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

Systematic review of post-treatment psychosocial and behaviour change interventions for men...



Full Title: Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer.

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.

My Sister Myself



by Marta J. Luzim, MS

On November 21, 2004, my sister Carla, at fifty-eight years of age died of breast cancer. When I was young I envied my sister's natural style and popularity. I wanted to hang out with her. I wanted to wear her mini skirts. I wanted to imitate the way she painted her eyes with bright blue eye shadow.

My sister was a beautiful woman who rejected her own beauty. She had a passion for conversation and loved to give advice whether you wanted it or not. She wove her husband and three sons into a tight-knit family structure believing that they would never leave her. Eight years prior to her death her husband Larry died of leukemia. Before my sister's husband died Carla had a will to live. Afterwards, she slowly slid into a depression. Therapy, medication weren't able to help, nor did her affinity for shopping or her supportive family.

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Pediatric oncologists' views toward complementary and alternative medicine in children with cancer.



BACKGROUND: Pediatric oncology patients commonly use complementary and alternative medicine (CAM), yet approximately only 50% of these patients discuss CAM with their oncologist. OBJECTIVE: The aim of this study is to assess barriers to CAM communication in pediatric oncology. DESIGN/METHODS: A 33-question survey was sent via electronic mail to 358 pediatric oncologists in the United States. RESULTS: Ninety pediatric oncologists completed the survey. Ninety-nine percent of pediatric oncologists think it is important to know what CAM therapies their patients use. However, less than half of pediatric oncologists routinely ask their patients about CAM. This is primarily because of a lack of time and knowledge. Many physicians think some forms of CAM may improve quality of life, such as massage (74%) and yoga (57%). Over half of physicians thought that dietary supplements, herbal medicine, special diets, vitamins, and chiropractic might be harmful to patients. CONCLUSIONS: Pediatric oncologists believe it is important to know which CAM therapies their patients use; however, they are not asking about them owing to lack of time and knowledge. To improve communication about CAM, increased physician education is needed. In addition, physicians should identify patients using potentially harmful CAM therapies. Furthermore, CAM research in pediatric oncology should focus on those modalities physicians believe may improve patient quality of life.

J Pediatr Hematol Oncol. 2009 Mar;31(3):177-82. Roth M, Lin J, Kim M, Moody K. Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY 10467, USA. mroth@montefiore.org

Brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients.



Venepuncture for blood sampling can be a distressing experience for a considerable number of children. A prospective controlled trial was conducted to compare the efficacy of a local anaesthetic (EMLA) with a combination of EMLA with self-hypnosis in the relief of venepuncture-induced pain and anxiety in 45 paediatric cancer outpatients (age 6-16years). A secondary aim of the trial was to test whether the intervention will have a beneficial effect on parents' anxiety levels during their child's procedure. Patients were randomized to one of three groups: local anaesthetic, local anaesthetic plus hypnosis, and local anaesthetic plus attention. Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety, and less procedure-related pain and anxiety, and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups. Parents whose children were randomized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child's procedure than parents whose children had been randomized to the other two conditions. The therapeutic benefit of the brief hypnotic intervention was maintained in the follow-up. The present findings are particularly important in that this study was a randomized, controlled trial conducted in a naturalistic medical setting. In this context, convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self-hypnosis, an intervention that can be easily taught to children, is noninvasive and poses minimal risk to young patients and their parents.

Pain. 2009 Apr;142(3):255-63. Liossi C, White P, Hatira P. School of Psychology, University of Southampton, Highfield, Southampton S017 1BJ, UK. cliossi@soton.ac.uk

CBT and hypnosis intervention on positive and negative affect during breast cancer radiotherapy.



Breast cancer radiotherapy can be an emotionally difficult experience. Despite this, few studies have examined the effectiveness of psychological interventions to reduce negative affect, and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients. The present study examined the effectiveness of a multimodal psychotherapeutic approach, combining cognitive-behavioral therapy and hypnosis (CBTH), to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy. Participants were randomly assigned to receive either CBTH or standard care. Participants completed weekly self-report measures of positive and negative affect. Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [F(1, 38)=13.49; p=.0007, omega(2)=.56], and increased levels of positive affect [F(1, 38)=9.67; p=.0035, omega(2)=.48], during the course of radiotherapy. Additionally, relative to the control group, the CBTH group demonstrated significantly more intense positive affect [F(1, 38)=7.09; p=.0113, d=.71] and significantly less intense negative affect [F(1, 38)=10.30; p=.0027, d=.90] during radiotherapy. The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect (85% of days assessed for the CBTH group versus 43% of the Control group) [F(1, 38)=18.16; p=.0001, d=1.16]. Therefore, the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy.

J Clin Psychol. 2009 Apr;65(4):443-55. Schnur JB, David D, Kangas M, Green S, Bovbjerg DH, Montgomery GH. Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. julie.schnur@mssm.edu

Fatigue during breast cancer radiotherapy: An initial randomized study of CBT plus hypnosis.



