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NEWS & VIEWS |
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Giving breast cancer patients a brief hypnosis session before surgery can actually reduce the cost of the procedure, according to a study published recently in the Journal of the National Cancer Institute (2007;99:1304–1312). A team led by researchers from Mount Sinai School of Medicine in New York found that surgical costs were $772.71 less for patients who underwent hypnosis compared with those who did not. What's more, women who had hypnosis also reported less pain, nausea, fatigue, discomfort, and emotional upset than their counterparts.
Such findings argue strongly for incorporating hypnosis into standard care for breast cancer patients, says lead study author Guy H. Montgomery, PhD, Associate Professor, Oncological Sciences, Mount Sinai School of Medicine.
"Breast cancer patients are going through a lot," he explains. "It's a distressing and difficult period to get through. They're worried about themselves, they're worried about their families. So if there's something we can do to make them feel better—and we don't have to say, ‘We don't have the money for that,’—we should translate this from a research protocol to actually doing something for breast cancer patients every day."
Montgomery's study involved 200 women scheduled for lumpectomy or excisional breast biopsy at Mount Sinai Medical Center. They were randomly assigned to receive either hypnosis or an "attention-control" intervention delivered within an hour before their procedure. Both interventions lasted 15 minutes and were conducted by PhD-level clinical psychologists with advanced training in use of hypnosis in medical settings.
The hypnosis intervention included relaxation techniques, visual imagery suggestions, and suggestions to experience reduced symptoms like pain, nausea, and fatigue. It also included instructions for how to use self-hypnosis at a future time. The attention-control intervention did not include these elements, but was instead a supportive conversation between therapist and patient.
Patients in both groups were administered the same anesthesia protocol during surgery, which included the drugs propofol, midazolam, fentanyl, and lidocaine. After surgery, they received pain medication as needed.
Patients in the hypnosis group spent 10.6 fewer minutes in surgery than those in the control group (43.37 minutes versus 53.97 minutes, P = .04), translating into an average cost savings of $772.71 per patient. Time in surgery was measured from the moment the surgical team was ready to begin operating until anesthesia was discontinued.
Montgomery suspects the time differential was due to hypnosis patients being more relaxed and comfortable going into surgery, though the study did not measure that directly. However, hypnosis patients did require significantly less lidocaine (12.25 mL versus 15.05 mL, P < .001) and propofol (92.93 µg versus 113.14 µg, P = .03) than controls. Time may have been saved because fewer pauses were required to administer more of these drugs, Montgomery speculated.
There were no differences in recovery time or use of postsurgical pain medications between groups. However, in interviews after surgery, hypnosis patients reported significantly fewer negative effects than controls, as measured by visual analog scales. The hypnosis group reported significantly lower scores for pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset (P < .001 for each).
Montgomery and his team estimate that the cost of employing a psychologist to perform a hypnosis intervention could be recouped by the savings seen in surgical time spent per breast cancer patient. Nevertheless, many hospitals don't have psychologists on staff and may not have immediate resources to get one.
"One of the things I want to do in future work is look at [whether we can] do this with other people. Can the OR nurse administer the intervention? Can we do it by CD? Are there ways to get this out there to make it available to everybody?" Montgomery says. "But the numbers clearly say that if you wanted to, you could hire one of these people, and it will wind up paying for itself."
Furthermore, the technique is likely to work for other types of patients, not only those with breast cancer, Montgomery says. Indeed, self-hypnosis has been part of care for more than 17 years at the University of Texas MD Anderson Cancer Center in Houston. Licensed social worker Aida Molano, LCSW, who is certified in clinical hypnosis, runs group and individual sessions there that she says help patients recover faster, experience less discomfort and anxiety, and improve sleep.
"It returns them to control of their lives," she says of hypnosis.
Both Molano and Montgomery emphasize that the techniques used in the medical setting do not involve dangling watches or embarrassing performances.
"The first thing we do with a patient is debunk the scary weird stuff," Montgomery says. "We're not going to make you sing like Madonna, we're going to help you feel better. We'll help you concentrate, focus your attention."
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