Hypnosis before breast cancer surgery eases pain, cuts costs

As a practicing oncologist who recommends biopsies of various tissues on a regular basis, the following report on the benefits of hypnosis for patients undergoing cancer surgery is a welcome one. The use of hypnosis as outlined here is worthy of notice and further study, as are other complimentary interventions such as acupuncture.

Several points are important when evaluating any study, and this study met two key qualifications: First, it was randomized, meaning patients were randomly chosen to either receive the treatment (in this case, hypnosis) or a placebo (in this case, a therapy session). Second, it was published in a peer reviewed journal (The Journal of the National Cancer Institute). This means that scientists and clinicians that did not conduct the research read, reviewed, commented upon, criticized, and finally accepted the work as credible for publication.

These two factors make this study markedly different from the unfounded claims that flood the media each and every day. This study, and others that are ongoing, need to be taken seriously. I hope that future results can confirm that hypnosis and other treatments can help patients cope with the traumas of the cancer experience.

The new study

Women who were hypnotized immediately before undergoing a breast biopsy or lumpectomy required less sedation and anesthesia during the procedure and experienced less pain, nausea, and emotional distress afterwards, according to a study reported in the Sept. 5, 2007, Journal of the National Cancer Institute. Hypnosis induces a state of deep relaxation and focused concentration. Exactly how it works to ease pain and anxiety isn’t fully understood, but neuroscientists have shown that it changes activity in brain areas involved in pain perception and the response to pain.

The trial, led by researchers at Mount Sinai School of Medicine in New York, also found that compared with usual care, hypnosis resulted in less time in the procedure room and cut per-patient hospital costs by nearly 10%. An editorial accompanying the study suggests that the technique may be especially helpful for people about to undergo diagnostic cancer surgery, who are especially likely to experience anxiety that intensifies their pain.

The researchers randomly assigned 200 women scheduled for a breast biopsy or lumpectomy to a brief pre-surgical session of either supportive therapy or hypnosis. The hypnotic procedure included guided relaxation, the use of imagery, and symptom-focused suggestions. All the women were treated with anesthesia and pain medications during the procedures and given painkillers as needed afterward.

During surgery, the hypnotized women required 22% less analgesia and 34% less sedation. After surgery, they reported 53% less pain intensity, 74% less nausea, 46% less fatigue, 47% less discomfort, and 74% less emotional upset. They also spent 11 fewer minutes in surgery, resulting in a cost savings of almost $800 per patient.

The Mount Sinai research builds on work by interventional radiologist Dr. Elvira Lang, at Harvard Medical School. Dr. Lang has studied the use of hypnosis in patients undergoing minimally invasive but physically and emotionally stressful procedures, such as angioplasties, liver biopsies, and kidney drainage. She too has found that hypnosis trims procedure times and costs while reducing pain and anxiety and the resulting need for medications.

Once the purview of watch-dangling charlatans, hypnosis has been taken much more seriously in recent decades. Besides pain and anxiety reduction, other uses include controlling unwanted behavior such as smoking or overeating and lessening the impact of disorders such as irritable bowel syndrome. Some clinicians are reluctant to use the technique because they don’t fully understand how it works or discount it as hocus-pocus. But that’s likely to change as evidence mounts that hypnosis is a safe and effective way to comfort patients and reduce health care costs.

For information about the medical uses of hypnosis and referrals to licensed practitioners, contact the American Society of Clinical Hypnosis on the Web at www.asch.net, by phone at 630-980-4740, or via e-mail: info@asch.net.

Marc Garnick, M.D., is an internationally renowned expert in medical oncology and urologic cancer, with a special emphasis on prostate cancer. He is a Clinical Professor of Medicine at Harvard Medical School and maintains an active oncology practice at Beth Israel Deaconess Medical Center. Dr. Garnick serves as Editor in Chief of Perspectives on Prostate Diseases, a quarterly report from Harvard Health Publications.

Breast Cancer
Medical knowledge about breast cancer is advancing rapidly. What causes it? Why are some people more likely to get it than others? Women now have many more choices to make about imaging tests, biopsies, surgeries, and drug treatments. Breast Cancer: Strategies for Living is a special health report from Harvard Medical School that explains the current state of knowledge regarding diagnosis, treatment and prevention in easy-to-understand language.

 
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