The study purpose was to test the effectiveness of a psychological intervention combining cognitive-behavioral therapy and hypnosis (CBTH) to treat radiotherapy-related fatigue. Design: Women (n = 42) scheduled for breast cancer radiotherapy were randomly assigned to receive standard medical care (SMC) (n = 20) or a CBTH intervention (n = 22) in addition to SMC. Participants assigned to receive CBTH met individually with a clinical psychologist. CBTH participants received training in hypnosis and CBT. Participants assigned to the SMC control condition did not meet with a study psychologist. Main Outcome Measures: Fatigue was measured on a weekly basis by using the fatigue subscale of the Functional Assessment of Chronic Illness Therapy (FACIT) and daily using visual analogue scales. Results: Multilevel modeling indicated that for weekly FACIT fatigue data, there was a significant effect of the CBTH intervention on the rate of change in fatigue (p < .05), such that on average, CBTH participants' fatigue did not increase over the course of treatment, whereas control group participants' fatigue increased linearly. Daily data corroborated the analyses of weekly data. Conclusion: The results suggest that CBTH is an effective means for controlling and potentially preventing fatigue in breast cancer radiotherapy patients. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Health Psychol. 2009 May;28(3):317-22. Montgomery GH, Kangas M, David D, Hallquist MN, Green S, Bovbjerg DH, Schnur JB. Department of Oncological Sciences, Mount Sinai School of Medicine.

Pediatric oncologists' views toward the use of complementary and alternative medicine for children.



Original Title: Pediatric oncologists' views toward the use of complementary and alternative medicine in children with cancer.

Pediatric oncology patients commonly use complementary and alternative medicine (CAM), yet approximately only 50% of these patients discuss CAM with their oncologist. OBJECTIVE: The aim of this study is to assess barriers to CAM communication in pediatric oncology. DESIGN/METHODS: A 33-question survey was sent via electronic mail to 358 pediatric oncologists in the United States. RESULTS: Ninety pediatric oncologists completed the survey. Ninety-nine percent of pediatric oncologists think it is important to know what CAM therapies their patients use. However, less than half of pediatric oncologists routinely ask their patients about CAM. This is primarily because of a lack of time and knowledge. Many physicians think some forms of CAM may improve quality of life, such as massage (74%) and yoga (57%). Over half of physicians thought that dietary supplements, herbal medicine, special diets, vitamins, and chiropractic might be harmful to patients. CONCLUSIONS: Pediatric oncologists believe it is important to know which CAM therapies their patients use; however, they are not asking about them owing to lack of time and knowledge. To improve communication about CAM, increased physician education is needed. In addition, physicians should identify patients using potentially harmful CAM therapies. Furthermore, CAM research in pediatric oncology should focus on those modalities physicians believe may improve patient quality of life.

J Pediatr Hematol Oncol. 2009 Mar;31(3):177-82. Roth M, Lin J, Kim M, Moody K. Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY 10467, USA. mroth@montefiore.org

Cognitive-behavioral therapy and hypnosis intervention on positive and negative affect



Breast cancer radiotherapy can be an emotionally difficult experience. Despite this, few studies have examined the effectiveness of psychological interventions to reduce negative affect, and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients. The present study examined the effectiveness of a multimodal psychotherapeutic approach, combining cognitive-behavioral therapy and hypnosis (CBTH), to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy. Participants were randomly assigned to receive either CBTH or standard care. Participants completed weekly self-report measures of positive and negative affect. Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [F(1, 38)=13.49; p=.0007, omega(2)=.56], and increased levels of positive affect [F(1, 38)=9.67; p=.0035, omega(2)=.48], during the course of radiotherapy. Additionally, relative to the control group, the CBTH group demonstrated significantly more intense positive affect [F(1, 38)=7.09; p=.0113, d=.71] and significantly less intense negative affect [F(1, 38)=10.30; p=.0027, d=.90] during radiotherapy. The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect (85% of days assessed for the CBTH group versus 43% of the Control group) [F(1, 38)=18.16; p=.0001, d=1.16]. Therefore, the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy.

J Clin Psychol. 2009 Apr;65(4):443-55. Schnur JB, David D, Kangas M, Green S, Bovbjerg DH, Montgomery GH. Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. julie.schnur@mssm.edu

Massage therapy reduces physical discomfort and improves mood disturbances in women w/ breast cancer



