Wednesday August 29 2007
Even simple handholding or being friendly might have good effects.
Hypnotising breast cancer patients before they have surgery reduces the pain, nausea and fatigue they experience during and after surgery, according to reports in The Daily Telegraph, Daily Express and Daily Mail. A 5-minute hypnosis session by a psychologist an hour before breast cancer surgery meant the women spent less time in the operating theatre and recovered better compared to those who simply chatted with a psychologist.
All the newspapers mentioned that a beneficial side effect of this is that less time spent in the operating theatre means lower costs and time for more operations.
The Daily Express and The Daily Telegraph quoted Dr Sarah Cant of the charity Breakthrough Breast Cancer who, in addition to pointing out the need for larger studies, said: “Anyone interested in using hypnosis should discuss this with their breast cancer care team first and ensure that they are using an appropriately trained and experienced hypnotherapist.”
This well-conducted study was limited by the fact that the patients were aware that they had been allocated to the hypnosis or comparison group. This may have affected their reporting of symptoms in the scales used, irrespective of the effect of hypnosis. Overall costs, including those of the hypnotist, will also need further evaluation in each hospital in which this treatment is being considered.
Where did the story come from?
Doctor Guy Montgomery and colleagues, from the Mount Sinai School of Medicine and associated hospitals in New York, carried out this research. The study was funded by the National Cancer Institute, American Cancer Society and Department of Defense.
The study was published in the peer-reviewed medical journal, Journal of the National Cancer Institute.
What kind of scientific study was this?
This was an unblinded, randomised controlled trial with a cost comparison done from the perspective of the institution.
200 patients who were scheduled for removal of a breast lump or excision biopsy were randomly assigned into one of two groups; a group that received hypnosis or another group that received only 'attention'. In the hour prior to surgery, both groups had 15 minutes with the same group of psychologists.
The hypnosis group had instruction in the use of relaxation and visual imagery. The comparison group that had 'attention', were listened to and given supportive and empathetic comments without any imagery, relaxation or discussion.
Patient-reported pain and other side effects were measured by questionnaire and a scale given to the patients at discharge.
The use of pain relieving medicines, operating time and costs were assessed by examining the patients’ charts.
All the patients and their therapists knew which group they were in. However, the measurement of costs and time was made by people who did not know which group the individual patient had been allocated to.
What were the results of the study?
Using the scale provided, patients in the hypnosis group reported fewer symptoms than patients in the attention group. Certain painkillers and sedatives were given less during surgery to the hypnosis group, but there was no difference in use of painkillers while on the ward afterwards.
The scales given to the patients assessed pain intensity, pain unpleasantness, nausea, fatigue, discomfort and emotional upset. These were all significantly better in people from the hypnosis group. For example, the average pain intensity in the hypnosis group was 22.43 points compared to 47.83 points in those who did not receive hypnosis. The average nausea score was 6.57 in the hypnosis group and 25.49 in the control group.
Although the hypnosis group used fewer painkillers and sedatives during the surgery and fewer painkillers afterwards, the difference was only statistically significant for two out of the six drugs assessed, and for those administered during surgery.
The cost of this type of breast cancer surgery at the Mount Sinai School of Medicine is $8,561, or about £4,300. A saving of $772 (about £380-£400) was made in the hypnosis cases, mainly due to reduced surgical time.
What interpretations did the researchers draw from these results?
The researchers concluded that hypnosis was superior to the treatment given to the control group, regarding the use of drugs during surgery and the range of patient symptoms around the surgical period, including pain and nausea.
What does the NHS Knowledge Service make of this study?
was a well-conducted study, and all the patients who participated had their results included. There are some limitations to the design of this study which the researchers acknowledge:
- The study was unblinded and therefore it is possible that the self-reported symptom scores may have been influenced by the fact that the patients knew which group they were in. The researchers suggested that this may have reduced the demand for medication.
- There was no assessment of how much the staff who reviewed the notes knew about which group the patients were allocated to. This is important, as assessors may been more objective the less they knew.
- There may be a variation in estimated costs of surgical time, medication costs and therapist time. The affect that alternative estimates would have on the overall savings was not evaluated. This “sensitivity” assessment would have added strength to the economic evaluation.
The positive outcomes from this study are encouraging for patients and doctors who are keen to reduce the side effects of surgery. It is recommended that people interested in investigating this possibility follow the advice given by Dr Sarah Cant.
No explanation could be found in the study as to why the hypnosis group had reduced time and therefore costs in surgery. As the researchers themselves speculate, patients were perhaps easier to prepare for surgery and to sedate, or perhaps less time was spent giving them medication.
Finally, the savings demonstrated may not apply to all hospitals or countries, and are especially dependent on the estimates of rates for surgical costs and time. Any implementation of this hypnosis intervention in other settings would also need to look at the additional costs of providing skilled therapists for hypnosis and supportive care.
Sir Muir Gray says...
The relationship between the psychological and the physical is consistently underestimated by the medical profession and the health service. Even simpler interventions, such as handholding or being friendly might also have good physical effects.