constructive, free, and personalized waiting period, overcoming the boredom, distress, and psychological suffering it causes.

J Cancer Educ. 2011 Jun;26(2):388-94. Epub 2010 Mar 4. Catania C, De Pas T, Minchella I, De Braud F, Micheli D, Adamoli L, Spitaleri G, Noberasco C, Milani A, Zampino MG, Toffalorio F, Radice D, Goldhirsch A, Nolè F. Division of Clinical Pharmacology and New Drugs, European Institute of Oncology, Milan, Italy, chiara.catania@ieo.it.

Psychosocial Issues in Cancer Pain.



Cancer pain is a complex and multidimensional experience that affects and is affected by psychological and social factors. This article reviews recent research that points to a number of key psychosocial factors associated with pain, including psychological distress, coping, and social support, as well as the impact of socioeconomic factors on barriers to pain management. We also review recent research suggesting that psychosocial interventions, including education, coping-skills training, and hypnosis, may be useful adjuncts to medical management of pain. Clinical implications and recommendations for future research are discussed.

Curr Pain Headache Rep. 2011 Mar 15. Porter LS, Keefe FJ. Duke University Medical Center, 2200 West Main Street, Suite 340, Durham, NC, 27705, USA, laura.porter@duke.edu.

An exploratory study on the effects of an expectancy manipulation...



FULL TITLE: An exploratory study on the effects of an expectancy manipulation on chemotherapy-related nausea.

CONTEXT: Previous research has shown that the effectiveness of acupressure bands in reducing chemotherapy-related nausea is related to patients' expectations of efficacy. OBJECTIVE: To test whether an informational manipulation designed to increase expectation of efficacy regarding acupressure bands would enhance their effectiveness. METHODS: We conducted an exploratory, four-arm, randomized clinical trial in breast cancer patients about to begin chemotherapy. All patients received acupressure bands and a relaxation CD. This report focuses on Arm 1(expectancy-neutral informational handout and CD) compared with Arm 4 (expectancy-enhancing handout and CD). Randomization was stratified according to the patient's level of certainty that she would have treatment-induced nausea (two levels: high and low). Experience of nausea and use of antiemetics were assessed with a five-day diary. RESULTS: Our expectancy-enhancing manipulation resulted in improved control of nausea in the 26 patients with high nausea expectancies but lessened control of nausea in 27 patients having low nausea expectancies. This interaction effect (between expected nausea and intervention effectiveness) approached statistical significance for our analysis of average nausea (P=0.084) and reached statistical significance for our analysis of peak nausea (P=0.030). Patients receiving the expectancy-enhancing manipulation took fewer antiemetic pills outside the clinic (mean(enhanced)=12.6; mean(neutral)=18.5, P=0.003). CONCLUSION: This exploratory intervention reduced antiemetic use overall and also reduced nausea in patients who had high levels of expected nausea. Interestingly, it increased nausea in patients who had low expectancies for nausea. Confirmatory research is warranted.

J Pain Symptom Manage. 2010 Sep;40(3):379-90. Epub 2010 Jun 25. Roscoe JA, O'Neill M, Jean-Pierre P, Heckler CE, Kaptchuk TJ, Bushunow P, Shayne M, Huston A, Qazi R, Smith B. University of Rochester James P. Wilmot Cancer Center, Rochester, New York 14642, USA. Joseph_Roscoe@urmc.rochester.edu

Use of complementary and alternative medical interventions for the management...



FULL TITLE: Use of complementary and alternative medical interventions for the management of procedure-related pain, anxiety, and distress in pediatric oncology: an integrative review.

This integrative review aims to identify evidence in four electronic databases (MEDLINE, CINAHL, PsyINFO, and COCHRANE) regarding the effectiveness of complementary and alternative medical interventions, either alone or as an adjunct to pharmacological therapy, in alleviating procedure-related pain, anxiety, and distress in children and adolescents with cancer. A total of 32 articles met inclusion criteria. Results suggest that mind-body interventions, including hypnosis, distraction, and imagery, may be effective, alone or as adjuncts to pharmacological interventions, in managing procedure-related pain, anxiety, and distress in pediatric oncology.