A randomized controlled trial was conducted to investigate the efficacy of classical massage treatment in reducing breast cancer-related symptoms and in improving mood disturbances.Methods. Women diagnosed with primary breast cancer were randomized into an intervention group and a control group. For a period of 5 weeks, the intervention group received bi-weekly 30-min classical massages in the back and head-neck areas. The control group received no additional treatment to their routine healthcare. To evaluate treatment efficacy, the following validated questionnaires were administrated at baseline (T1), at the end of the intervention (T2), and at a followup at 11 weeks (T3): the Short Form-8 Health Surveytrade mark, the European Organization of Research and Treatment of Cancer quality of life questionnaire breast module (EORTC QLQ-BR23), the Giessen Complaints Inventory (GBB), and the Berlin Mood Questionnaire (BSF).Results. Eighty-six eligible women (mean age: 59 years) were enrolled in the study. A significantly higher reduction of physical discomfort was found in the intervention group compared with the control group at T2 (p=0.001) and at T3 (p=0.038). A decrease in fatigue was also observed. Women in the intervention group reported significantly lower mood disturbances at T2 (p<0.01) but not at T3. The effect of treatment on mood disturbances was significantly higher if a patient was treated continuously by the same masseur.Conclusion. Classical massage seems to be an effective adjuvant treatment for reducing physical discomfort and fatigue, and improving mood disturbances in women with early stage breast cancer. Copyright (c) 2009 John Wiley & Sons, Ltd.

Psychooncology. 2009 Feb 2. Listing M, Reißhauer A, Krohn M, Voigt B, Tjahono G, Becker J, Klapp BF, Rauchfuß M. Department of Psychosomatics and Psychotherapy, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Hypnosis for Postradiation Xerostomia in Head and Neck Cancer Patients: A Pilot Study.



Xerostomia, the sensation of dry mouth, affects almost all patients who undergo radiotherapy for cancer in the head and neck area. Current therapies for xerostomia are inadequate, and the condition negatively impacts the quality of life. This prospective observational pilot aimed to evaluate whether hypnosis could improve salivation and decrease xerostomia. Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry. They then received a single hypnosis session with specific suggestions to increase salivation. The session was recorded on a compact disk (CD), and the participants were instructed to listen to it twice a day for one month. Sialometry was repeated immediately after hypnosis. Validated xerostomia questionnaires were completed at one, four, and 12 weeks after hypnosis. A substantial overall improvement was reported by eight patients at 12 weeks (66%). The saliva flow rate increased on sialometry in nine patients following hypnosis (75%). There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures (Spearman's correlation coefficient r=0.134). Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD (r=0.714, P=0.009). No adverse events were reported. The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia. Confirmation in a larger randomized and controlled investigation is warranted.

J Pain Symptom Manage. 2009 Jan 29. Schiff E, Mogilner JG, Sella E, Doweck I, Hershko O, Ben-Arye E, Yarom N. Department of Internal Medicine (E.S.), Bnai-Zion Hospital, Haifa; Department for Complementary/Integrative Medicine, Law and Ethics (E.S.), and The International Center for Health, Law and Ethics (E.S.), Haifa University, Haifa; Department of Pediatric Surgery (J.G.M.), The Ruth & Bruce Rappaport Faculty of Medicine, and the Complementary and Traditional Medicine Unit (E.B.-A.), Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; Department of Otolaryngology-Head and Neck Surgery (E.S., I.D.), Carmel Medical Center, Haifa, Israel; Faculty of Medicine (O.H.), Semmelweis University, Budapest, Hungary; Clalit Health Services (E.B.-A.), Haifa and Western Galilee District; and Oral Medicine Clinic (N.Y.), Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel.

Practical hypnotic interventions during invasive cancer diagnosis and treatment.



Novel advances in biotechnology and medical imaging techniques have enabled an evolution toward earlier diagnosis and treatment by way of "minimally invasive" surgical techniques performed on the conscious patient without the use of general anesthesia. Although the risks of diagnostic and therapeutic interventions have been reduced with these approaches, patients still face many physical and psychologic challenges. Several randomized controlled trials have shown that hypnotic techniques are effective in reducing pain, anxiety, and other symptoms; in reducing procedure time; and in stabilizing vital signs. The benefits of adjunctive hypnotic treatments come at no additional cost. Patients, health care providers, hospitals, and insurance companies are advised to take advantage of hypnotic techniques.

Hematol Oncol Clin North Am. 2008 Aug;22(4):709-25, ix. Flory N, Lang E. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA 02215, USA. nflory@bidmc.harvard.edu

Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review.



PURPOSE: Adverse effects of chemotherapy can be severe and can have a significant impact on a person's quality of life. With chemotherapy treatment increasingly administered in the ambulatory setting, there is a need for patients to be informed about effective self-care strategies to manage treatment adverse effects. Advice for patients needs to be based on evidence. This systematic review provides an overview of the intervention research in this area as well as an effectiveness review of nonpharmacologic (self-care) strategies evaluated in high-quality randomized controlled trials (RCTs). METHODS: An extensive literature search was conducted to identify RCTs relating to self-care strategies for reducing nausea/vomiting, constipation, diarrhea, fatigue, hair loss, or mucositis. Relevant studies published in peer-reviewed journals between 1980 and August 2007 were included. Study characteristics, results and methodologic quality were examined. High-quality RCTs were further analyzed to establish the effectiveness of specific self-care strategies. RESULTS: The search identified 77 RCTs. Findings from RCTs of reasonable quality provide limited support for cognitive distraction, exercise, hypnosis, relaxation, and systematic desensitization to reduce nausea and vomiting, psycho-education for fatigue, and scalp cooling to reduce hair loss. CONCLUSION: Although some strategies seem promising, the quality of the RCTs was generally quite low, making it difficult to draw conclusions about the effectiveness of self-care strategies. Future studies require better design and reporting of methodologic issues to establish evidence-based self-care recommendations for people receiving chemotherapy.

J Clin Oncol. 2008 Dec 1;26(34):5618-29. Lotfi-Jam K, Carey M, Jefford M, Schofield P, Charleson C, Aranda S. Department of Nursing and Supportive Care Research, Peter MacCallum Cancer Centre, the University of Melbourne, Melbourne, Victoria 8006, Australia.

Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Surv.



PURPOSE: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.

J Clin Oncol. 2008 Sep 22. Elkins G, Marcus J, Stearns V, Perfect M, Rajab MH, Ruud C, Palamara L, Keith T. Department of Psychology and Neuroscience, Baylor University, Waco; Scott and White Memorial Hospital and Clinic, Department of Psychiatry and Behavioral Sciences, Temple; Cancer Treatment and Research Center, San Antonio; and University of Texas at Austin, TX; University of Arizona, Tucson, AZ; and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.

Complementary and alternative medicine use in children with cancer and pediatrics.



The objective of this survey is to determine the frequency, reasons, and factors influencing use of complementary and alternative medicine (CAM) in general and specialty pediatrics within the same geographic area. Of the 281 surveys completed, CAM use was higher in children with epilepsy (61.9%), cancer (59%), asthma (50.7%), and sickle cell disease (47.4%) than in general pediatrics (36%). Children most often used prayer (60.5%), massage (27.9%), specialty vitamins (27.2%), chiropractic care (25.9%), and dietary supplements (21.8%). Parents who used CAM for themselves (68.7%) were more likely to access CAM for their child. Most parents (62.6%) disclosed some or all of their child's use of CAM to providers. This study confirms that within the same geographic region, children with chronic and life-threatening illness use more CAM therapies than children seen in primary care clinics. Children with cancer use CAM for different reasons than children with non-life-threatening illnesses.

J Pediatr Oncol Nurs. 2009 Jan-Feb;26(1):7-15. Post-White J, Fitzgerald M, Hageness S, Sencer SF. University of Minnesota, postw001@umn.edu.

Mind-Body Interventions in Oncology.



OPINION STATEMENT: A number of mind-body interventions have been studied for use with cancer patients, primarily measuring outcomes relating to pain control, anxiety reduction, and enhancing quality of life. This chapter defines the scope and characteristics of mind-body interventions, followed by a selective review of research indicating their appropriate use or cautions in cancer care. Mind-body interventions included are hypnosis, imagery/relaxation, meditation, yoga, and creative therapies. Current evidence supports the efficacy of hypnosis and imagery/relaxation for control of pain and anxiety during cancer treatments. Meditation is supported for reductions in stress and improvements in mood, quality of life, and sleep problems. There is a growing body of support for yoga from randomized controlled trials for improving quality of life, sleep, and mood. Creative therapies such as visual arts, dance, and music may help cancer patients express their feelings and cope with the demands of a cancer experience. Research on biological marker effects of mind-body therapies remains inconclusive. Study of mind-body interventions generally requires additional, methodologically rigorous investigation of how various interventions best assist patients during various phases of cancer survivorship, although a major benefit of these therapies lies in the opportunity for patients to self-select them.

Curr Treat Options Oncol. 2008 Aug 13. Carlson LE, Bultz BD. Department of Psychosocial Resources, Tom Baker Cancer Centre/Alberta Cancer Board, Holy Cross Site, 2202 2nd St. SW, Calgary, AB, Canada, T2S 3C1, l.carlson@ucalgary.ca.

Use of complementary and alternative medical therapy by patients with primary brain tumors.



The use of complementary and alternative medicine (CAM) is increasing. CAM includes mind-body interventions, biologically based therapies, energy therapies, and body-based methods. Primary brain tumors arise within the brain and have a poor prognosis when malignant. Even patients with benign tumors suffer neurologic and systemic symptoms as a result of the tumor or its treatment. CAM is used by 30% of brain tumor patients, who often do not report its use to their physician. Herbal medicines may affect the metabolism of prescribed medications or produce adverse effects that may be attributed to other causes. In patients with systemic cancer, mind-body modalities such as meditation and relaxation therapy have been shown to be helpful in reducing anxiety and pain; acupuncture and hypnotherapy may also reduce both pain and nausea. Recent preclinical studies have reported that ginseng, Scutellaria baicalensis, and Angelica sinensis may promote apoptosis of tumor cells or exercise antiangiogenic effects. Further studies are needed to evaluate the impact of CAM on symptom control or tumor growth in this vulnerable patient population.

Armstrong TS, Gilbert MR. Department of Integrative Nursing Care, University of Texas Health Science Center School of Nursing, 6901 Bertner Avenue, Houston, TX 77030, USA. Terri.S.Armstrong@uth.tmc.edu Curr Neurol Neurosci Rep. 2008 May;8(3):264-8.