J Pediatr Nurs. 2010 Dec;25(6):566-79. Epub 2010 Mar 12. Landier W, Tse AM. School of Nursing and Dental Hygiene, University of Hawai'i at Manoa, Honolulu, HI, USA. landier@hawaii.edu

Intentions to use hypnosis to control the side effects of cancer...



FULL TITLE: Intentions to use hypnosis to control the side effects of cancer and its treatment.

Evidence suggests that hypnosis is an effective intervention for reducing distress, pain and other side effects associated with cancer and its treatment. However, hypnosis has failed to be adopted into standard clinical practice. This study (n = 115) investigated overall intentions to use hypnosis to control side effects of cancer and its treatment, as well as demographic predictors of such intentions among healthy volunteers. Results suggest that the vast majority of participants (89%) would be willing to use hypnosis to control side effects associated with cancer treatment. Mean intention levels did not differ by gender, ethnicity, education or age. These results indicate that in the general public, there is a willingness to consider the use of hypnosis, and that willingness is not determined by demographic factors. This broad acceptance of hypnosis argues for more widespread dissemination.

Am J Clin Hypn. 2010 Oct;53(2):93-100. Sohl SJ, Stossel L, Schnur JB, Tatrow K, Gherman A, Montgomery GH. Dept. of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Piedmont Plaza 11, 2nd Fl, Winston-Salem, NC 27157-1063, USA. ssohl@wfubmc.edu

Mind-body therapies in integrative oncology.



There is growing interest in mind-body therapies as adjuncts to mainstream cancer treatment, and an increasing number of patients turn to these interventions for the control of emotional stress associated with cancer. Increased research funding has enabled many such interventions to be evaluated for their efficacy, including studies of mind-body interventions to reduce pain, anxiety, insomnia, anticipatory, and treatment-related nauseas, hot flashes, and improved mood. Mind-body treatments evaluated for their utility in oncology include relaxation therapies, biofeedback, meditation and hypnosis, yoga, art and music therapy, tai chi, and qigong. Although studies are not always methodologically sound and results mixed, a growing number of well-designed studies provide convincing evidence that mind-body techniques are beneficial adjuncts to cancer treatment. The evidence is sufficient to recommend further investigation and adoption of these techniques in mainstream oncology care.

Curr Treat Options Oncol. 2010 Dec;11(3-4):128-40. Elkins G, Fisher W, Johnson A. Mind-Body Medicine Research Laboratory, Department of Psychology and Neuroscience, Baylor University, 77 Cottonwood Drive, Waco, TX 76706, USA. Gary_Elkins@baylor.edu

Management of menopausal symptoms in breast cancer patients.



In breast cancer patients, menopausal symptoms such as hot flashes, urogenital problems, musculoskeletal symptoms and cognitive dysfunction are common, regardless of age at diagnosis. They affect quality of life and systemic therapy will worsen this. Endocrine and/or chemotherapy may induce temporary or permanent ovarian failure and can exacerbate these symptoms. Hormone therapy (HT) has been studied in breast cancer survivors, but safety has been questioned. The HABITS trial investigating estrogen-based HT, as well as the LIBERATE trial investigating tibolone, found a reduction in disease-free survival for those treated. Alternative strategies are needed, as menopause symptoms may reduce compliance with breast cancer treatments. This article reviews recently published strategies to tackle menopausal problems in breast cancer patients. Antidepressants may help with hot flashes. Acupuncture and hypnosis can also be used but the evidence is conflicting. For urogenital problems vaginal moisturizers or topical estrogens can be employed. A musculoskeletal syndrome induced by aromatase inhibitors (AIs) is frequently encountered and currently there are no effective treatment strategies. Bisphosphonates reduce AI-induced bone resorption and can also increase disease-free and overall survival. Standard-dose endocrine and chemotherapy are associated with a decline in cognitive function.