The conjoint use of music therapy and reflexology with hospitalized advanced stage cancer patients.



ABSTRACTAdvanced stage cancer patients experience debilitating physical symptoms as well as profound emotional and spiritual struggles. Advanced disease is accompanied by multiple changes and losses for the patient and the family. Palliative care focuses on the relief of overall suffering of patients and families, including symptom control, psychosocial support, and the meeting of spiritual needs. Music therapy and reflexology are complementary therapies that can soothe and provide comfort. When used conjointly, they provide a multifaceted experience that can aid in the reduction of anxiety, pain, and isolation; facilitate communication between patients, family members, and staff; and provide the potential for a more peaceful dying experience for all involved. This article addresses the benefits of the combined use of music therapy and reflexology. Two case studies are presented to illustrate the application and benefits of this dual approach for patients and their families regarding adjustment to the end of life in the presence of anxiety and cognitive impairment.

Magill L, Berenson S. School of Music, Faculty of Arts and Social Sciences, University of Windsor, Windsor, Ontario, Canada. Palliat Support Care. 2008 Sep;6(3):289-96.

Mechanisms of change in cognitive therapy for panic disorder with agoraphobia.



The purpose of this study was to test the predictions of an integrated cognitive and behavioral model of agoraphobic avoidance in patients with chronic panic disorder and agoraphobia during the process of observed therapeutic change. Treatment was residential with the majority (n=165, 88%) receiving cognitive therapy, while the remaining 23 (12%) received guided mastery therapy. The results of latent variable path modeling of the changes occurring over the course of this treatment suggested that the anxiety elicited by bodily sensations influenced catastrophic beliefs, which, in turn, increased avoidance. Avoidance increased the anxiety elicited by bodily sensations.

J Behav Ther Exp Psychiatry. 2008 Sep;39(3) Hoffart A, Sexton H, Hedley LM, Martinsen EW. Research Institute, Modum Bad, N-3370 Vikersund, Norway.

Beneficial effects of hypnosis and adverse effects of empathic attention dur. percutaneous tumor tx



PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.

Lang EV, Berbaum KS, Pauker SG, Faintuch S, Salazar GM, Lutgendorf S, Laser E, Logan H, Spiegel D. Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts 02215, USA. elang@bidmc.harvard.edu J Vasc Interv Radiol. 2008 Jun;19(6):897-905.

Integrative oncology: complementary therapies for cancer survivors.



Cancer survivors experience a wide range of symptoms during and following completion of treatment, and some of these symptoms may persist for years or even decades. While pharmacologic treatments relieve many symptoms, they too may produce difficult side effects. Complementary therapies are noninvasive, inexpensive, and useful in controlling symptoms and improving quality of life, and they may be accessed by patients themselves. Rigorous scientific research has produced evidence that acupuncture, massage therapy, music, and mind-body therapies effectively and safely reduce physical and emotional symptoms. These therapies provide a favorable risk-benefit ratio and permit cancer survivors to help manage their own care.

Hematol Oncol Clin North Am. 2008 Wesa K, Gubili J, Cassileth B. Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue (at 74(th) Street), New York, NY 10021, USA. gubilij@mskcc.org

Potential role of mind-body therapies in cancer survivorship.



The use of complementary and alternative medicine (CAM) by cancer survivors is high, particularly among those with psychosocial distress, poor quality of life, culturally based health beliefs, and those who experience health disparities in the mainstream healthcare system. As the number of cancer survivors continues to increase, so does the diversity of the survivorship population, making it increasingly important to understand and address the CAM culture in different survivor groups. Given the known communication barriers between cancer patients and their physicians regarding CAM, it would be useful for oncology providers to have a platform from which to discuss CAM-related issues. It is proposed that mind-body therapies with some basis in evidence could provide such a platform and also serve as a possible means of connecting cancer survivors to psychosocial supportive services. This article reviews a few mind-body therapies that may have particular relevance to cancer survivors, such as hypnosis and meditation practices. A theoretical foundation by which such therapies provide benefit is presented, with particular emphasis on self-regulation.

Cancer. 2008 Jun 1;112(11 Suppl):2607-16. Monti DA, Sufian M, Peterson C. Myrna Brind Center of Integrative Medicine, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania 19107, USA. daniel.monti@jefferson.edu

Beneficial Effects of Hypnosis and Adververse Effects of Empathic Attention.



PURPOSE: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events. MATERIALS AND METHODS: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (>/=50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment. RESULTS: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118). CONCLUSIONS: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.

J Vasc Interv Radiol. 2008 Jun;19(6):897-905. Epub 2008 Mar 17. Lang EV, Berbaum KS, Pauker SG, Faintuch S, Salazar GM, Lutgendorf S, Laser E, Logan H, Spiegel D. Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.

Hypnosis decreases presurgical distress in excisional breast biopsy patients.



Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients. METHODS: Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures. RESULTS: Groups did not differ in terms of the following: demographics (age, education, ethnicity, marital status, all P's > 0.28); medical variables (presurgery diagnosis, previous excisional biopsy, previous breast cancer, all P's > 0.11); or preintervention distress (SV-POMS P > 0.74) assessed on the day of surgery. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls. CONCLUSIONS: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

Anesth Analg. 2008 Feb;106(2):440-4, table of contents. Schnur JB, Bovbjerg DH, David D, Tatrow K, Goldfarb AB, Silverstein JH, Weltz CR, Montgomery GH. Department of Oncological Sciences, Box 1130, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York City, NY 10029-6574, USA. julie.schnur@mssm.edu

Melatonin, environmental light, and breast cancer.



Although many factors have been suggested as causes for breast cancer, the increased incidence of the disease seen in women working in night shifts led to the hypothesis that the suppression of melatonin by light or melatonin deficiency plays a major role in cancer development. Studies on the 7,12-dimethylbenz[a]anthracene and N-methyl-N-nitrosourea experimental models of human breast cancer indicate that melatonin is effective in reducing cancer development. In vitro studies in MCF-7 human breast cancer cell line have shown that melatonin exerts its anticarcinogenic actions through a variety of mechanisms, and that it is most effective in estrogen receptor (ER) alpha-positive breast cancer cells. Melatonin suppresses ER gene, modulates several estrogen dependent regulatory proteins and pro-oncogenes, inhibits cell proliferation, and impairs the metastatic capacity of MCF-7 human breast cancer cells. The anticarcinogenic action on MCF-7 cells has been demonstrated at the physiological concentrations of melatonin attained at night, suggesting thereby that melatonin acts like an endogenous antiestrogen. Melatonin also decreases the formation of estrogens from androgens via aromatase inhibition. Circulating melatonin levels are abnormally low in ER-positive breast cancer patients thereby supporting the melatonin hypothesis for breast cancer in shift working women. It has been postulated that enhanced endogenous melatonin secretion is responsible for the beneficial effects of meditation as a form of psychosocial intervention that helps breast cancer patients.

Breast Cancer Res Treat. 2008 Apr;108(3):339-50. Srinivasan V, Spence DW, Pandi-Perumal SR, Trakht I, Esquifino AI, Cardinali DP, Maestroni GJ. Department of Physiology, School of Medical Sciences, University Sains Malaysia, Kubang kerian, Kelantan, 16150, Malaysia.

Hypnosis for nausea and vomiting in cancer chemotherapy.



To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A comprehensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases' inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer. Further research into the fectiveness, acceptance and feasibility of hypnosis in CINV, particularly in adults, is suggested. Future studies should assess suggestibility and provide full details of the hypnotic intervention.

Eur J Cancer Care (Engl). 2007 Sep;16(5):402-12. Richardson J, Smith JE, McCall G, Richardson A, Pilkington K, Kirsch I. Faculty of Health and Social Work, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon, UK. janet.richardson@plymouth.ac.uk

A review of the effects of hypnosis on the immune system in breast cancer patients.



In order to make a recommendation about the use of hypnosis as adjuvant therapy in the treatment of breast cancer, 2 studies assessing the immunological effects of hypnosis in patients with early stage breast cancer were evaluated: (a) an experiment that taught hypnotic guided-imagery therapy to patients and (b) one that provided participants with home visits and autogenic training. Both investigations demonstrated improvement in depression and increased natural killer (NK) cell counts after 2 months of hypnosis treatment. However, neither study determined the clinical significance of hypnosis in the setting of cancer, and therefore future experiments are needed to relate the immune-mediated effects of hypnosis to hard clinical outcomes like survival rates.

Int J Clin Exp Hypn. 2007 Oct;55(4):411-25. Hudacek KD. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. hudacek@mail.med.upenn.edu

Hypnosis and cognitive-behavioral therapy during breast cancer radiotherapy: a case report.



This case report describes an effort to control two primary side-effects of breast cancer radiotherapy (fatigue and skin discomfort) that used a combination of cognitive-behavioral therapy with hypnosis (CBTH). Two patients, matched on demographic and medical variables (marital status, employment status, number of children, cancer diagnosis, surgical history, radiation dose), were compared: one who received a CBTH intervention and one who received standard care. Results were consistent with the view that CBTH was effective in managing fatigue and skin discomfort, and increasing relaxation.

Am J Clin Hypn. 2008 Jan;50(3):209-15. Schnur JB, Montgomery GH. Department of Oncological Sciences, Box 1130 Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029-6574, USA. julie.schnur@mssm.edu

Hypnosis decreases presurgical distress in excisional breast biopsy patients.



Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients. METHODS: Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures. RESULTS: Groups did not differ in terms of the following: demographics (age, education, ethnicity, marital status, all P's > 0.28); medical variables (presurgery diagnosis, previous excisional biopsy, previous breast cancer, all P's > 0.11); or preintervention distress (SV-POMS P > 0.74) assessed on the day of surgery. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls. CONCLUSIONS: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

Anesth Analg. 2008 Feb;106(2):440-4, table of contents. Schnur JB, Bovbjerg DH, David D, Tatrow K, Goldfarb AB, Silverstein JH, Weltz CR, Montgomery GH. Department of Oncological Sciences, Box 1130, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York City, NY 10029-6574, USA. julie.schnur@mssm.edu

When medication is not enough: nonpharmacologic management of pain.