Maturitas. 2010 Dec 22. Loibl S, Lintermans A, Dieudonné AS, Neven P. German Breast Group, GBG Forschungs GmbH, Martin-Behaim-Str. 12, 63263 Neu-Isenburg, Germany.

Hypnotizability, posttraumatic stress, and depressive symptoms in metastatic breast cancer.



This study assessed whether high hypnotizability is associated with posttraumatic stress and depressive symptoms in a sample of 124 metastatic breast cancer patients. Hypnotic Induction Profile Scores were dichotomized into low and high categories; posttraumatic intrusion and avoidance symptoms were measured with the Impact of Events Scale (IES); hyperarousal symptoms with items from the Profile of Mood States; and depressive symptoms with the Center for Epidemiologic Studies-Depression Scale. High hypnotizability was significantly related to greater IES total, IES intrusion symptoms, and depressive symptoms. A logistic regression model showed that IES total predicts high hypnotizability after adjusting for depressive symptoms and hyperarousal. The authors relate these results to findings in other clinical populations and discuss implications for the psychosocial treatment of metastatic breast cancer.

Int J Clin Exp Hypn. 2010 Jan;58(1):39-52. Keuroghlian AS, Butler LD, Neri E, Spiegel D. Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5718, USA. alexk22@stanford.edu

The effectiveness of hypnosis in reducing pain and suffering among women.



Full Title: The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder.

The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.

Int J Clin Exp Hypn. 2010 Oct;58(4):497-504. Nash MR, Tasso A. University Of Tennessee, Knoxville, USA.

Skin Cancer: Knowledge, Behaviors, and Attitudes of College Students.



OBJECTIVES: Knowledge, attitudes, and behaviors of college students regarding melanoma and skin protection were examined.

METHODS: We surveyed 492 students at a mid-sized southern university. The Melanoma Risk Behavior Survey was administered in lecture classes.

RESULTS: Mean knowledge score was 10.6 +/- 3.8 (24 questions). A majority of participants knew that sun exposure increases the risk for skin cancer; however, only 29% correctly identified behaviors that reduce this risk. Mean attitude score was 5.26 +/- 2.73 (11 questions). Sixty-nine percent agreed that all people should take precautions against skin cancer; however, only 51% believed they themselves should practice sun safe behaviors. Mean behavior score was 1.29 +/- 1.22 (9 possible). Only 3.1% reported avoiding the sun during peak hours, and only 5.1% regularly use sunscreen when exposed to the sun.

CONCLUSION: Campus programs for increasing awareness of skin cancer risk are warranted. Changing attitudes and behaviors regarding exposure and protective measures is increasingly important.

Spradlin K, Bass M, Hyman W, Keathley R. South Med J. 2010 Sep 2. From the Department of Health and Kinesiology, Sam Houston State University, Huntsville, TX; and Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS.

Use of complementary and alternative therapy by women...



Full Title: Use of complementary and alternative therapy by women in the first 2 years after diagnosis and treatment of invasive breast cancer

OBJECTIVE:: Our aim was to document patterns of consultation with alternative practitioners, use of complementary and alternative medicine (CAM) commonly used to alleviate menopausal symptoms, and lifestyle changes made by women in the first 2 years after their diagnosis with invasive breast cancer. METHODS:: A total of 1,588 women in the MBF Foundation Health and Wellbeing After Breast Cancer Study completed both the enrollment questionnaire and the first follow-up questionnaire (FQ1), on average, 41 and 92 weeks after diagnosis, respectively. The Menopause Quality of Life Questionnaire and the Psychological General Wellbeing Index were included in the FQ1. Logistic regression analysis was used to examine characteristics associated with consulting a CAM practitioner or using CAMs. RESULTS:: At the time of completion of the FQ1, 16.4% of women had consulted a CAM practitioner and 10.6% reported using at least one CAM commonly used to alleviate menopausal symptoms. Women who consulted a CAM practitioner and women who were using at least one CAM at the time of completion of the FQ1 were, on average, younger and more educated and had a higher Menopause Quality of Life Questionnaire score than did women who did not. Of the women, 33.6% reported having made a dietary change, and the most common lifestyle change was an increase in physical activity, which was reported by 29.0% of women. CONCLUSIONS:: The frequency of use of CAMs in common usage for menopausal symptoms by women with breast cancer was lower than anticipated, increased with time from diagnosis, and is associated with more severe menopausal symptoms.