Patients with cancer commonly experience pain, which typically is controlled pharmacologically. Despite advances in pain management, pain continues to be undertreated. Nonpharmacologic measures may effectively manage pain but often are overlooked or underused. Nurses who are familiar with simple, noninvasive, nonpharmacologic measures, such as patient positioning, thermal measures, massage therapy, aromatherapy, and mind-body therapies, can identify and educate patients who may benefit from nonpharmacologic interventions.

Clin J Oncol Nurs. 2007 Oct;11(5):699-704. Gatlin CG, Schulmeister L. River Ridge, LA.

A review of the effects of hypnosis on the immune system in breast cancer patients.



In order to make a recommendation about the use of hypnosis as adjuvant therapy in the treatment of breast cancer, 2 studies assessing the immunological effects of hypnosis in patients with early stage breast cancer were evaluated: (a) an experiment that taught hypnotic guided-imagery therapy to patients and (b) one that provided participants with home visits and autogenic training. Both investigations demonstrated improvement in depression and increased natural killer (NK) cell counts after 2 months of hypnosis treatment. However, neither study determined the clinical significance of hypnosis in the setting of cancer, and therefore future experiments are needed to relate the immune-mediated effects of hypnosis to hard clinical outcomes like survival rates.

Int J Clin Exp Hypn. 2007 Oct;55(4):411-25. Hudacek KD. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.

The use of biofield therapies in cancer care.



Biofield therapies form a subcategory of the domain of energy therapies, as defined by the National Center for Complementary and Alternative Medicine. Specific biofield therapies addressed in this article include Therapeutic Touch, Healing Touch, Polarity Therapy, Reiki, and Qigong. This article will identify core concepts in biofield therapies, review controlled trials of the use of biofield therapies with patients with cancer, describe the process of biofield therapies implementation in one cancer center, and suggest research to benefit not only patients with cancer but also family members and oncology professionals.

Pierce B. Suburban Hospital, Bethesda, MD, USA. bpierce@suburbanhospital.org

Clin J Oncol Nurs. 2007 Apr;11(2):253-8.

Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidenc



To systematically review the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting (CINV). A compre-hensive search of major biomedical databases including MEDLINE, EMBASE, ClNAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research. Citations were included from the databases' inception to March 2005. Randomized controlled trials (RCTs) were appraised and meta-analysis undertaken. Clinical commentaries were obtained. Six RCTs evaluating the effectiveness of hypnosis in CINV were found. In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy. Meta-analysis has demonstrated that hypnosis could be a clinically valuable intervention for anticipatory and CINV in children with cancer. Further research into the effectiveness, acceptance and feasibility of hypnosis in CINV, particularly in adults, is suggested. Future studies should assess suggestibility and provide full details of the hypnotic intervention.

Eur J Cancer Care (Engl). 2007 Sep;16(5):402-12.

Richardson J, Smith JE, McCall G, Richardson A, Pilkington K, Kirsch I., Faculty of Health and Social Work, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon, UK.

A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surge



Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective. METHODS: We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review. RESULTS: Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 microg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time. CONCLUSIONS: Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.

J Natl Cancer Inst. 2007 Sep 5;99(17):1304-12.

Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, Schechter C, Graff-Zivin J, Tatrow K, Price DD, Silverstein JH., Department of Oncological Sciences, Mount Sinai School of Medicine, Box 1130, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA. guy.montgomery@mssm.edu

Management of cancer pain with complementary therapies.



Pain is one of the most feared consequences of cancer. Pain is a major symptom in 75% of hospitalized cancer patients. Poorly relieved pain contributes to the suffering of the patient and family, which may motivate them to seek additional complementary and alternative therapies. Evidence-based complementary therapies are being used for symptom control and to improve quality of life. There is recent research on several complementary therapies-acupuncture, mind-body therapies, massage, reflexology, and Reiki--that provides evidence for pain management. These therapies are not well utilized due to a lack of information on benefits, risks, and resources. There is a call for education to alert patients, families, nurses, and physicians to the benefits of evidence-based complementary therapies and to the dangers of "unproven" cancer therapies. Oncology nurses are ideally positioned to assess patients' pain, to educate patients, to determine with the patient and physician the most appropriate and safe complementary therapy for pain, to refer patients to appropriate resources, and in some cases to provide the therapy itself. This article will discuss specific complementary therapies for pain control and will arm nurses with the confidence to intervene with knowledge, referrals, and ideas for hands-on implementation.

Oncology (Williston Park). 2007 Apr;21(4 Suppl):10-22; discussion 22. Related Articles, Links

Memorial Sloan-Kettering Cancer Center, Integrative Medicine Service New York, New York, USA.

A review of the effects of hypnosis on the immune system in breast cancer patients.