Menopause. 2010 May 24. Davis SR, Lijovic M, Fradkin P, Bradbury J, La China M, Schwarz M, Bell RJ. From the 1Women's Health Program, Department of Medicine, Monash University, Alfred Hospital; 2Department of Medicine, Monash University, Alfred Hospital; and 3Alfred Health, Prahran, Victoria, Australia.

The Outcomes of Visualization and Acupuncture on the Quality of Life of Adult Cancer Patients...



Full Title: The Outcomes of Visualization and Acupuncture on the Quality of Life of Adult Cancer Patients Receiving Chemotherapy

BACKGROUND:: The use of complementary and alternative medicine (CAM) to treat cancer patients has increased around the world, and its benefits have been described. These therapies represent an important theme in oncology and have been used in parallel with conventional therapies. OBJECTIVES:: This study aimed to assess the outcomes of using relaxation with visualization and acupuncture on the quality of life of cancer patients undergoing chemotherapy treatment and to compare these outcomes with patients who did not choose to receive the intervention. METHODS:: Participants chose to be in either the intervention group (IG) or control group (CG). They completed the Quality of Life Questionnaire-Core 30 at the start and end of chemotherapy. The IG was chosen by 38 patients with different types of cancer who completed weekly relaxation with visualization and acupuncture sessions, whereas the CG was composed of 37 patients who did not receive the intervention. RESULTS:: Statistically significant results evidenced an increase in global health and emotional and social functions and a decrease in fatigue and loss of appetite for the IG, and an increase in global health for the CG (P Cancer Nurs. 2010 Jun 17. Sawada NO, Zago MM, Galvão CM, Cardozo FM, Zandonai AP, Okino L, Nicolussi AC. Author Affiliations: College of Nursing at Ribeirão Preto-University of São Paulo (Sawada, Zago, Galvão, Cardozo, Zandonai, and Nicolussi); and Centre University Barão de Mauá, Brazilian Association of Acupuncture, Ribeirão Preto, São Paulo, Brazil (Okino).

Role of hypnosis and hypno-suggestions methods in the complex therapy of tumor patients



Besides more conventional tumor risks, depression and negative life events are significant risk factors in cancer here in Hungary, therefore oncopsychology is increasingly important. We discuss traumatizing effects of the diagnosis and invasive diagnostic and therapeutic procedures from the viewpoint of altered state of consciousness. During stress and hypnosis brain functioning is altered in a similar way, which can be seen both in the patient's symptoms and his/her physiological and neuroimaging findings. In trance state patients part from reality, they no longer communicate conventionally or maturely. Hypnosis is characterized not only by physical and mental changes, but important unique social interactions as well. These interactions affect the endocrine and immune system and the mental state of the patient, they strengthen and synchronize resources and help posttraumatic growth. Since in the stress induced spontaneous altered state of consciousness the susceptibility to suggestions is increased, suggestive communication can be used effectively and it can even result in formal hypnosis induction. Under the strong time and mental pressure characterizing the work of the oncologic departments, it might help the staff to improve the cooperation with the patient if staff members, physicians and nurses as well, are aware of the nature and the neurophysiologic background of the spontaneous trance state induced by the life-threatening diagnosis of cancer.

Magy Onkol. 2010 Jun;54(2):153-60. Jakubovits E. Semmelweis Egyetem Egészségtudományi Kar Morfológiai és Fiziológiai Intézet 1088 Budapest Vas. u. 17. ELTE Pszichológiai Doktori Iskola Magatartáspszichológiai PhD Program Budapest.

Taiwanese adult cancer patients' reports of using complementary therapies



BACKGROUND: More information is needed by cancer clinicians regarding cancer patients' use of complementary and alternative medicine (CAM). OBJECTIVE: In this qualitative study, in-depth interviews were used to obtain the reports of adult cancer patients regarding their use of CAM. METHODS: Seven cancer patients (4 women, 3 men) who reported using CAM were recruited by snowball sampling. Content analysis was used to examine the interview transcriptions. RESULTS: Five themes and multiple categories were identified related to CAM use: (1) facing the challenges of cancer (I can't be defeated, need to cooperate with conventional medical treatment, rebuilding my confidence), (2) handling the physical and psychological distress of CAM use (extra loading due to the therapy, uncertainty and fear about the efficacy of CAM, being understood and supported, feeling guilty about being sick, (3) lifestyle disruption (altering social life, changing family living style), (4) having reasons for seeking other therapies (finding a way to cure the disease, boosting my immunity, improving my overall health status, and prolonging life and searching for peace of mind), and (5) unresolved practical concerns about CAM (finding an easy and effective way to practice CAM, needing CAM to be integrated into mainstream health care, and where to get the related information). CONCLUSION: Adult Taiwanese cancer patients who use CAM do experience burdens secondary to CAM use and prefer that oncology specialists be more informed about CAM. IMPLICATIONS FOR PRACTICE: Oncology specialists who know where adult cancer patients could obtain helpful information about CAM would help to decrease the burdens that patients who use CAM experience.

Cancer Nurs. 2010 Jul-Aug;33(4):320-6. Lu JH, Tsay SL, Sung SC. Department of Nursing, Chang Gung Institute of Technology, Tao-Yuan, Taiwan.

Complementary medicine use in patients with head and neck cancer in Ireland



The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM/TM since their diagnosis with head and neck cancer. CAM/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM/TM were to counteract the ill effects of treatment and increase the body's ability to fight cancer. Sources of information on CAM/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM/TM therapies currently offered to patients.

Eur Arch Otorhinolaryngol. 2010 Aug;267(8):1291-7. Epub 2010 Mar 14. Amin M, Glynn F, Rowley S, O'Leary G, O'Dwyer T, Timon C, Kinsella J. Department of Otolaryngology, Head and Neck Cancer, St. James's Hospital, Dublin, Ireland. mohamin@rcsi.ie

From Cancer Patient to Respant



by Bernie Siegel, MD

Unfortunately doctors and health professionals, in general, do not study success. We are far more likely to consider an unexpected recovery to be due to the treatment or a spontaneous remission. However, I have learned from my experience with patients and by asking them, "Why didn't you die when you were supposed to?" that they always had a story to tell. I can recall, as an intern, realizing that the seniors, with hip fractures, who were noisy and demanding didn't develop pneumonia and die while the submissive, quiet seniors who never raised their voice or caused a problem had a much higher mortality rate.

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Music's relevance for pediatric cancer patients



Full Title: Music's relevance for pediatric cancer patients: a constructivist and mosaic research approach

PURPOSE: Music is important in most children's lives. To advance efficacious pediatric supportive care, it is necessary to understand young cancer patients' thoughts about music. Concern about inviting unwell children to express opinions has resulted in scant research examining their views. "Mosaic" research examines children's experiences through investigating multiple perspectives which inform a "co-constructed meaning." This study examines pediatric cancer patients' and their parents' perspectives about music and music therapy's role in the children's lives. MATERIALS AND METHODS: Children were receiving care at three hospitals with the Paediatric Integrative Cancer Service in Melbourne, Victoria, Australia. A constructivist research approach with grounded theory design was applied. Children up to 14 years old with cancer and parents participated. Data included transcripts from semi-structured research interviews and observations of children's music behaviors. Qualitative inter-rater reliability was integrated. Findings were compared with music therapists' perspectives examined elsewhere. RESULTS: Interviews were conducted with 26 patients, median age 5.7 years, and 28 parents. Data "saturation" was achieved. A substantive grounded theory emerged: Children's adverse cancer experiences are often alleviated by music usages. Broader family, social, and electronic musical interactions also promote children's resilience and "normal" development. Music therapy and associated programs often, but not always, alleviate children's distress. Positive effects may carry over into children's home lives and vicariously support families. CONCLUSIONS: Health professionals should consider ways to assist parents who are often using music to support children with cancer. Hospitals can promote pediatric cancer patients' resilience by providing music-based support services, including music therapy, and reducing unwanted stressful sounds.