In order to make a recommendation about the use of hypnosis as adjuvant therapy in the treatment of breast cancer, 2 studies assessing the immunological effects of hypnosis in patients with early stage breast cancer were evaluated: (a) an experiment that taught hypnotic guided-imagery therapy to patients and (b) one that provided participants with home visits and autogenic training. Both investigations demonstrated improvement in depression and increased natural killer (NK) cell counts after 2 months of hypnosis treatment. However, neither study determined the clinical significance of hypnosis in the setting of cancer, and therefore future experiments are needed to relate the immune-mediated effects of hypnosis to hard clinical outcomes like survival rates.

Int J Clin Exp Hypn. 2007 Oct;55(4):411-25

Hudacek KD. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.

Hypnosis for procedure-related pain and distress in pediatric cancer patients



The aim of this study was to systematically review and critically appraise the evidence on the effectiveness of hypnosis for procedure-related pain and distress in pediatric cancer patients. A comprehensive search of major biomedical and specialist complementary and alternative medicine databases was conducted. Citations were included from the databases' inception to March 2005. Efforts were made to identify unpublished and ongoing research. Controlled trials were appraised using predefined criteria. Clinical commentaries were obtained for each study. Seven randomized controlled clinical trials and one controlled clinical trial were found. Studies report positive results, including statistically significant reductions in pain and anxiety/distress, but a number of methodological limitations were identified. Systematic searching and appraisal has demonstrated that hypnosis has potential as a clinically valuable intervention for procedure-related pain and distress in pediatric cancer patients. Further research into the effectiveness and acceptability of hypnosis for pediatric cancer patients is recommended.

Faculty of Health and Social Work, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom. janet.richardson@plymouth.ac.uk

J Pain Symptom Manage. 2006 Jan;31(1):70-84.Click here to read

Effectiveness of hypnotherapy with cancer patients' trajectory: emesis, acute pain, and analgesia an



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.

Jewish General Hospital. Montréal, Quebec. Canada.

Int J Clin Exp Hypn. 2007 Jul;55(3):336-54.

Pain and anxiety during interventional radiologic procedures



PURPOSE: To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures. MATERIALS AND METHODS: Two hundred thirty-six patients undergoing vascular and renal interventions, who had been randomized to receive during standard care treatment, structured empathic attention, or self-hypnotic relaxation, were divided into two groups: those with low state anxiety scores on the State-Trait Anxiety Inventory (STAI, scores < 43; n = 116) and those with high state anxiety scores (> or = 43; n = 120). All had access to patient-controlled analgesia with fentanyl and midazolam. Every 15 minutes during the procedure, patients rated their anxiety and pain on a scale of 0-10 (0, no pain/anxiety at all; 10, worst possible pain/anxiety). Effects were assessed by analysis of variance and repeated-measures analysis. RESULTS: Patients with high state anxiety levels required significantly greater procedure time and medication. Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients. These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than standard care for patients with low anxiety levels. Anxiety decreased over the time of the procedure; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions. CONCLUSION: Patients' state anxiety level is a predictor of trends in procedural pain and anxiety, need for medication, and procedure duration. Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, WCC 308, Boston, Massachusetts 02215, USA.

J Vasc Interv Radiol. 2005 Dec;16(12):1585-92.Click here to read

Correlates of use of different types of CAM by breast cancer survivors



Among breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM). PATIENTS AND METHODS: We included 2,022 women diagnosed with breast cancer 1998-2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers. RESULTS: Sixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1-1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2-2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3-0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery. CONCLUSIONS: Factors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA, 02215-3325, USA, catherine_buettner@hms.harvard.edu.

Breast Cancer Res Treat. 2006 Nov;100(2):219-27. Epub 2006 Jul 5.

A critical review of complementary therapies for cancer-related fatigue.



PURPOSE: To review the available literature on the use of complementary and alternative medicine (CAM) treatments for cancer-related fatigue with an aim to develop directions for future research. METHODS: PubMed, EMBASE, CINAHL, PsycINFO, and SPORTDiscus were searched for relevant studies. Original clinical trials reporting on the use of CAM treatments for cancer-related fatigue were abstracted and critically reviewed. RESULTS: CAM interventions tested for cancer-related fatigue include acupuncture, aromatherapy, adenosine triphosphate infusions, energy conservation and activity management, healing touch, hypnosis, lectin-standardized mistletoe extract, levocarnitine, massage, mindfulness-based stress reduction, polarity therapy, relaxation, sleep promotion, support group, and Tibetan yoga. Several of these interventions seem promising in initial studies. CONCLUSION: Currently, insufficient data exist to recommend any specific CAM modality for cancer-related fatigue. Therefore, potentially effective CAM interventions ready for further study in large, randomized clinical trials (eg, acupuncture, massage, levocarnitine, and the use of mistletoe) should be pursued. Other interventions should be tested in well-designed feasibility and phase II trials.

Sood A, Barton DL, Bauer BA, Loprinzi CL. Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. sood.amit@mayo.edu

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