Support Care Cancer. 2010 Apr 28. O'Callaghan C, Baron A, Barry P, Dun B. Peter MacCallum Cancer Centre, Melbourne, Australia, clare.ocallaghan@petermac.org.

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients



Full Title: Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress.

Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). Results: Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p < .0001) but not by distress (p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). Conclusions: The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

J Consult Clin Psychol. 2010 Feb;78(1):80-8. Montgomery GH, Hallquist MN, Schnur JB, David D, Silverstein JH, Bovbjerg DH. Integrative Behavioral Medicine Program.

Mind-Body Treatments for the Pain-Fatigue-Sleep Disturbance Symptom Cluster



Full Title: Mind-Body Treatments for the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Persons with Cancer

CONTEXT: Co-occurring pain, fatigue, and sleep disturbance comprise a common symptom cluster in patients with cancer. Treatment approaches that target the cluster of symptoms rather than just a single symptom need to be identified and tested. OBJECTIVE: To synthesize evidence regarding mind-body interventions that have shown efficacy in treating two or more symptoms in the pain-fatigue-sleep disturbance cancer symptom cluster. METHODS: A literature search was conducted using CINAHL, Medline, and PsychInfo databases through March 2009. Studies were categorized based on the type of mind-body intervention (relaxation, imagery/hypnosis, cognitive-behavioral therapy/coping skills training [CBT/CST], meditation, music, and virtual reality), and a preliminary review was conducted with respect to efficacy for pain, fatigue, and sleep disturbance. Mind-body interventions were selected for review if there was evidence of efficacy for at least two of the three symptoms. Forty-three studies addressing five types of mind-body interventions met criteria and are summarized in this review. RESULTS: Imagery/hypnosis and CBT/CST interventions have produced improvement in all the three cancer-related symptoms individually: pain, fatigue, and sleep disturbance. Relaxation has resulted in improvements in pain and sleep disturbance. Meditation interventions have demonstrated beneficial effects on fatigue and sleep disturbance. Music interventions have demonstrated efficacy for pain and fatigue. No trials were found that tested the mind-body interventions specifically for the pain-fatigue-sleep disturbance symptom cluster. CONCLUSIONS: Efficacy studies are needed to test the impact of relaxation, imagery/hypnosis, CBT/CST, meditation, and music interventions in persons with cancer experiencing concurrent pain, fatigue, and sleep disturbance. These mind-body interventions could help patients manage all the symptoms in the cluster with a single treatment strategy.

J Pain Symptom Manage. 2009 Nov 7. Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B. School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Is there a role for complementary therapy in the management of leukemia?



Patients with leukemia often seek additional treatments not prescribed by their oncologist in an effort to improve their cancer treatment outcome or to manage symptoms. Complementary therapies are used in conjunction with traditional cancer treatments to decrease symptoms and side effects associated with cancer or cancer treatment, and to improve patients' overall quality of life. Complementary therapies are distinct from so-called 'alternative' therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind-body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences. Physical fitness with regular exercise and healthy dietary habits can significantly decrease side effects of cancer treatments and may prolong survival. Botanical extracts and vitamin supplements may interfere with active cancer treatments, and should be discussed with the oncologist or pharmacist before use.

Expert Rev Anticancer Ther. 2009 Sep;9(9):1241-9. Wesa KM, Cassileth BR. Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, NY 10021, USA. wesak@mskcc.org

Systematic review of post-treatment psychosocial and behaviour change interventions



FULL TITLE: Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer

Objectives: The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post-treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended.Methods: Ten databases were searched via Ovid and Web of Science. Papers were systematically extracted by title, abstract and full paper according to the inclusion/exclusion criteria. Full papers were assessed by two authors. Inclusion criteria: participants at any stage of a cancer diagnosis, >/=50% male and aged 18+; psychosocial and/or behavioural post-treatment interventions, using any format; a one-three level of evidence. Couple/carer/family interventions were excluded.Results: From 9948 studies initially identified, 11 were finally included in the review. They implemented cognitive behaviour therapy, hypnosis or psychoeducational interventions. All studies had some positive results, however, lack of reporting of intervention content and methodological issues limit the findings. No studies intervened with single men, and none provided comparative outcomes for marital status.Conclusions: Effectiveness of interventions was difficult to assess as, while all had benefits, their generalisability was limited due to methodological and reporting limitations. Improved reporting procedures are required to allow for replication. Copyright (c) 2009 John Wiley & Sons, Ltd.

Psychooncology. 2009 Jul 9. Dale HL, Adair PM, Humphris GM. Department of Clinical Psychology, NHS Fife, Cupar, UK.

Complementary and alternative medical therapies used by children with cancer



Full Title: Complementary and alternative medical therapies used by children with cancer treated at an Italian pediatric oncology unit

BACKGROUND: Research has identified a growing use of complementary and alternative medicines (CAM) in the pediatric oncology setting and health care professionals should consider how they might interact with and/or be used in lieu of conventional treatment. The present study was designed to establish the prevalence of CAM usage at an Italian pediatric oncology department, and the reasons why patients used these unconventional therapies. PROCEDURE: This was an observational study involving parents whose children were treated for tumors at the pediatric oncology unit of the Istituto Nazionale Tumori in Milano. Data were collected on their sociodemographic variables and their use of CAM by means of a self-administered questionnaire. RESULTS: We distributed 145 questionnaires and 97 of them (67%) were returned. Judging from this survey, 12.4% of the children used at least one type of CAM and homoeopathy was the most often used. Benefits were reported by 83% of parents. The most common reasons for using CAM were to reduce the side-effects of conventional therapies. The oncologists taking care of the patients were notified of the child's use of CAM in only one case. CONCLUSION: CAM were used not as a substitute but in addition to conventional treatments. In almost all cases, oncologists were not informed that a child was using CAM, posing a risk of any interaction with pharmacological treatments being inadequately understood.

Pediatr Blood Cancer. 2009 Oct;53(4):599-604 Clerici CA, Veneroni L, Giacon B, Mariani L, Fossati-Bellani F. Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. carlo.clerici@unimi.it

Complementary and alternative medicine in patients with chronic lymphocytic leukemia



BACKGROUND: Despite the widespread use of complementary and alternative medicine (CAM) in the general population for the treatment of chronic diseases, only few data have been published for patients with leukemia. The aim of this survey was to study systematically the use of CAM in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS: A structured questionnaire was sent to 247 CLL patients of all clinical stages and disease durations, treated and untreated. The questionnaire was returned anonymously by 87 patients (35%). RESULTS: Thirty-nine patients (44%) had used alternative treatments. No correlation was seen with educational level, gender, or previous or current chemotherapy. The most common alternative or complementary treatment modality was vitamin supplementation (26%), followed by mineral (18%), homeopathic (14%), and mistletoe therapy (9.2%). Some 21% of patients considered their alternative treatment as being successful. Most patients reported that they decided to use CAM after conducting a personal investigation and based on the information they found, without outside recommendations (59%). The majority of the patients used patient brochures about CLL as an important source of information (54%), followed by specific lectures (34%) or the internet (32%). CONCLUSION: Our data show that patients with CLL use a wide range of CAM, among them potentially harmful methods. Rational, evidence-based medical information about the effects and risks of CAM use should be made available through patient brochures distributed by patient organizations, through information events with lectures, or via the internet.

Support Care Cancer. 2009 Jan;17(1):47-52. Epub 2008 May 6. Hensel M, Zoz M, Ho AD. Department of Medicine V, University of Heidelberg, Heidelberg, Germany. Hensel@mannheimer-onkologie-praxis.de

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